Practice with Swan-Ganz values and Shock
This practice session will present a series of measured hemodynamic values with a statement about the patient's skin color and temperature. For each problem set, selects the following as the most likely interpretation.
1) Normal
2) Cardiogenic Shock (The Pump)
3) Hypovolemic Shock (The Volume)
4) Low Resistance Shock (The Space)
Base your selection on your assessment of the origin of the Shock. Only mean values will be reported in this practice session. Normal Ranges reported in previous sections are :
Mean CVP 2-7 mm Hg
Mean PA 10-22 mm Hg
Mean PCWP 6-15 mm Hg
Skin Changes will be described, if applicable.
|
CVP |
PA |
PCWP |
Skin |
|
0 |
13 |
10 |
Cool and Pale |
1) Normal
2) Cardiogenic Shock
3) Hypovolemic Shock
4) Low Resistance Shock
Answer--3--This is Hypovolemic Shock as all values are low, and the skin is cool and pale due to shunting of blood flow to the critical organs.
1)
|
CVP |
PA |
PCWP |
Skin |
|
4 |
13 |
8 |
warm and dry |
1) Normal
2) Cardiogenic Shock
3) Hypovolemic Shock
4) Low Resistance Shock
Answer--1--normal--All values and the skin are within normal range.
2)
|
CVP |
PA |
PCWP |
Skin |
|
5 |
15 |
24 |
no changes |
1)Normal
2) Cardiogenic Shock
3) Hypovolemic Shock
4) Low Resistance Shock
Answer--2--Cardiogenic Shock--Only the PCWP is elevated indicating Left-sided Heart failure.
3)
|
CVP |
PA |
PCWP |
Skin |
|
0 |
8 |
7 |
Cool and Pale |
1)Normal
2) Cardiogenic Shock
3) Hypovolemic Shock
4) Low Resistance Shock
Answer--3--Hypovolemic Shock--All the values are decreased and the skin is poorly perfused indicating shunting to the vital organs.
4)
|
CVP |
PA |
PCWP |
Skin |
|
5 |
24 |
20 |
no changes |
1)Normal
2) Cardiogenic Shock
3) Hypovolemic Shock
4) Low Resistance Shock
Answer--2--Cardiogenic Shock--Only the PCWP is elevated indicating CHF.
5)
|
CVP |
PA |
PCWP |
Skin |
|
0 |
5 |
10 |
Hot and Flushed |
1)Normal
2) Cardiogenic Shock
3) Hypovolemic Shock
4) Low Resistance Shock
Answer--4--Low Resistance Shock--All the values are decreased, but the skin is hot and flushed indicating peripheral vasodilatation.
6)
|
CVP |
PA |
PCWP |
Skin |
|
5 |
17 |
10 |
warm and dry |
1)Normal
2) Cardiogenic Shock
3) Hypovolemic Shock
4) Low Resistance Shock
Answer--1--Normal--all the values and the skin are within normal range.
7)
|
CVP |
PA |
PCWP |
Skin
|
|
0 |
8 |
6 |
Hot and Flushed |
1)Normal
2) Cardiogenic Shock
3) Hypovolemic Shock
4) Low Resistance Shock
Answer--4--Low Resistance Shock--all values are decreased and the peripheral blood vessels are dilated.
8)
|
CVP |
PA |
PCWP |
Skin |
|
10 |
25 |
20 |
Warm and dry |
1) Normal
2) Cardiogenic Shock
3) Hypovolemic Shock
4) Low Resistance Shock
5) Hypervolemia
Answer--5--Hypervolemia is normally iatrogenic in nature caused by poor IV fluid regulation.
9)
|
CVP |
PA |
PCWP |
Skin |
|
5 |
18 |
18 |
no changes |
1) Normal
2) Cardiogenic Shock
3) Hypovolemic Shock
4) Low Resistance Shock
Answer--2--Cardiogenic Shock--Only the PCWP is elevated.
10)
|
CVP |
PA |
PCWP |
Skin |
|
0 |
7 |
5 |
Cool and Pale |
1) Normal
2) Cardiogenic Shock
3) Hypovolemic Shock
4) Low Resistance Shock
Answer--3--Hypovolemic Shock--all values are decreased and blood is being shunted to the vital organs.
Score-