Hemodynamics Fundamentals for Paramedics
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Questions and Answers

What is the minimal mean arterial pressure (MAP) required to perfuse the kidneys?

  • $65-75$ mmHg
  • $60-70$ mmHg
  • $55-65$ mmHg (correct)
  • $50-60$ mmHg

    • Which of the following is NOT a clinical significance of mean arterial pressure (MAP)?

  • The oxygen content of the blood (correct)
  • The rate at which the heart pumps blood into the large arteries
  • Arterial wall compliance
  • The rate of blood flow out of the large arteries to enter smaller arteries and arterioles

    • Which formula is used to calculate mean arterial pressure (MAP)?

  • (Systolic × 2) + Diastolic / 3
  • (Systolic + 2 × Diastolic) / 3
  • (Diastolic × 2) + Systolic / 3 (correct)
  • (Systolic + Diastolic) / 2

    • What is the normal range for mean arterial pressure (MAP)?

    <p>70-110 mmHg</p> Signup and view all the answers

    How does mean arterial pressure (MAP) relate to cerebral perfusion pressure (CPP)?

    <p>CPP = MAP - ICP</p> Signup and view all the answers

    Which of the following is NOT a factor that determines mean arterial pressure (MAP)?

    <p>Oxygen content of the blood</p> Signup and view all the answers

    If the ventricles spent an equal amount of time in systole and diastole, how would the mean arterial pressure (MAP) compare to the average of systolic and diastolic pressures?

    <p>MAP would be the same as the average of systolic and diastolic pressures</p> Signup and view all the answers

    How does mean arterial pressure (MAP) allow the paramedic to have a better clinical evaluation of blood pressure?

    <p>MAP is more physiologically relevant to arterial wall compensation or disease</p> Signup and view all the answers

    Which of the following factors would lead to a decrease in mean arterial pressure (MAP)?

    <p>Decreased cardiac output and increased systemic vascular resistance</p> Signup and view all the answers

    Which of the following medications is used to increase mean arterial pressure (MAP) in a patient with high afterload?

    <p>Phenylephrine</p> Signup and view all the answers

    What is the formula for Cardiac Output?

    <p>Heart Rate x Stroke Volume</p> Signup and view all the answers

    Which drug influences the rate of spontaneous depolarization at the SA node?

    <p>None of the above</p> Signup and view all the answers

    Which phase of the electrical activity in the heart represents the repolarization and resting phase?

    <p>T phase</p> Signup and view all the answers

    What term describes the quality of conduction and rate of conduction in the heart?

    <p>SVR assessment</p> Signup and view all the answers

    Which factor determines the strength of the circulation system via systolic resistance?

    <p>Palpable Pulses</p> Signup and view all the answers

    What component influences heart rate by determining the rate of spontaneous depolarization at the SA node?

    <p>Autonomic Nervous System</p> Signup and view all the answers

    Which factor does not influence heart rate?

    <p>Contractility</p> Signup and view all the answers

    What influences the rate of spontaneous depolarization at the SA node?

    <p>Sympathetic tones</p> Signup and view all the answers

    What provides information about both systemic vascular resistance and heart rate?

    <p>SVR assessment</p> Signup and view all the answers

    What determines the rate of spontaneous depolarization at the SA node?

    <p>Electrical Impulse</p> Signup and view all the answers

    Which of the following is the primary mechanism by which Dopamine increases cardiac output?

    <p>Increasing contractility</p> Signup and view all the answers

    What is the normal range for cardiac output?

    <p>4-6 Liters/min</p> Signup and view all the answers

    Which of the following factors DECREASES cardiac output?

    <p>Decreased body metabolism</p> Signup and view all the answers

    What is the primary mechanism by which Nitroglycerin increases cardiac output?

    <p>Decreasing afterload</p> Signup and view all the answers

    Which of the following is the primary determinant of stroke volume?

    <p>Contractility</p> Signup and view all the answers

    What is the primary mechanism by which Epinephrine increases cardiac output?

    <p>Increasing heart rate</p> Signup and view all the answers

    Which of the following is the primary function of the Renin-Angiotensin-Aldosterone System (RAAS) in relation to afterload?

    <p>Increasing afterload</p> Signup and view all the answers

    Which of the following is the primary mechanism by which Dobutamine increases cardiac output?

    <p>Increasing contractility</p> Signup and view all the answers

    Which of the following is the primary determinant of diastolic blood pressure?

    <p>Preload</p> Signup and view all the answers

    What is the primary mechanism by which Norepinephrine (Levophed) increases cardiac output?

    <p>Increasing afterload</p> Signup and view all the answers

    What is the primary determinant of cardiac output (CO)?

