Anesthesia Central is an all-in-one web and mobile solution for treating patients before, during, and after surgery. This collection of drug, procedures and test information is derived from Davis’s Drug, MGH Clinical Anesthesia Procedures, Pocket Guide to Diagnostic Tests, and MEDLINE Journals. Explore these free sample topics:
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First Things First (assess & treat for the following)
- Remember, the ultimate goal is to provide adequate oxygen delivery (DO2) to meet the metabolic demands of the tissues.
- Inadequate DO2 leads to anaerobic metabolism and generation of lactic acidosis.
- Primary determinants of DO2 are oxygen content (CaO2) and cardiac output (CO)
- CaO2 = Huffner’s constant (approx 1.39 mL oxygen/gm Hgb) * Hgb * SaO2
- CO = stroke volume (SV) * heart rate (HR)
- Primary determinants of myocardial performance and SV are preload, afterload and contractility.
- Preload is related to muscle fiber length, with increasing force of contractility related to increasing muscle fiber length with an optimal limit (Starling’s Law).
- Left ventricular end diastolic volume (LVEDV) is the preload that causes circumferential LV muscle stretch and contributes to SV.
- Assess the need for invasive monitoring: are non-invasive and/or clinical indicators inadequate for assessment and optimization of DO2?
- Early goal-directed therapy mandates the monitoring of CVP (central venous pressure) and SvO2 (mixed venous saturation) in severe sepsis.