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% Document Info
\author{vloneker}
\pdfinfo{
  /Title (complex-exam-2.pdf)
  /Creator (Cheatography)
  /Author (vloneker)
  /Subject (Complex Exam 2 Cheat Sheet)
}

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\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Complex Exam 2 Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{vloneker} via \textcolor{DarkBackground}{\uline{cheatography.com/176321/cs/36913/}}}
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\noindent
\begin{multicols}{3}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}vloneker \\
  \uline{cheatography.com/vloneker} \\
  \end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 5th February, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Hemodynamics}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Hemodynamics:}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Hemodynamic Monitoring:}}measurement of pressure, flow, and oxygenation within the cardiovascular system. Monitoring is used to asses heart function, fluid balance, and the effects of fluids and drugs on cardiac output.} \tn 
% Row Count 6 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Indications for hemodynamic monitoring}} include: shock, sepsis, anaphylaxis, MI with right/left ventricular failure, Hypo/Hypertension, Cardiac tamponade, ARDS, Post open heart surgery, fluid resuscitation, and evaluation of cardiac output} \tn 
% Row Count 11 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Mean Arterial Pressure (MAP):}} the average pressure within the arterial system that is felt by organs in the body. {\bf{Essentially how hard the blood is flowing when hitting the organs.}}} \tn 
% Row Count 15 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Calculating MAP}} 2xDiastolic + Systolic = \#. \# divided by 3. {\bf{Example:}} BP:120/60: 2x60+120=240. 240/3= 80. MAP of 80.} \tn 
% Row Count 18 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pulse Pressure:}} the difference between the systolic blood pressure (SBP) and diastolic blood pressure (DBP). {\bf{Narrow/decreased:}} shock state or HF- meaning insufficient preload leading to reduced cardiac output (CO). {\bf{Wide/increase:}} occurs during exercise or in atherosclerosis- Increased ICP.} \tn 
% Row Count 25 (+ 7)
% Row 6
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Calculating Pulse Pressure:}} SBP-DBP=Pulse Pressure} \tn 
% Row Count 27 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Stroke Volume:}} the amount of blood pumped by a ventricle with each {\bf{beat.}}} \tn 
% Row Count 29 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Calculating Stroke Volume:}} Cardiac Output/ HR= stroke volume} \tn 
% Row Count 31 (+ 2)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Hemodynamics (cont)}}  \tn
% Row 9
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Cardiac Output:}} Amount of blood ejected from the heart into circulation each {\bf{minute}}} \tn 
% Row Count 2 (+ 2)
% Row 10
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Calculating Cardiac Output:}} HRxSV= Cardiac Output} \tn 
% Row Count 4 (+ 2)
% Row 11
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Cardiac Index:}} cardiac out that is adjusted for each individual based on the body surface area (BSA).} \tn 
% Row Count 7 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Ranges:}} \newline MAP: \textgreater{}60mm Hg. \textless{}65 needs to be addressed. \textless{}60 inadequate tissue and organ perfusion \newline Pulse Pressure: 40-60mm Hg \newline Stroke Volume: 60-150mL/beat \newline Cardiac Output: 4-8L/min \newline Cardiac Index: 2.2-4L/min}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Autonomic Nervous System}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Autonomic Nervous System:ANS}}} \tn 
% Row Count 1 (+ 1)
% Row 1
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\mymulticolumn{1}{x{5.377cm}}{{\bf{ANS consists of the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS)}}} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{SNS:}} this is the bodys' {\bf{fight of flight}}. It controls blood flow by constricting the arteries throughout the body and increases blood pressure and blood flow.} \tn 
% Row Count 8 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{How does SNS work?:}} The body senses a low arterial pressure. The SNS is then stimulated to maintain CO. Norepi and epi (catecholamies) is released. The receptors respond the the norepi and epi by increasing the HR, contractility, and conduction (chronotropic, inotropic, dromotropic effects). This then increases myocardial oxygen demand.} \tn 
% Row Count 15 (+ 7)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{SNS Effects:}} Chronotropic- increases the {\bf{rate.}} Inotropic- increases the {\bf{contractility.}} Dromotropic- cardiac {\bf{conductivity time}}.} \tn 
% Row Count 18 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Chronotropic:}} responds to norepinephrine and epinephrine by {\bf{increasing the HR.}}} \tn 
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% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Inotropic:}} responds to norepinephrine and epinephrine by {\bf{increasing the contractility.}}} \tn 
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% Row 7
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Dromotropic:}} responds to norepinephrine and epinephrine by {\bf{increasing the speed of conduction.}}} \tn 
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% Row 8
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\mymulticolumn{1}{x{5.377cm}}{{\bf{PNS:}} this is the bodys' {\bf{rest and digest.}} It controls blood flow by dilating the arteries which decrease blood pressure and blood flow.} \tn 
% Row Count 28 (+ 3)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{How does PSN work?}} Happens after SNS response. It "reverses" the SNS effects. Acetylcholine is released which then decreases HR, conduction and irritability. Stimulates the GI tract.} \tn 
% Row Count 32 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Monitoring}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Four Parameters of Hemodynamics:}} Preload (think volume), Afterload (think resistance), Contractility (thing ability to pump), and Cardiac Output (think perfusion status).} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Contractility:}} {\bf{Hypokinesia:}} reduced movement or contraction of a segment of the heart muscle. {\bf{Dyskinesia:}} abnormal movement, myocardium bulges out in systole. {\bf{Akinesia:}} lack of movement or contraction of a region of the heart muscle.} \tn 
% Row Count 9 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Preload:}}Amount the ventricles stretch at the end of diastole (the filling phase). Preload is once the ventricles are completely filled.} \tn 
% Row Count 12 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{How to increase preload?}} (pt in hypovolemic shock) give fluids (increasing the amount of volume to fill the ventricle). Stimulate SNS - give vasopressors (causing vasoconstriction- making the area to fill "smaller").} \tn 
% Row Count 17 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{How to decrease preload?}} (pt is fluid overload) give diuretics (excreting excess fluids). Give vasodilators (creating more space for fluid to flow).} \tn 
% Row Count 21 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Afterload:}} the pressure the ventricles have to work against to get valves to open to pump blood out of the heart. Afterload is affected by {\bf{vascular resistance}}.} \tn 
% Row Count 25 (+ 4)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Vascular Resistance in the right side of the heart:}} Right ventricle pumps blood to pulmonic valve. Pulmonic valve has to fight against {\bf{pulmonary vascular resistance (PVR)}} to open and pump blood to the lungs.} \tn 
% Row Count 30 (+ 5)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Monitoring (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Vascular Resistance in the left side of the heart:}} Left ventricle pumps blood to aortic valve. Aortic valve needs to fight against {\bf{systemic vascular resistance}} to open and pump blood to the rest of the body (systemically).} \tn 
% Row Count 5 (+ 5)
% Row 8
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{How to increase afterload?}} (pt is hypotensive) Can increase naturally by vasoconstriction such as {\bf{pulmonary HTN}} for left sided or {\emph{HTN{\bf{ for right sided. This happens due to the increase vascular resistance. Valve problems cause an increase in after load }}(aortic stenosis)}}* due to the constriction of the valve increasing pressure on the ventricles.} \tn 
% Row Count 13 (+ 8)
% Row 9
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{How to decrease afterload?}} Give vasodilators. This will decrease vascular resistance resulting in a decrease of pressure to work against.} \tn 
% Row Count 16 (+ 3)
% Row 10
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Effects on Cardiac Output:}} {\bf{If HR, Preload, contractility is increased/decreased CO will follow suite}}} \tn 
% Row Count 19 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}