    <p>Heart rate (HR) and stroke volume (SV)</p> Signup and view all the answers

    Which of the following is NOT a factor that affects preload?

    <p>Systemic vascular resistance (SVR)</p> Signup and view all the answers

    What is the primary determinant of afterload?

    <p>Systemic vascular resistance (SVR)</p> Signup and view all the answers

    Which of the following interventions would be appropriate for decreasing afterload?

    <p>Administration of nitroglycerin (NTG)</p> Signup and view all the answers

    What is the primary determinant of contractility?

    <p>The electrical conduction system of the heart</p> Signup and view all the answers

    Which of the following interventions would be appropriate for increasing contractility?

    <p>Administration of epinephrine</p> Signup and view all the answers

    What is the normal range for pulmonary artery pressure (PAP)?

    <p>15-25 mmHg</p> Signup and view all the answers

    What is the normal range for systemic vascular resistance (SVR)?

    <p>800-1200 dyn·s/cm^5</p> Signup and view all the answers

    What is the normal range for ejection fraction?

    <p>60-70%</p> Signup and view all the answers

    Which of the following interventions would be appropriate for increasing heart rate (HR)?

    <p>Administration of atropine</p> Signup and view all the answers

    Which of the following is an example of when the central venous pressure (CVP) is low, indicating hypovolemia?

    <p>CVP &lt; 0 mmHg</p> Signup and view all the answers

    What is the primary function of systemic vascular resistance (SVR) in the circulatory system?

    <p>To create blood pressure</p> Signup and view all the answers

    What is the relationship between systemic vascular resistance (SVR) and blood pressure?

    <p>When SVR is high, blood pressure is increased</p> Signup and view all the answers

    How does positive pressure ventilation from a bag-valve mask (BVM) affect central venous pressure (CVP)?

    <p>Positive pressure ventilation only affects CVP when pressure exceeds 15 cmH2O</p> Signup and view all the answers

    Which of the following is NOT a key element that affects hemodynamics?

    <p>Insulin levels</p> Signup and view all the answers

    What is the primary determinant of afterload?

    <p>Systemic vascular resistance (SVR)</p> Signup and view all the answers

    What is the relationship between central venous pressure (CVP) and blood volume?

    <p>CVP is directly related to blood volume</p> Signup and view all the answers

    Which of the following is the primary determinant of cardiac output (CO)?

    <p>Stroke volume</p> Signup and view all the answers

    Which of the following factors would lead to a decrease in mean arterial pressure (MAP)?

    <p>Decreased cardiac output</p> Signup and view all the answers

    Which agent is most appropriate for increasing contractility?

    <p>Dobutamine</p> Signup and view all the answers

    What is the effect of atropine on the heart rate?

    <p>Increases heart rate</p> Signup and view all the answers

    Which of the following is a common response to β2-receptor stimulation in the lungs?

    <p>Contraction of bronchial smooth muscles</p> Signup and view all the answers

    What is a notable characteristic of β3-receptors compared to β2-receptors?

    <p>Located in adipose tissues</p> Signup and view all the answers

    Which of the following would be an expected result of activating β2-receptors in the bronchi?

    <p>Bronchial smooth muscle relaxation</p> Signup and view all the answers

    What is the primary metabolic effect of β3-receptor activation?

    <p>Weight loss</p> Signup and view all the answers

    Which receptor type is primarily associated with bladder incontinence?

    <p>β3-receptors</p> Signup and view all the answers

    What is the main benefit of utilizing Albuterol in EMS treatment?

    <p>Bronchodilation</p> Signup and view all the answers

    What is a significant clinical application of β2-receptor stimulation?

    <p>Asthma treatment</p> Signup and view all the answers

    Which parameter does Cardiac Output (CO) depend on?

    <p>Heart rate and stroke volume</p> Signup and view all the answers

    What is the primary purpose of a fluid challenge?

    <p>To increase venous return and preload</p> Signup and view all the answers

    What is the primary determinant of contractility?

    <p>Inotropic state of the heart muscle</p> Signup and view all the answers

    Which component of the electrical conduction system affects the rate of spontaneous depolarization at the sinoatrial (SA) node?

    <p>Chronotropic component</p> Signup and view all the answers

    What is the primary determinant of afterload?

    <p>Systemic vascular resistance</p> Signup and view all the answers

    Which of the following medications would be appropriate for decreasing afterload?

    <p>Nitroglycerin</p> Signup and view all the answers

    What is the primary mechanism by which central venous pressure (CVP) reflects preload?

    <p>CVP measures the pressure in the vena cava blood returning to the right atrium and ventricle</p> Signup and view all the answers

    Which factor primarily influences the rate of spontaneous depolarization at the sinoatrial (SA) node?

