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Invasive and non-invasive

monitoring
Non-invasive Monitoring
●BP non-invasive
●Temperature

●Pulsoximetry

●CO2-capnometry - the most effective non-

invasive method for monitoring the efficiency of


CPR
●ECG 12 derivations

●Capillary refill time

●Diuresis
Invasive Monitoring
BP invasive monitoring
Arterial line or pulmonary artery catheter. Provides
continuous measurement, high accuracy, can take
samples used in determining gasometry.
Pulmonary artery catheter
Pressure measured is approximately equal to that
of the left atrium (excellent indicator for adequate
volemic resuscitation), Cardiac Output, Central
Venous Pressure
Monitorizare invaziva

● Invasive haemodynamic pressure monitoring


Central venous catheterization, aortic and arterial
catheterization together, allowing precise
measurement of pressure gradients aorta - right
atrium and coronary infusion pressure.
● Monitoring oxygen saturation at central venous

level

Adrenalina

Endogenous catecholamines
↑ Heart rate,
↑ Ventricular contractility
Alpha-adrenergic vasoconstriction in the
peripheral arterial system - centralization of
circulation
Increase aortic pressure and coronary infusion
pressure
Adrenalina

Indicated:
cardiac arrest, status asmaticus, heart failure, shock
Dosage: - 2 mcg / min bronchodilator effect
2-10 mcg / min inotropic effect
- Over 10mcg/min vasopressor effect
Adverse effects: hypertension, tachycardia, arrhythmias, skin
necrosis when given perivenous, continuous administration
may cause agitation, tremor, headache, palpitations
.
Adrenalina

Patterns: the form of ampoules 1mg/ml


Method of calculation: Place 3 ampoules of adrenaline + 47ml
NaCl 0.9% in a 50ml syringe.
In 1ml of solution so prepared we have 3mg / 50 ml ie
3000mcg/50 ml = 60 mcg / 1ml.
At a rate of 1 ml / h administering 60 mcg / h or 1 mcg / min.
Rate in ml / h corresponding to the dose in mcg / min and will
be based on the therapeutic indication (status asmaticus, heart
failure, etc..).
Noradrenalina
Cronotrop ↑, ↑ inotrop, vasoconstriction
Notes: in hypotensive states because of its
predominantly vasoconstrictor.
Dose: 2 to 12 mcg / min produces
vasoconstriction without significant change
of cardiac output and heart rate.
Side effects: bradycardia, arrhythmia, anxiety,
headache, hypertension, injection site necrosis
when perivenous (infiltration with phentolamine
prevent necrosis).
Presentation: ampoules 0.2% - 4ml.
Dopamina
Indications: cardiac failure, shock (except shock
hypovolemia)
Dosage:
2-10 mcg/kg/min predominant inotropic action
10-20 mcg /kg/min predominant vasopressor effect,
may be associated with dobutamine
Adverse effects: hypertension, tachycardia,
arrhythmias, skin necrosis when given perivenous
Presentation: usually in the form of ampoules 50 mg in
10 ml.
Dopamina

Method of calculation:
Place 5 ampoules in a 50 ml syringe, we mean
250 mg in 50 ml 5mg/ml.
The infusion rate of 1 ml / h, the patient is
receiving 5 mg / h ; 5000mcg/1h or 83,3 mcg/min
Our patient weight is 80 kg.
10 mcg x 80kg /min = 800 mcg/min
800 : 83,3 = 9,6 ml/h
Dobutamine:
Indications: heart failure,
Inotropic effect, increasing frequency
heart to a lesser extent than Dopamine,
decreases filling ventricular pressure , is
preferable to treat decompensated heart failure.
Peripheral vascular resistance remains
unchanged or decreases slightly.
Dose: 5-20 mcg / kg / min
Side effects: arrhythmia, hypertension, angina
pectoris, phlebitis
Presentation: 250 mg vials of lyophilized powder
Method of calculation: similar to Dopamine
II. Vasodilators
Nitroglycerine:
Indications: hypertension, pulmonary edema, acute
myocardial infarction.
Dose: 20-200 mcg / min has a vasodilator effect.
Side effects: hypotension, tachycardia, increased
intracranial pressure.
Presentation: ampoule 5mg/ml
Method of calculation: 6 Place 44ml ampoules + 0.9%
NaCl in 50ml syringe;
50ml solution containing 30 mg nitroglycerin. In one ml of
solution so prepared have 30/50 mg / ml ie 30000/50
mcg / ml = 600 mcg / ml.
At a rate of 1 ml / h administer 600 mcg / h or 10 mcg /
min.
Example: at a rate of 5ml / h injected 50mcg/min.

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