{"id":39,"date":"2017-01-11T11:28:12","date_gmt":"2017-01-11T11:28:12","guid":{"rendered":"http:\/\/www.deltexmedical.com\/decision_tree\/?page_id=39"},"modified":"2025-10-10T12:46:38","modified_gmt":"2025-10-10T11:46:38","slug":"trigger-points-and-concerns","status":"publish","type":"page","link":"https:\/\/www.deltex-academy.com\/decision_tree\/trigger-points-and-concerns\/","title":{"rendered":"Trigger points and concerns"},"content":{"rendered":"<style>.entry-title {display:none;}<br \/><\/style>\n<style>.site-info {display: none;}<br \/><\/style>\n<h2 style=\"text-align: center;\"><strong><span style=\"color: #003087;\">TRIGGER POINTS AND CONCERNS<\/span><\/strong><\/h2>\n<p>The decision tree was developed to be used in conjunction with flow measurements using the <a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/the-oesophageal-doppler-monitor-odm\/\">oesophageal Doppler monitor.<\/a><br \/>\n\u200b<br \/>\nA good understanding of cardiovascular physiology is essential, including <a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/preload-afterload-and-contractility\/\">preload, afterload and contractility<\/a>. Always ensure <a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/how-to-focus\/\">optimal focus<\/a> of the Doppler probe is achieved before analysing the data.<\/p>\n<p><strong>NOTE<\/strong> &#8211; These trigger points and concerns:\u200b<\/p>\n<ul>\n<li>Should not be assessed in isolation<\/li>\n<li>Are not the same as physiological targets<\/li>\n<li>Are indicative and not absolute<\/li>\n<li>Are not prioritised<\/li>\n<\/ul>\n<h3><strong><span style=\"color: #003087;\">Primary Clinical Indicators<\/span><\/strong><\/h3>\n<ul>\n<li><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/blood-pressure\/\"><strong>Hypotension:<\/strong><\/a> e.g. Systolic &lt; 100 mmHg, MAP &lt; 60-70 mmHg, or a clinically significant drop in MAP e.g. 30-40 mmHg from assumed \u2018normal\u2019 or baseline<\/li>\n<li><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/glossary\/\"><strong>Tachycardia:<\/strong><\/a> e.g. &gt; 90 bpm<\/li>\n<li><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/glossary\/\"><strong>Oliguria:<\/strong><\/a> &lt; 0.5 mL\/kg\/hr<\/li>\n<li><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/stroke-volume-and-cardiac-output\/\"><strong>Low Cardiac Output State<\/strong><\/a>\u200b<\/li>\n<\/ul>\n<h3><strong><span style=\"color: #003087;\">Flow Indicators<\/span><\/strong><\/h3>\n<ul>\n<li><strong>\u200b<a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/doppler-specific-parameters\/\">Reduced FTc<\/a>:<\/strong> &lt; 330 ms, or considered low for clinical condition e.g. any high resistant state<\/li>\n<li><strong><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/stroke-volume-and-cardiac-output\/\">Low Cardiac Output<\/a>:<\/strong> significantly below \u2018normal\u2019 e.g. CO &lt; 4-6 L, CI &lt; 2.5 L\/min\/m\u200b\u00b2<\/li>\n<li><strong><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/stroke-volume-and-cardiac-output\/\">Low Stroke Volume<\/a>:<\/strong> significantly below \u2018normal\u2019 e.g. SV &lt; 50-70 mL, SVI &lt; 30 mL<\/li>\n<\/ul>\n<h3><strong><span style=\"color: #003087;\">Supplementary Clinical Indicators<\/span><\/strong><\/h3>\n<ul>\n<li><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/blood-pressure\/\"><strong>Hypertension:<\/strong><\/a> e.g. Systolic &gt; 180mmHg, or &gt; 30-40 mmHg above baseline<\/li>\n<li><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/glossary\/\"><strong>Lactate:<\/strong><\/a> &gt; 2 mmol\/L<\/li>\n<li><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/glossary\/\"><strong>\u200bBase Excess:<\/strong> <\/a>-3 or +3 mEq\/L\u200b<\/li>\n<li><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/glossary\/\">\u200b<strong>Peripheral Shutdown:<\/strong> <\/a>&#8211; Looks \u2018unwell\u2019 e.g. pale, sweaty or a clinical picture of poor\u00a0perfusion<\/li>\n<li><span style=\"font-size: 1rem; line-height: 1.66;\"><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/glossary\/\"><strong>SaO2:<\/strong><\/a> &lt; 93% <strong>or<\/strong> having to increase FiO2 by 20% to maintain sats.<\/span><\/li>\n<li><span style=\"font-size: 1rem; line-height: 1.66;\"><strong>\u200b<a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/glossary\/\">Low ScVO2<\/a><\/strong>: &lt; 65-70%<\/span><\/li>\n<li><span style=\"font-size: 1rem; line-height: 1.66;\"><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/glossary\/\"><strong>Reduced Conscious Level:<\/strong><\/a> any deterioration rather than a score\u200b<\/span><\/li>\n<\/ul>\n<h3><strong><span style=\"color: #003087;\">Exclusions<\/span><\/strong><\/h3>\n<ul>\n<li><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/temperature\/\"><strong>Temperature<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/delivered-oxygen-do2\/\"><strong>DO2<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/central-venous-pressure-cvp\/\"><strong>CVP<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/preload-afterload-and-contractility\/\"><strong>SVR<\/strong><\/a><\/li>\n<li><a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/stroke-volume-variation-svv-and-pulse-pressure-variation-ppv\/\"><strong>\u200bSVV\/PPV<\/strong><\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>TRIGGER POINTS AND CONCERNS The decision tree was developed to be used in conjunction with flow measurements using the oesophageal Doppler monitor. \u200b A good understanding of cardiovascular physiology is essential, including preload, afterload and contractility. Always ensure optimal focus of the Doppler probe is achieved before analysing the data. NOTE &#8211; These trigger points &hellip; <a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/trigger-points-and-concerns\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &#8220;Trigger points and concerns&#8221;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-39","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/pages\/39","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/comments?post=39"}],"version-history":[{"count":5,"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/pages\/39\/revisions"}],"predecessor-version":[{"id":1302,"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/pages\/39\/revisions\/1302"}],"wp:attachment":[{"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/media?parent=39"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}