SHOCK MONITORING MODERN METHODS

9.1 MODERN TECHNIQUES

Pulmonary artery catheterization usng Swan-Ganz catheters can
supplement the parameters discussed above.
It is required in
-Major trauma,
-High risk surgical patients,
-Cardiac surgery or
-Diagnosis is uncertain.
It is passed per-cutaneous through internal Jugular or Subclavian veins into the right atrium, right ventricle, and into the pulmonary artery.
Proper placement shows the dichrotic pulmonary/artery wave.
The balloon is inflated and the wave form shows the pulmonary capillary wedge pressure (PCWP) this represents, left ventricular preload pressure.
Cardiac output can be measured using thermo-dilution techniques.
Some of the parameter used in monitoring a shock patient are given in table 4.2.

The volumetric oximetery PAC measures right ventricular volumes, has proven to be very useful in the care of critically ill patients.
This modified PAC measures beat to beat temperature changes with sampling, from which the right ventricular ejection fraction (RVEF) is calculated.
This technology improves the clinician’s ability to estimate preload, contractility, and afterload.
Continuous mixed venous oxygen saturation (Svo2) monitoring using fiber optics incorporated into the PAC has been available and monitoring Svo2.
The ability to continuously monitor cardiac output represents a recent advance in PAC technology. Monitoring systems that measure cardiac output as often as every 15 seconds are now available.

9.1.1 Continuous Cardiac Output

The most widely used method is noninvasive skin electrodes that
measure small amplitude alternating current.

Invasive and non-invasive Doppler methods have been used to
provide continuous cardiac output measurement.

9.1.2 Mixed Venous Oxygen

This is possible with a modified pulmonary artery catheter with a
Fiber-optic bundle, and use of reflectance spectrometer.
This technique can give us mixed venous oxygen saturation
SV(overbar)O2.

The arterial base deficit (BD) represents a rapid, widely available measure of post-traumatic metabolic acidosis.
-This variable is calculated from directly measured values of arterial pH and arterial carbon dioxide tension (Paco2) from an arterial blood gas sample
-Persistently elevated values of BD throughout the resuscitation period have been correlated with impaired oxygen utilization, and may provide insight into the adequacy of ongoing resuscitation and therapy.
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