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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, September 6, 2016

Pulmonary HPT and RVF

EM Crit
EM Crit - Podcast 181 - September 5, 2016 - By Scott Weingart
"The Right Ventricle gets no respect, but it is an easy source of clean kills in the ED. We haven’t covered pulmonary hypertension and acute on chronic RV failure on the show yet–we need to fix that ASAP. So, let’s hear from Susan Wilcox, MD on this critical topic. She just wrote an amazing review on the subject for Ann Emerg Med and as an EM Intensivist, she is the perfect person to talk on this topic...
Right ventriculo-centric cardiovascular rules
  1. Central venous pressure is only elevated in disease Normally central venous pressure is zero or slightly higher than intrathoracic pressure
  2. If central venous pressure rises and remains elevated following a fluid challenge: STOP Make sure the patient is not slipping into acute cor pulmonale before proceeding
  3. For cardiac output to increase the RV must dilate There is a physical limit to which fluid resuscitation alone can increase cardiac output
  4. Right ventricular hypertrophy is essentially a deal with the devil: it is a losing proposition Increased filling must be associated with increased filling pressure limiting venous return and impairing LV diastolic compliance"