Page 23 - Critical Care Notes

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■ Pancuronium (Pavulon)
■ Vecuronium
Peripheral Nerve Stimulator
■ Monitors the level of blockade with NMBA use.
■ Electrical stimulation is applied to the ulnar nerve, the facial nerve, or the
posterior tibial nerve.
■ Train of four (TOF) testing and monitoring should be instituted. The number
of twitches elicited through electrodes along a nerve path is counted. Depth
of blockage increases, number of twitches on the TOF decreases. Prevents
overparalyzing the patient and causing prolonged muscular weakness.
Specific Nursing Management
■ Patient must be intubated or have tracheostomy in place. Keep airway
patent, and respond to ventilator alarms quickly.
■ Monitor and assess response to NMBAs.
■ Monitor VS and neurological status, especially pupillary response.
■ Monitor ABGs and oxygenation levels.
■ Provide eye lubrication and/or taping.
■ Provide DVT prophylaxis.
■ Initiate pressure sore prevention actions.
Hemodynamic Monitoring
Hemodynamic Parameters
Arteriovenous oxygen difference...................................3.5–5.5 vol% or 4–8 L/min
Aortic pressure:
■ Systolic.........................................................................................100–140 mm Hg
■ Diastolic ...........................................................................................60–80 mm Hg
■ Mean ................................................................................................70–90 mm Hg
Cardiac output (CO = HR × SV)..................................................................4–8 L/min
Cardiac index (CO/BSA) ..........................................................................2.5–4 L/min
Central venous pressure (CVP)...............................................................2–8 mm Hg
**Same as right atrial pressure (RAP)
Cerebral perfusion pressure (CPP).....................................................70–90 mm Hg
Coronary artery perfusion pressure (CAPP)......................................60–80 mm Hg
Ejection fraction (Ej Fx or EF).....................................................................60%–75%
Left atrial mean pressure......................................................................4–12 mm Hg
Left ventricular systolic pressure ...................................................100–140 mm Hg
Left ventricular diastolic pressure..........................................................0–5 mm Hg
Left ventricular end-diastolic pressure (LVEDP)..................................5–10 mm Hg
Left ventricular end-diastolic volume (LVEDV) .............120–130 mL up to 250 mL
BASICS