Rt heart cath to diagnose the etiology of shock

Use of Right Heart Catheterization to Diagnose the Etiology of Shock

Diagnosis	PAOP	T	Miscellaneous Comments
Cardiogenic shock
Cardiogenic shock due to myocardial dysfunction			Usually extensive infarction (>40% of left ventricle), severe cardiomyopathy, or myocarditis
Cardiogenic shock due to mechanical defects
Acute ventricular septal defect			Oxygen "step-up" at RV level
Acute mitral regurgitation		Forward T	V waves in Paop tracing

RV infarction	Normal or		Elevated RA and RV filling pressures with low or normal Paop
Extracardiac obstructive forms of shock
Pericardial tamponade		Or	RA mean, RV end-distolic pulmonary capillary wedge mean pressures are elevated and within 5 mm Hg of one another
Massive pulmonary embolism	Normal or		Usual finding is elevated right-side pressures
Hypovolemic shock
Distributive forms of shock
Septic shock	Or normal	Or normal, rarely
Anaphylactic shock	Or normal	Or normal

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Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...

Lumbar and thoracic epidural in Pediatrics-Technical aspect

The midline approach is most commonly used. The ligamentum flavum is considerably thinner and less dense in infants than in older children and adults. This makes recognition of engagement in the ligament more difficult and requires both extra care and slower, more deliberate passage of the needle to avoid subarachnoid puncture. The angle of approach to the epidural space is slightly more perpendicular to the plane of the back than in older children and adults, owing to the orientation of the spinous processes in infants and small children. The loss of resistance technique should be used, but only with saline, not air. There are several reports of venous air embolism in infants and children when air was used to test for loss of resistance Use a short (5 cm) 18-gauge Tuohy needle and a 20- or 21-gauge catheter in infants and children. Epidural kits specifically for infants and children are available Maximum of 0.4 mg/kg/hr of bupivacaine after the initial block is estab...

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