Invasive and non-invasive monitoring

Non-invasive Monitoring
BP non-invasive ●Temperature ●Pulsoximetry ●CO2-capnometry - the most effective noninvasive 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
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Endogenous catecholamines ↑ Heart rate, ↑ Ventricular contractility Alpha-adrenergic vasoconstriction in the peripheral arterial system - centralization of circulation Increase aortic pressure and coronary infusion pressure

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 .

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..).

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.

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.

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.