Cardiovascular system

The cardiac rhythm is monitored continuously, as dysrhythmia can be unexpected. An ECG should be obtained to look for pre-existing abnormalities and for ST- and T-wave changes indicative of ischemia, which may affect treatment choices. Invasive blood pressure monitoring will continously record extremes of pressure and also allow access for serum chemistries and blood gases. Monitoring central venous pressure and pulmonary artery occlusion pressure provides hemodynamic and oxygen transport data and is useful in precarious situations.

Cardiac output is difficult to assess clinically and can be vital for planning subsequent treatment. Cardiac output is usually measured by thermodilution using a pulmonary artery catheter; suprasternal or esophageal Doppler may also be utilized. Left and right ventricular stroke work and systemic and pulmonary arterial resistance provide information on the status of cardiac and circulatory function. Echocardiography, either surface or transesophageal, is also useful for assessing regional cardiac function, particularly if a new murmur is detected which may be indicative of cardiac dilation, papillary muscle dysfunction, or endocarditis.

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