    <p>Sympathetic nervous system activity</p> Signup and view all the answers

    What is the primary mechanism by which diuretics, such as Lasix (furosemide) or Bumex (bumetanide), decrease preload?

    <p>Reducing circulating blood volume</p> Signup and view all the answers

    Which component of the electrical conduction system affects the speed of conduction through the atrioventricular (AV) node?

    <p>Dromotropic component</p> Signup and view all the answers

    How does the Renin-Angiotensin System (RAS) affect hemodynamics?

    <p>Increases afterload</p> Signup and view all the answers

    Which medication primarily causes vasoconstriction to blood vessels?

    <p>Phenylephrine (neo-synephrine)</p> Signup and view all the answers

    What is the primary function of Adrenergic receptor beta 3 (3-Receptors)?

    <p>Smooth muscle relaxation</p> Signup and view all the answers

    How do Carotid Bodies Chemoreceptors contribute to hemodynamics?

    <p>Detect acute changes in blood pressures</p> Signup and view all the answers

    What is the primary role of a2B adrenergic receptors in the pancreas?

    <p>Pumps out glucagon</p> Signup and view all the answers

    What is the main effect of Alpha-1 Receptors at the cellular level?

    <p>Involved in smooth muscle contractions</p> Signup and view all the answers

    Which receptor subtype primarily acts on stress responses?

    <p>1-Receptors</p> Signup and view all the answers

    How do Beroreceptors at the Carotid Bodies contribute to hemodynamics?

    <p>Detect changes in PaCO2</p> Signup and view all the answers

    Study Notes

    Mean Arterial Pressure (MAP)

    • Minimal mean arterial pressure required for kidney perfusion is typically around 60 mmHg.
    • Normal range for MAP is generally accepted to be 70-100 mmHg.
    • Formulas to calculate MAP:
      • MAP = DBP + 1/3 (SBP - DBP)
      • Alternatively, MAP = CO x SVR (Cardiac Output x Systemic Vascular Resistance).
    • MAP is crucial for understanding cerebral perfusion pressure (CPP), where adequate MAP ensures sufficient brain blood flow.
    • Factors affecting MAP include cardiac output, systemic vascular resistance, and blood volume.

    Cardiac Output and Its Determinants

    • Cardiac output (CO) formula: CO = Stroke Volume x Heart Rate.
    • Normal range for cardiac output is approximately 4-8 L/min.
    • Major determinants of stroke volume include preload, afterload, and contractility.
    • Norepinephrine (Levophed) and dopamine can increase CO under specific conditions, especially during high afterload.
    • Medications like Nitroglycerin can enhance CO by reducing afterload.

    Heart Rate and Electrical Activity

    • Heart rate is influenced by rate of spontaneous depolarization at the sinoatrial (SA) node, primarily regulated by beta-adrenergic receptors.
    • Phase 3 of the cardiac cycle indicates repolarization and the resting state of cardiac muscle.
    • Factors that do not affect heart rate include changes in blood volume.

    Afterload and Preload Dynamics

    • Afterload is determined by systemic vascular resistance (SVR).
    • Fluid challenges are utilized to assess volume status and correct hypotension.
    • Preload is influenced by venous return and can be decreased by diuretics, such as Lasix or Bumex.

    Systemic Vascular Resistance (SVR) and Central Venous Pressure (CVP)

    • SVR is critically linked to blood pressure; increased SVR translates to elevated blood pressure.
    • CVP reflects preload and is impacted by blood volume; low CVP may signify hypovolemia.
    • Positive pressure ventilation can raise CVP by increasing intrathoracic pressure.

    Adrenergic Receptors and Clinical Implications

    • Alpha-1 receptors induce vasoconstriction, enhancing peripheral resistance.
    • Beta-2 receptors primarily cause bronchodilation and are important in treating obstructive airway diseases.
    • Beta-3 receptors are associated with fat metabolism and regulation in the bladder.

    Miscellaneous Key Points

    • Ejection fraction normal range is 55-70%, essential in evaluating cardiac function.
    • Beroreceptors in carotid bodies play a role in blood pressure regulation by detecting changes in blood flow.
    • This pressure-regulation involves feedback mechanisms impacting heart rate and coronary perfusion.

    Interventional Strategies

    • Increasing contractility can be achieved with agents like Dobutamine.
    • Interventions to decrease afterload may include medications like vasodilators or fluid management strategies.

    Understanding these fundamental concepts is crucial for evaluating and managing cardiac and vascular dynamics effectively.

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    Description

    This quiz covers the fundamental concepts of hemodynamics tailored for paramedics, developed by Steve Casarez, RN, MICN, and Paramedic. It includes information on pumps, pipes, fluids, and the electrical system relevant to clinical practice and resuscitation guidelines.

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