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Thread: The Clinical Status That the Clinicians Must Know How to Evaluate

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    PharmD Year 1 TomHsiung's Avatar
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    Default The Clinical Status That the Clinicians Must Know How to Evaluate

    Clinical Status of Your Patient
    • Hemodynamics
      • Cardiac Function
      • Cardiac Output
      • Transcapillary Transport (transport between intravascular volume and extravascular volume)
      • Arterial Pressure

    • Systemic oxygenation
    • Acid-Base balance
    • Fluid status
    • Hemostasis and thrombosis
    • Electrolyte balance
      • Sodium balance
      • Potassium balance

    • Status of jaundice
    • Status of hemolysis
    • Nutritional status
    Last edited by TomHsiung; Fri 16th December '16 at 2:28pm.
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease.

  2. #2
    PharmD Year 1 TomHsiung's Avatar
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    Default Re: The Clinical Status That the Clinicians Must Know How to Evaluate

    Direct Determinants of Cardiac Output (CO)
    • HR
      • Pacemaker activity
        • Rates of spontaneously depolarizing
        • Threshold level of pacemaker action potentials

      • Conduction velocity

    • SV
      • Cardiac filling
      • Total muscle wall tension (cardiac muscle wall tension)
        • Ventricular chamber radium
        • Ventricular wall thickness
        • Ventricular pressure
          • Pleural pressure
          • Aortic impedance (pulsatile flow)
          • Systemic vascular resistance (steady flow)

      • Contractility


    Examples (HR):
    Autonomic nervous system, ECF ions, circulating hormones, body temperature, atrial wall stretch.

    Determinants of Venous Return (rate at which blood returns to the thorax from the peripheral venous compartment [venous pool 1])
    • CVP
    • Peripheral venous pressure
      • Peripheral venous volume
      • ANS
      • Muscle compression

    • Resistance of connecting venous vessels


    Determinants of Vascular Tone/Diameter/Resistance
    • Arteriolar
      • Basal/Intrinsic tone
      • External influences on vessels
        • Local
          • Metabolic substances
          • Substances produced by endothelial cells
          • Other substances
          • Transmural pressure

        • Neural (ANS)
        • Hormonal (catecholamines, vasopressin, and angiotensin II)

    • Venous
      • Neural (ANS)
      • Physical influences (passive distention)
      • Muscle compression


    Measurement of Cardiac Function
    • Imaging techniques
      • Echocardiography
      • Cardiac angiography
      • Radionuclide ventriculography
      • Positron emission tomography (PET) scans
      • Computed tomography angiography (CTA) scans
      • Magnetic resonance imaging (MRI)

    • End-systolic pressure-volume relationship


    The end-systolic pressure-volume relationship can be used to assess cardiac contractility (systolic function). End-systolic volume for a given cardiac cycle is estimated by one of the imaging techniques described above, whereas end-systolic pressure for that cardiac cycle can be obtained from the arterial pressure recorded at the point of closure of the aortic valve (the incisura). Values for several different cardiac cycles may be obtained during infusion of a vasoconstrictor (which increases vascular impedance and resistance), and the data plotted as in Figure 4-1 in the context of overall ventricular pressure-volume loops. This method of assessing cardiac function is particular important because it provides an estimate of contractility that is independent of the end-diastolic volume.

    The Clinical Status That the Clinicians Must Know How to Evaluate-screen-shot-2016-12-13-at-9-35-35-pm-png

    Measurement of Cardiac Output
    • Fick principle
    • Indicator dilution techniques
    • Echocardiography
    • Impedance cardiography
    • MRI
    • Pulse pressure evaluations


    Transport Between Intravascular and Extravascular Volumes
    • Starling hypothesis, net filtration rate = K [(Pc - Pi) - (Pic - Pii)]
    • Lymphatic pathway
      • Tissue interstitial pressure (due to fluid accumulation or due to movement of surrounding tissue)
      • Contractions of the lymphatic vessels themselves.


    Determinants of Arterial Pressure
    • ​Mean arterial pressure (MAP = CO x SVR + RAP)
    • Pulse pressure (Pp = [SV- X] / CA = ~SV / CA), X: some blood volume leaving the arterial compartment during cardiac ejection (which could be neglected)
    Last edited by TomHsiung; Wed 14th December '16 at 7:16pm.
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease.

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