Cardio_Chapter_013

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Chapter 13: Monitoring and Life Support Equipment:

Chapter 13: Monitoring and Life Support Equipment

Introduction:

Introduction Life support & monitoring equipment is migrating into long-term and outpatient rehabilitation and home care settings Important for clinician to recognize the reason for the presence of equipment, interpret settings, and be able to assimilate information Will take extra training beyond the scope of this course

Noninvasive Monitoring Equipment:

Noninvasive Monitoring Equipment Electrocardiogram Monitors heart rate and heart rhythm Graphic representation of electrical activity of the heart Clinician must know reason for monitoring, baseline rhythm, be able to recognize rhythm changes Allows continuous surveillance of the patient

Noninvasive Monitoring Equipment:

Noninvasive Monitoring Equipment Fig. 13-1. ECG monitor.

Noninvasive Monitoring Equipment:

Noninvasive Monitoring Equipment Box 13-1. Some Indications of Declining Cardiac Status

Noninvasive Monitoring Equipment:

Noninvasive Monitoring Equipment Pulse Oximetry Measurement of arterial oxygen saturation Expressed as a percentage of oxygen that is bound to hemoglobin Principles Threshold level – above 90% Reasons for inaccuracies

Noninvasive Monitoring Equipment:

Noninvasive Monitoring Equipment Blood Pressure Provides digital measurement of systolic/diastolic blood pressure and mean arterial pressure Result of rate of flow of blood through and against the resistance of the circulatory system Sphygmomanometer/stethoscope – auscultate over brachial artery – Korotkoff sounds

Noninvasive Monitoring Equipment:

Noninvasive Monitoring Equipment Respiratory Rate Normal adult respiratory rate = 12–18 bpm Causes of tachypnea – above normal Causes of bradypnea – below normal Indications of respiratory distress

Noninvasive Monitoring Equipment:

Noninvasive Monitoring Equipment Box 13-3. Causes of Tachypnea and Bradypnea

Noninvasive Monitoring Equipment:

Noninvasive Monitoring Equipment Level of Consciousness Bispectral (BIS) Index Monitor – assists with monitoring sedation levels in ICU Measures the muscular and cortical activity using a single, small, flexible sensor applied to forehead and temporal region Value – 0 (no cortical electrical activity/full suppression) to 100 (awake, aware, no suppression)

Invasive Monitoring Equipment:

Invasive Monitoring Equipment Arterial Line Measurements of arterial blood pressure continuously Allows access for drawing blood for arterial blood gas Common location – radial artery or femoral artery Mean arterial pressure (MAP) interpretation Positioning of arterial line

Invasive Monitoring Equipment:

Invasive Monitoring Equipment Central Line Measures central venous pressure (CVP) or right artrial pressure Allows IV access for medication administration Interpretation of elevated CVP Interpretation of low CVP values Prolonged placement is termed PICC line inserted in cephalic, basilic, or brachial vein Risks associated during insertion and delayed risks associated with central line

Invasive Monitoring Equipment:

Invasive Monitoring Equipment Pulmonary Artery Catheter (Swan-Ganz Catheter) Functions of the pulmonary artery catheter Complications of insertion and dislodgement of the PA catheter Pulmonary Capillary Wedge Pressure (PCWP) Reasons for measuring – provides information regarding left atrial and ventricular end-diastolic pressures

Invasive Monitoring Equipment:

Invasive Monitoring Equipment Cardiac Output Amount of blood pumped by heart per unit of time Normal CO = 4 to 8 liters/minute Measured using thermodilution technique Cardiac Index – cardiac output per square meter of body surface area Mixed Venous Oxygen Saturation Amount of oxygen returning to the heart Direct measure of venous oxygen reserve

Intracranial Pressure Monitoring:

Intracranial Pressure Monitoring Alterations result from neurological insults Normal range – 0 to 10 (adults) Activities that can cause an increase

Life Support Equipment:

Life Support Equipment Noninvasive Ventilatory Devices Noninvasive positive-pressure ventilation Form of mechanical ventilation that uses a mask instead of an artificial airway Short-term ventilatory support Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (biPAP)

Life Support Equipment:

Life Support Equipment Noninvasive Ventilatory Devices (cont’d) Manual Resuscitators Emergency response situation Need to disconnect the patient from mechanical ventilator for a prolonged period of time Stimulate or mimic a cough and/or to augment tidal volume

