Hemodynamics Management

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This screenshot you provided shows the monitor of an Impella CP which appears to be positioned in the aorta instead of the correct position within the left ventricle (LV).

Ao Pressure: 126/73 mmHg (Mean 93 mmHg), indicating the device is picking up aortic pressure signals.
LV Pressure: There is a loss of clear pressure signals from the left ventricle, which would normally be used to monitor proper positioning.
The low fluctuation of the motor current, (with readings showing a current of 399/350 mA), suggests that there is minimal pressure gradient across the two pressure sensors of the Impella device. These sensors normally detect pressure differences between the aorta and the left ventricle.

The motor current stability (almost flat) suggests that the Impella is likely not in the left ventricle (as intended) but rather in the aorta. Since both sensors are exposed to aortic pressure, there is little to no pressure gradient detected…

Noor Ali Shah

6 days ago

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This is totally new procedure for me.

Jazak Allah khair.

Mazen Kherallah

August 17, 2024

Distributive shock with adequate preload indicated by SVV of 10%, high SV and cardiac output, and low SVR. On levophed, epinephrine, and vasopressin. Lactic acid 13.

Monitoring

Shocks

Vasopressors

Noor Ali Shah

Aug 17

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A case of distributive shock, preload is adequate as shown CVP 14 , SVV is 10 % , SV , CO and CI are high , Very low SVR 411. On triple vasopressors but lactate is very high 13.

Clinical history in details is important.

I will optimise the vasopressors especially noradrenaline infusion according to SVR and UOP. I will recommend to add a small dose of dobutamine to improve tissue perfusion which will help in lowering down the lactate levels and will check lactate levels frequently to know the right path of resuscitation and management. I will do SCvO2 level and HB value . As per protocol I will treat the underlying cause as soon as possible. In case of septic shock, initiation of adequate and appropriate antibiotics will be given accordingly.

I will do liver function test , as in liver dysfunction the lactase level remains high.

I will check renal function test and close eyes 👀 on UOP.

Edited

Mazen Kherallah

August 15, 2024

Shock with cytokine release syndrome on norepinephrine and vasopressin in addition to steroid.

Aug 16

The EV 1000 has both thermodilution + pulseconture (which require special condition)

It looks to be missing some data (it could be missing the thermodilution thermostat for the CVC?)

From the only available data:

- distributive shock

- cardiac function are already optimised (CO, CI)

- PVR still low, but systematic flow is supplied (MAP)

- Preload (we need more data, specifically setting, rhythm, breath generation, Tv), GEDV, (CVP: the volume is not depleted), EVLW

Mazen Kherallah

July 27, 2024

Hepatic Vein Doppler:

Systolic Wave (S-wave): A large, antegrade wave reflecting atrial relaxation and ventricular systole, indicating blood flowing from the liver into the right atrium.
Diastolic Wave (D-wave): A smaller, antegrade wave during ventricular diastole, indicating blood flowing from the liver into the right atrium as the tricuspid valve opens.
A-wave: A small retrograde wave occurring during atrial contraction, reflecting a brief reversal of flow as the right atrium contracts