RT 150 - Cardiovascular Evaluation and Monitoring

Credits: 3
Instructional Contact Hours: 3

Presents the theory and application of skills required to provide adult hemodynamic and ECG monitoring and interpretation.

Prerequisite(s): RT 132, RT 135, RT 146, & RT 149 each with a minimum grade of “C”
Corequisite(s): None
Lecture Hours: 41 Lab Hours: 8
Meets MTA Requirement: None
Pass/NoCredit: No

Outcomes and Objectives

Demonstrate an understanding of the heart cycle.
1. Explain the limitations of monitoring or lab values.
2. Describe the “feelings” of the patient facing a life threatening situation.
3. Define:
  1. Ventilation
  2. Diffusion
  3. Perfusion
4. Explain those factors that effect:
  1. Ventilation
  2. Diffusion
  3. Pulmonary Vascular Resistance (PVR)
5. Calculate:
  1. O2 content
  2. O2 consumption
  3. Cardiac output
  4. O2 delivery
  5. A-aD02
  6. a-vDO2
  7. Qs/Qt
6. Describe and explain the significance of those factors involved in the physical assessment of the pulmonary system.
7. Define:
  1. Pericardium
  2. Epicardium
  3. Myocardium
  4. Endocardium
8. Describe the anatomy of the heart.
9. Describe the blood flow and intrachamber pressures through the heart.
10. Describe the phases of the cardiac cycle.
11. Explain those factors affecting CO.
12. Describe the coronary circulation.
13. Explain the primary determinants of myocardial O2 consumption.
14. Describe those factors that contribute to PVR.
15. Describe and explain the function of:
  1. Arteries
  2. Capillaries
  3. Veins
16. Calculate mean arterial pressure. (MAP)
17. Compare and contrast the pulmonary and systemic circulations in terms of:
  1. Structure
  2. Function
  3. Pressures
  4. Pressure drop
Demonstrate an understanding of pulmonary artery catheters.
1. Define and explain the effect on fluid-filled monitoring systems of:
  1. Dynamic pressure element
  2. Static pressure head
2. Explain the function of the following components of a pressure monitoring system:
  1. Transducer
  2. Transducer dome
  3. Amplifier/Monitor
  4. Flush system and tubing
3. Explain the clinical application of CVP monitoring:
  1. Assessment of cardiac function
  2. Assessment of fluid volume
  3. Administration of fluids/drugs
4. Describe the complications of CVP monitoring.
5. State the normal pressures and identify the pressure waveforms as the PA catheter passes through the heart.
6. Calculate and give the normal values for:
  1. PVR
  2. SVR
Demonstrate an understanding of the complications of pulmonary artery catheters.
1. Describe the indications for PAP monitoring.
2. Describe the general design of the PA catheter.
3. Explain the function of each of the following ports of the catheter and where the terminal opening would lie when the catheter is properly placed:
  1. Proximal
  2. Distal
  3. Inflation
  4. Thermistor
4. Describe the two approaches for gaining vascular access.
5. Identify the common site used for pulmonary artery catheterization.
6. Describe the steps involved in the insertion and floatation of the catheter.
7. Describe techniques to document a true wedge position.
8. Explain the significance of the PADP to PCWP gradient.
9. Explain postinsertion and rewedging protocol.
10. Describe the use of the PA catheter in assessing:
  1. Preload
  2. Afterload
11. Explain the complications associated with PA catheters:
  1. Arrhythmias
  2. Balloon rupture
  3. Knotting
  4. Trauma
  5. Infection
  6. Thromboemboli
  7. Pneumothorax
  8. Pul. Ischemia or infarction
12. Describe methods of determining cardiac output.
13. List the equipment required for the thermaldilution method of determining C.O.
14. Describe those factors that affect C.O.
15. Explain the significance of the cardiac index.
16. Explain the significance of SvO2 monitoring.
Identify cardiac arrhythmias.
1. Describe the types of myocardial cells.
2. Define:
  1. Contractility
  2. Automaticity
  3. Excitability
  4. Conductivity
3. Identify the components of the electrical conduction system of the heart.
4. Describe the phases of the action potential of the myocardial cells.
5. Relate the phases of the action potential to depolarization and repolarization of the cells.
6. Explain the significance of Phase 4 in pacemaker cells.
7. Identify the various segments of the normal ECG.
8. Identify those arrhythmias covered in class.
Demonstrate an understanding of respiratory care during cardiac arrest.
1. Identify those individuals involved in the in-hospital resuscitation and the responsibilities of each.
2. Define and give the indications for:
  1. Defibrillation
  2. Synchronized cardioversion
  3. Precordial thump
3. Describe the standard electrode placement and energy requirements for defibrillation.
4. Describe the phases of the action potential of the myocardial cells.
5. Relate the phases of the action potential to depolarization and repolarization of the cells.
6. Explain the mechanism of action, indications, and dosages of the following medications:
  1. Epinephrine
  2. Atropine
  3. Lidocaine
  4. Procainamide
  5. Sodium bicarbonate
  6. Morphine
  7. Calcium chloride
  8. Norepinephrine
  9. Dopamine
  10. Dobutamine
  11. Isoproterenol
  12. Amrinone
  13. Digitalis
  14. Sodium nitroprusside
  15. Nitroglycerin
  16. Propranolol
  17. Furosemide
Demonstrate an understanding of capnometry.
1. Define capnometry and capnography.
2. Differentiate between mainstream vs sidestream capnometers.
3. Explain the principles of operation of the infrared capnometer.
4. Identity and explain the phases of the normal capnogram.
5. Relate changes in the ventilation/perfusion ratio to the expected PACO2 value.
6. Identify causes of increased or decreased end tidal CO2 values.
7. Identify and explain possible causes of abnormal capnograms.
8. Explain the use of capnometry:
  1. During spontaneous ventilation.
  2. With increased deal space ventilation.
  3. To detect esophageal intubation.
  4. During cardiac arrest.
  5. During weaning from mechanical ventilation.
  6. To determine peep levels.