Answer
Hypovolemic shock is due to a reduction in circulating blood volume resulting from either hemorrhage or fluid depletion. Preload is markedly decreased, leading to inadequate ventricular filling. The patient with hypovolemic shock manifests hypotension and tachycardia. Systemic, venous, and intracardiac pressures are abnormally low. The overall PAC pressure tracing has a damped appearance.
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Media Gallery
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A pulmonary artery catheter is shown here.
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The balloon of the catheter should be checked prior to insertion.
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Pulmonary artery catheter being introduced from pulmonary artery in to wedge position.
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Normal hemodynamic parameters.
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Central venous pressure (CVP) measured in superior vena cava (SVC) is identical to right atrial pressure (RAP).
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Respiratory variation is easily identified on the right atrial waveform.
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Various waveforms of central venous pressure (CVP) monitoring are shown here.
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Pulmonary arterial pressure (Ppa) waveform.
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Pulmonary artery wedge pressure (PAWP) waveform can be distinguished easily from the pulmonary arterial waveform in most clinical scenarios.
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Pulmonary artery wedge pressure (PAWP) reflects left atrial pressure (LAP).
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Inflated balloon obstructs arterial flow and reflects pressures at J point. Redrawn from Principles of Critical Care by Jesse B. Hall, Gregory A. Schmidt, Lawrence D. H. Wood, 2000, McGraw-Hill, Inc.
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Having an inflated balloon in a proximal vessel is better because a vessel branch is likely to reflect left atrial pressure (LAP) accurately. Redrawn from Principles of Critical Care by Jesse B. Hall, Gregory A. Schmidt, Lawrence D. H. Wood, 2000, McGraw-Hill, Inc.
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Right or left atrial pressure waveform.
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Timing of the pulmonary artery waveforms in relation to electrocardiographic monitoring is shown here. An A wave follows the QRS wave on ECG, whereas V wave follows the T wave on ECG.
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Physiologic lung zones. For pulmonary capillary wedge pressure (PCWP) to be reliable, the catheter tip must lie in zone 3. Pulmonary artery pressure (Ppa) is greater than pulmonary venous pressure (Ppv), which is greater than alveolar pressure (Palv) at end-expiration. In zones 1 and 2, Ppw reflects Palv if Palv is greater than Ppv. Redrawn from Principles of Critical Care by Jesse B. Hall, Gregory A. Schmidt, Lawrence D. H. Wood, 2000, McGraw-Hill, Inc.
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Hemodynamic parameters in different pathologic states.
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Tall V waves presented here on pulmonary arterial and wedge pressure waveforms are characteristic of severe mitral regurgitation.
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Large V waves in a case of mitral regurgitation.
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Simultaneous recording of ECG helps identify V waves in mitral valve regurgitation; V waves correspond to T waves on ECG.
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Hemodynamic monitoring can confirm the diagnosis of pericardial tamponade. Equalization of diastolic pressures on the left and right sides of the heart, elevated right atrial pressure, and Kussmaul sign (ie, increase in right atrial pressure with inspiration) are noted.
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In cardiac tamponade, systemic arterial pressure (Pa) reflects pulsus paradoxus. Right atrial pressure (RAP) is elevated. Pulmonary artery (PA) diastolic pressure equals mean right atrial (RA), right ventricular (RV) diastolic, and wedge pressures.
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Simultaneous recordings of pulmonary capillary wedge pressure and left ventricular pressure waveforms in a patient with constrictive pericarditis. Note the equalization of diastolic pressures and "square root sign" or "dip and plateau sign" of the left ventricular waveforms, which are confirmatory of the diagnosis of constrictive pericarditis.
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Right atrial pressure waveform of a patient with constrictive pericarditis. Please note rapid X and Y descents, and elevated A and V waves. This gives an impression of the letter "M" or "W" and is confirmatory of the diagnosis of constrictive pericarditis.
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Principle of cardiac output measurement.
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