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Hemodynamic monitoring can identify cardiovascular insufficiency and ensure optimal treatment of the critically ill. Advanced techniques help identify and prioritize various causes of hemodynamic instability and can enable tailored interventions.
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Hemodynamic monitoring changes therapeutic decisions in more than 50% of patients and can detect cryptic cardiovascular compromise. We will focus on techniques applicable to the ED: blood pressure monitoring, central venous pressure (CVP) monitoring, cardiac output (CO) monitoring, and blood oxygenation and organ perfusion monitoring (Table 32-1). Use of any technology must be associated with a therapy and a response to therapy—functional hemodynamic monitoring. Applying a technology without a therapeutic strategy limits any potential benefit. In practice, it is best to use more than one approach and monitor therapeutic responses (Table 32-2).1
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ARTERIAL BLOOD PRESSURE
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Blood pressure is the force exerted by the circulating blood through a blood vessel. Assessing arterial pressure is very important, as hypotension implies tissue hypoperfusion; shock is a state of organ hypoperfusion but is not always associated with hypotension. Hypotension is always pathologic and reflects a failure of normal circulatory homeostatic mechanisms, whereas normotension does not necessarily indicate cardiovascular stability. Normal blood pressure can occur in the setting of profound circulatory shock in the face of significant vasoconstriction or in a patient with antecedent high arterial pressure. For example, a patient in cardiogenic or hypovolemic ...