Critical Care Medicine: The Essentials by John J. Marini MD, Arthur P. Wheeler MD

By John J. Marini MD, Arthur P. Wheeler MD

Ideally suited to scholars in severe care rotations and citizens, this concise, sensible guide provides the necessities of scientific and surgical severe care in an easy-to-read structure. The authors succinctly clarify the pathophysiology underlying scientific problems and the main rules of analysis and sufferer administration, emphasizing economical approaches.

The Fourth version contains Controversies in severe Care packing containers in lots of chapters, which in short summarize opposing arguments on debatable issues. different highlights contain more advantageous dialogue of CT for stomach issues, new ACLS directions, and new fabric on detachable IVC filters, interventional radiologic strategies for GI bleeding, and use of vascular ultrasound.

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Example text

Because no resistive pressure drop occurs along this newly created static column, the pressure at the catheter tip equilibrates with the pressure at the downstream junction (“j” point) of flowing and nonflowing venous blood. It is believed that this junction normally occurs in a vessel of a size similar to that of the occluded artery—that is, in a large vein. Pulmonary wedge pressure, therefore, provides a low-range estimate of the mean hydrostatic pressure within the more proximal fluid-exchanging vessels.

After insertion, a simple check for adequate frequency response can be conducted using the rapid flush device of the catheter system (“snap test”) (Fig. 2-4). During the rapid flush, a sustained pulse of high pressure is temporarily applied to the transducer membrane. When the flush is suddenly terminated, pressure abruptly falls. Immediately upon sudden release, the tracing from a responsive system should overshoot (plunge below) its normal baseline and briefly (<1 s) oscil2 late before recovering a crisp, well-defined PA waveform.

For wedge pressure recording, for example, an uninterrupted fluid column must extend from the left atrium (LA) through the catheter lumen to the flexible diaphragm of an electromechanical transducer. The transducer membrane deforms in response to pressure exerted by the fluid column 8/8/2009 6:59:38 PM CHAPTER 2 • HEMODYNAMIC MONITORING 25 ■ FIGURE 2-3 Zeroing the transducer. The transducer must not be moved from its original position after the display has been adjusted to record zero pressure with the liquid-filled system exposed to atmospheric pressure at the LA level.

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