急性心衰和心源性休克.ppt
- 文档编号:2000492
- 上传时间:2022-10-26
- 格式:PPT
- 页数:51
- 大小:137.50KB
急性心衰和心源性休克.ppt
《急性心衰和心源性休克.ppt》由会员分享,可在线阅读,更多相关《急性心衰和心源性休克.ppt(51页珍藏版)》请在冰豆网上搜索。
AcuteHeartFailure/CardiogenicShockApril16,2004DarrenM.Triller,PharmDTheplanStickclosetothetextReviewpharmacologyandpathophysiologyonlytoenhanceunderstandingofthedrugtherapyKnowthefewdrugswellExpectationsforpharmacistsingeneralhospitalorhomecarepracticeTestquestionswilltargetthesegoalsWhyisthisimportant?
HFcommondiagnosisHospitalizationsarecommonAssociatedcostsareastronomicalPharmacistswillroutinelybeinvolvedinpreparinganddispensingtoICU/CCUUseofthedrugsisfrequentlyinurgent/emergentsituationsAcuteHF/CardiogenicshockDeathShockIIIHeartFailureIIIIVHTNDrugsMIValveDzMIRelationships/KeyTermsCardiacoutput=HRxStrokevolumeMAP=COxSVRPreloadContractilityAfterloadFrank-StarlingrelationshipTheBigPictureinFailurePreloadContractilityNeedvolumetoincreasestretch,FrankStarlingNeedcontractilityandratetomaintainoutputNeedconstrictiontomaintainpressureAfterloadVeinsHeartArteriesAutoregulationTheabilitytomaintainbloodflowoverwiderangeofperfusionpressuresCerebralandcoronaryarteriesAbilitydeclinesatMAP60mmHgMediatedbyvasoconstrictors:
epi,NE,AngII,TxA2,vasopressinvasodilators:
PGI2,NO,adenosine,natriureticpeptidesNormalreflexmechanismsIncreasepreload:
Na/H20retention,RAASIncreasedcontractility:
adrenergicoutflow(NE)Increasedafterload:
norepi,AngII,endothelin,vasopressinItisimportanttorelax!
RememberthatcoronaryarteriesfillduringdiastoleRememberthatfillingduringdiastolecontributestostrokevolume(Starling)Rememberthatincreasingheartratedecreasesventricularandcoronaryfilling,upsetscalciumprocessingbySR,O2demandincreaseChronicHFpatientshavetypicallymaxedoutpreload,anddonothavethereservethatyoudoContractilityIncreasedcontractilitywillprovideincreasedstrokevolume/COforagivenlevelofpreloadandafterloadChronicHFpatientshavehighcirculatinglevelsofcatecholaminesandarelessresponsivetoadrenergicstimulireceptordownregulationCatecholaminescardiotoxic?
Necrosis/apoptosis?
Arrhythmias?
AfterloadisdoubleedgedswordIncreasedSVRisimportantformaintainingMAPIncreasedafterloadwillreducestrokevolumeslamsthescreendoorbeforeallthekidsgetoutChronicHFpatientsareverysucceptabletoincreasesinafterloadApproachtopatientAssessstatus:
s/s,targetorgandamageAddressalterablecausesDrugsDiseases/conditionsAssessfluidstatus-overorunderhydrated?
AssessseverityandinitiatepharmacotherapyAdjustmomentbymomentPatientmonitoringVitalsignsAcid/baseOxygenationHydrationRenalfunctionSwanlinePCWPCardiacoutputApproachbyhemodynamicsubsetPCWPCISTDtreatment/monitoringMortalityincreasesfromsettoset!
Seefigure13-7intext.SubsetOnePatientsymptomaticWarrantfullwork-upAddressothercauseMaximizeoraltherapyforchronicHFACEIBBDiureticsDigMisc.:
vaccines,smokingcessation,diet,education,etc.ApproachbyhemodynamicsubsetPCWPCILowerpcwp(preload)withnitrates,diureticsMortalityincreasesfromsettoset!
Seefigure13-7intext.SubsetTwoPatientperfusingatexpenseofhigherpressureGraduallylowerPAOPwithoutcausingadverseeffectsAvoidover-shootingorelse!
AvoidpromptingreflexmechanismsTypicallyinvolvesdiuretics,nitratesand(morerecently)nesiritide.NitroglycerinePreferredpreloadreducerDecreasesPCWP,decreasespulmonarycongestionCheap,shortT50,easilytitratedUsedincombinationwithinotropesinpatientswithpulmonarycongestionandreducedLVfunctionCoronarydilationathighdoses:
usefulinpatientswithischemiaAvoidifelevatedintracranialpressureTolerancein12-72hoursTypicalDosage/AdministrationProtectfromlightStableinD5WorNSinGLASSorspecialcontainerSpecial“nitro”tubing,avoidfiltersCheckforinfusionincompatabilities5to10mcg/mininitiallyTitrateuptoabout200mcg/minascontinuousIVinfusionDiureticsVasodilation:
5-10min,prostaglandinmediatedDiuresis:
20+minutesReductioninpreloadinpatientswithvolumedepletionordecreaseddiastolicfunctionmaybeharmfulDoesnotimproveCI/COinmostpatients(curveflat)Role:
usecarefullytoreducesymptomsofcongestionwithoutcompromisingcardiacoutputLoopdiureticsFurosemide(Lasix)IV(40mg/5ml),IM,POBioavailabilitypoor/variableStableinLR,D5WorLRTypically40mg80mgIVPover1-2minRepeatevery1-2hoursasneededMonitorhemodynamicsMonitorI/OformeasureofnetfluidlossAdministerpotassiumasneededinfluidsOtotoxicity,allergypossibleOtherDiureticsBumetanide(Bumex):
1/40thdoseoflasixGoodbioavailabilityIV,IM,PO0.5-1mgIVPover1-2minutes,repeat1-2hrs0.25mg/mlsolution;0.5mg,1mg,2mgtabletLasixrefractoryorallergicpatientsCancausemusculoskeletals/sTorsemide(Demadex)IV/PODoseapproximatelyhalfoflasixdoseGoodbioavailabilityPotentialPKandelectrolyteadvantagesoverfurosemideDiureticresistanceAfterloadreduction“Renaldose”dopamineIncreasebolusdoseContinuousinfusionAddthiazideDiuril(chlorothiazide)ContinuousInfusionsBum
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 急性 心衰 心源性 休克