Life Support Equipment:

Life Support Equipment Noninvasive Ventilatory Devices (cont’d) Oxygen delivery devices Nasal cannula Simple mask Aerosol mask Venturi mask Nonrebreather masks Pediatric delivery devices

Life Support Equipment:

Life Support Equipment Invasive Ventilatory Devices Oral pharyngeal airway Nasal pharyngeal airway Endotracheal tube Indications Note position of tube

Life Support Equipment:

Life Support Equipment Fig. 13-11A. Airway adjuncts. A, Oral pharyngeal tube. B, Nasal pharyngeal tube. C, Oral endotracheal tube. D, Tracheostomy tube.

Life Support Equipment:

Life Support Equipment Fig. 13-11C. Airway adjuncts. A, Oral pharyngeal tube. B, Nasal pharyngeal tube. C, Oral endotracheal tube. D, Tracheostomy tube.

Life Support Equipment:

Life Support Equipment Invasive Ventilatory Devices (cont’d) Tracheostomy Artificial airway inserted into the trachea Complications Passy muir valve Fig. 13-12.

Life Support Equipment:

Life Support Equipment Invasive Ventilatory Devices (cont’d) Mechanical Ventilation Negative-pressure ventilators Positive-pressure ventilators Ventilator terminology (Table 13-7) Assist control Synchronized intermittent mandatory ventilation Continuous positive airway pressure Pressure support ventilation Tube compensation

Life Support Equipment:

Life Support Equipment

Life Support Equipment:

Life Support Equipment Invasive Ventilatory Devices (cont’d) Clinical Note – know ventilator settings, respiratory rate, and oxygen saturation

Life Support Equipment:

Life Support Equipment Invasive Ventilatory Devices (cont’d) Other Modes of Mechanical Ventilation Pressure control ventilation High-frequency oscillatory ventilation High-frequency jet ventilation Pressure control-inverse ratio ventilation Bilevel positive airway pressure

Life Support Equipment:

Life Support Equipment Invasive Ventilatory Devices (cont’d) Other Modes of Mechanical Ventilation High-frequency jet ventilation Pressure control-inverse ratio ventilation Bilevel positive airway pressure Airway pressure release ventilation Pressure regulated volume control Extracorporeal support

Life Support Equipment:

Life Support Equipment Invasive Ventilatory Devices (cont’d) Portable ventilators Innovative ventilation system Neurally adjusted ventilatory system Chest tubes – used to remove and prevent the reentry of air or fluid from pleural or mediastinal space, provide intrapleural pressure

Life Support Equipment:

Life Support Equipment Fig. 13-15. A, Chest tube drainage. B, Anterior view; mediastinal drains.

Life Support Equipment:

Life Support Equipment Box 13-12. Effective Mobilization

Life Support Equipment:

Life Support Equipment Invasive Cardiac Devices Cardiac Pacemaker Automatic Implantable Cardiac Defibrillator (AICD) Exercise HR should be 20 to 30 beats below threshold rate of defibrillator Intraaortic Balloon Pump (IABP) No hip flexion on catheter side Out-of-bed activities usually contraindicated for patients on IABP Pulmonary Artery Balloon Counterpulsation

Life Support Equipment:

Life Support Equipment Ventricular Assistive Device (VAD) Augments the pumping capability of the heart Most common – left ventricular Indications in end-stage heart failure PT initiated early Extracorporeal Membranous Oxygenation (ECMO) External circulatory assist device that provides direct oxygenation of the blood and assists with removal of carbon dioxide

Life Support Equipment:

Life Support Equipment Hemodialysis Replaces the function of the kidneys If patient is hemodynamically stable, PT is appropriate Must monitor vital signs Avoid using the arm with arteriovenous fistula when measuring BP

Physical Therapy for Patients on Monitoring and Life Support Equipment:

Physical Therapy for Patients on Monitoring and Life Support Equipment *Individualized program to minimize problems of immobility and to promote functional recovery *Presence of lines, tubes, monitors, etc. are not usually contraindications for PT *Interdisciplinary approach essential *PT must know anatomy and physiology, medical conditions, normal vs abnormal parameters, and emergency procedures

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