D6.iv · Cardiac Output Monitoring

This viva will explore your knowledge of measurement of cardiac output and the determinants of systemic vascular resistance (SVR). How can the cardiac output be measured?

This viva is about pulmonary anatomy and circulation. Please explain the components of this pulmonary artery catheter trace. (Image removed from report.)

This viva discussed cardiovascular physiology including measurement of cardiac output, the Valsalva manoeuvre and alterations with acute blood loss.

This viva tested knowledge of cardiovascular physiology and pharmacology, the Frank Starling mechanism, venous return and stroke volume. It went on to discuss cardiac output measurement and the pharmacology of milrinone, West’s zones of the lung and pulmonary vascular resistance.

techniques? An understanding of the principles of monitoring in clinical practice including the evaluation of the accuracy, reliability, convenience and hazards of methods of monitoring (S 1) was the subject of this viva. This question required candidates to describe the components of a thermodilution cardiac output catheter system (R 2.e) and invasive blood pressure transducer (R 2.d). Detailed knowledge of the physics of accurately reproducing biological waveforms, including discussion of natural resonant frequency and damping co-efficient was essential. Understanding of the sources of error such as zeroing, baseline drift, suboptimal damping and performance of a “flush test” was assessed (C1h 2.b, S 2.b). Candidates were expected to discuss the Fick Equation and the Stewart-Hamilton Equation related to cardiac output measurement by the indicator method (C1h 2.c, S 2.c). Better answers incorporated a labelled diagram of the thermodilution curve. Additional marks were awarded for a discussion of the sources of error in cardiac output measurement, computation constant and potential complications of pulmonary artery catheterisation. Syllabus: S 1, R 2.e, R 2.d, C1h 2.b, S 2.b, C1h 2.c, S 2.c 2 candidates (100%) passed this question. A detailed syllabus has been developed and forms the foundation for the knowledge base for the JFIC Primary Examination. All questions are sourced directly from that syllabus and candidates should have a sound understanding of those topics, and confidence to express their understanding of the subject material in both written and oral form. The candidates should also be able to integrate and express the general basic, and the topic specific, physiological and pharmacological principles detailed within the syllabus. Dr Gillian Bishop Chair Dr Arthas Flabouris Deputy Chair Primary Examination Circulation: Board of joint faculty Panel of Examiners Supervisors of Intensive Care Training Course Supervisors Regional Education Offices Registered Trainees