肺动脉漂浮导管 PAC.ppt

Contents Clinical use of the PAC （Diagnosis） Differentiation among causes of shock Cardiogenic Hypovolemic Distributive (sepsis) Obstructive (massive pulmonary embolism) Differentiation of pulmonary edema Cardiogenic Noncardiogenic Evaluation of pulmonary hypertension Diagnosis of left-to-right intracardiac shunt Diagnosis of pericardial tamponade Clinical use of the PAC（Therapy） Management of perioperative patient with unstable cardiac status Management of complicated myocardial infarction Management of severe preeclampsia Guide to pharmacologic therapy Vasopressors； Inotropes ； Vasodilators Guide to nonpharmacologic therapy Fluid management ；Burns ； Renal failure ； Sepsis ； Heart failure ；Decompensated cirrhosis Ventilator management Assessment of best PEEP for DO2 Contents PAC 首选：右颈内静脉 Comparison among PA catheter insertion sites PAC insertion Right internal jugular vein Shortest and straightest path to the heart Left subclavian Does not require the PAC to pass and course at an acute angle to enter the SVC Femoral veins Distant sites Passing a PAC into the heart can be difficult Fluoroscopic assistance may be necessary Compressible and preferable if the risk of hemorrhage is high PAC insertion After inserting the PAC as far as the 20cm mark，the balloon is inflated with air. Inflation should be slow and controlled (1 mL/s) and should not surpass the recommended volume (1.5 mL). Always inflate the balloon before advancing the PAC and always deflate the balloon before withdrawing the PAC. CRX：check the position of the PAC PA diastolic pressure ~ PAWP PAC on CRX（PA） Placement of the catheter? Right Atrium Waveforms of CVP? EKG-RAP Right Atrium Right ventricular waveform Pulmonary artery waveform? EKG-PAP Pulmonary artery waveform? P