The CVP in hypovolemic shock.
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The CVP in patient with hypovolemic shock case : Mostafa 22years old Agitated and compleaning of abdominal pain Airway is patent Respiratory rate 32 per min. BP 90/60 mmHg. Pulse 130 bpm. Temp 36C. Abdominal distension. Cold skin Nsogastric tube rvealed green liqued Urinary cathetar revealed dark urine Hemoglobin is 7. FAST is postive.
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The CVP in hypovolemic shock.
- 1. Hwmo Clinical vignette 2 Shock Maryam AL-Qahtani. G:3
- 2. Objectives: What would be the central venous and/or pulmonary capillary occlusion pressure (Low, normal, high )?
- 3. Hemorrhagic shock is a condition of reduced tissue perfusion, resulting in the inadequate delivery of oxygen and nutrients that are necessary for cellular function.
- 4. Central venous pressure Venous pressure: is a term that represents the average blood pressure within the venous compartment. Central venous pressure: considered a direct measurement of the blood pressure in the right atrium and vena cava.
- 5. Equation: ΔCVP = ΔV / Cv Normal value : CVP is 2-6 mm Hg. change in volume (ΔV) The compliance (Cv)
- 6. Factors influencing the Central Venous Pressure: Cardiac output. Blood volume. Venous constriction. Changing from standing to supine body posture. Arterial dilation.
- 7. CVP is elevated by : Heart failure or PA stenosis which limit venous outflow and lead to venous congestion. CVP decreases with: Hypovolemic shock from hemorrhage, fluid shift, dehydration.
- 8. Pulmonary capillary occlusion pressure: intravascular pressure as measured by a catheter wedged into the small pulmonary artery ; used to measure indirectly the mean left atrial pressure. Normally about 8-10 mmHg.
- 9. In our case : What would be the central venous and/or pulmonary capillary occlusion pressure (Low, normal, high )? Early stage of shock . Compensate stage
- 10. The central venous pressure and pulmonary capillary occlusion pressure …… Due to the compensatory mechanism
- 11. Initial stage: CVP slightly decrease Blood volume Systemic arterial blood venous return volume pressure pulmonary arteries blood the central venous pressure flow
- 12. Compensatory stage: 1/ increasing stroke volume. 2/ increasing the heart rate. 3/raising blood pressure. 4/increasing the rate of return of venous blood to the heart. Vasoconstriction blood vessels + increase blood volume …..>increase arterial pressure. CVP Normal
- 13. •Hemorrhage decreases blood volume and decreases CVP (A→B) •By compensatory mechanism (B→C), which increases CVP and shifts blood volume toward heart…..> increase pulmonary capillary occlusion pressure In Short:
- 14. The CVP & PCWP in hypovolemic shock differs depend on the stage of the shock. Initial stage decrease Compensatory stage normal Uncompensatory stage decrease
- 15. Guyton & Hall. Text book of Medical physiology . .Merck Manual. .Up to data. Website http://www.rnceus.com/hemo/cvp.htm http://www.medscape.com/viewarticle/749208_7 http://cvphysiology.com/Blood%20Pressure/BP020.htm
Editor's Notes
- A change in CVP (ΔCVP) is determined by the change in volume (ΔV) of blood within the thoracic veins divided by thecompliance (Cv) of the these veins according to the following equation:
- Vascular Compliance The ability of a blood vessel wall to expand and contract passively with changes in pressure is an important function of large arteries and veins. This ability of a vessel to distend and increase volume with increasing transmural pressure(inside minus outside pressure) is quantified as vessel compliance (C), which is the change in volume (ΔV) divided by the change in pressure (ΔP). The volume-pressure relationship (i.e., compliance) for an artery and vein are depicted in Figure 1. Two important characteristics stand out. First, the slope is not linear because the blood vessel wall is a heterogeneous tissue. Therefore, compliance decreases at higher pressures and volumes (i.e., vessels become "stiffer" at higher pressures and volumes). Second, at lower pressures, the compliance of a vein is about 10 to 20-times greater than an artery. Therefore, veins can accommodate a large changes in blood volume with only a small change in pressure. However, at higher pressures and volumes, venous compliance (slope of compliance curve) becomes similar to arterial compliance. This makes veins suitable for use as arterial by-pass grafts.
- (PCWP) intravascular pressure as measured by a catheter wedged into the distal pulmonary artery ; used to measure indirectly the mean left atrial pressure. The pulmonary capillary wedge pressure or PCWP (also called the pulmonary wedge pressure or PWP, or pulmonary artery occlusion pressure or PAOP) or cross-sectional pressure, is the pressure measured by wedging a pulmonary catheter with an inflated balloon into a small pulmonary arterial branch.[1]
- Reduce the central venous pressure “right atrial pressure Reduce pulmonary arteries blood flow --> Reduce the pulmonary capillary wedge pressure “left atrial pressure" --> reduce pre-load --> reduce cardiac output