Critical Care: Hemodynamics and drips

Definitions:3
 Stroke Volume : the amount of blood the heart pumps with EACH BEAT
 Cardiac output_ ___ : expressed in L/min, is the amount of blood the heart pumps in ONE MINUTE (SV x HR)
 Cardiac index : the cardiac output expressed as a flow (L/min) per body surface area (m2), since CO for a
250 lb person is expected larger than a 100 lb person
 Heart rate : the number of contractions (or beats) in one minute
 Contractility : the “strength” of contraction at a given preload and afterload
 Preload : is the degree of myocardial distension prior to shortening and largely depends on the
amount of ventricular filling (venous return)
 Afterload : is the force against which the ventricles must act in order to eject blood, and is largely
dependent on the arterial blood pressure and vascular tone. Also, can be Systemic vascular resistance (SVR) .

Target organ and receptor “refresher”

TAKE AWAY:

When thinking about the

HEART and BETA AGONISM,
the effect will be:
Increased heart rate and/or
contractility .

TAKE AWAY:

When thinking ARTERIES and ALPHA

AGONISM, the effect will be:
Constriction .

Nitric Oxide , will vasodilate

The other constricting receptor when

activated: V1 and 2 .
Matching Critical Care Drips Main Receptor: Circle: Vasopressor, inotrope, or vasodilator
1. Norepinephrine (Levophed) Selective α1-receptor Vasopressor inotrope vasodilator

2. Phenylephrine (Neo-synephrine) V1 receptor agonist Vasopressor inotrope vasodilator

3. Dobutamine (Dobutrex) α1-receptor Vasopressor inotrope vasodilator

4. Epinephrine (Adrenaline) Nitric oxide (vein and Vasopressor inotrope vasodilator

artery)
5. Nitroglycerin (“Nitro”) β1-receptor initially Vasopressor inotrope vasodilator

6. Milrinone (Primacor) cGMP and Nitric oxide Vasopressor inotrope vasodilator

7. Vasopressin (Vasostrict) α1-receptor and β1- Vasopressor inotrope vasodilator

receptor
8. Sodium Nitroprusside (Nipride) Β agonist, Vasopressor inotrope vasodilator

9. Dopamine Vasopressor inotrope vasodilator

HANDS-ON: The SWAN line

*White line: “VIP,” able to infuse multiple COMPATIBLE
drips into this line
*Blue line: CVP, central venous pressure, helps
determine fluid balance. Can infuse into CVP and draw
blood but will not have a reading during this time
*Yellow line: PAP, pulmonary arterial pressure, helps
see pulmonary hypertension and fluid balance
*SVo2: measures the end result of O2 consumption and
delivery
*CO and CI are included on monitor, as well as Temp

FYI: Nurses “calibrate” the line every morning using a

carefully drawn sample from the PAP and running a “mixed
venous” gas on the “rapid point” machine

Brain storming:
 Increased heart rate will initially INCREASE cardiac
output

 Increased SVR will INCREASE blood pressure

 Decreased SVR will INCREASE cardiac output

initially
https://medical-dictionary.thefreedictionary.com/Swan-Ganz+catheter
1. Lexi-Comp Online. Lexi-Comp, Inc. Hudson, OH. Available at: http://online.lexi.com/crlonline. Acce AMA Citation
2. Maclaren R, Dasta JF. Chapter 13. Use of Vasopressors and Inotropes in the Pharmacotherapy of Shock. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG,
Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 9e New York, NY: McGraw-Hill; 2014.
http://accesspharmacy.mhmedical.com.maproxy.palni.edu/content.aspx?bookid=689&sectionid=45310473. Accessed September 11, 2019.
3. Vincent J. L. (2008). Understanding cardiac output. Critical care (London, England), 12(4), 174. doi:10.1186/cc6975. Accessed October, 2018.