Abg By Faruk Cfh

IN THE NAME OF ALLAAH,THE BENEFICENT,THE MERCIFUL A PRESENTATION BY DR FAROOQUE CHEST & FEVER HOSPITAL NAJRAN KSA [email_address]

Taking Arterial Blood Gases Dr MUHAMMAD FAROOQUE M.B;B.S D.T.C.D. MEMBER EXECUTIVE COUNCIL PAKISTAN CHEST SOCIETY

IS THERE AN ALTERNATIVE TO ARTERIAL SAMPLE? ,[object Object],[object Object]

SUMMARY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The Blood Gas Report: normals… pH 7.40 + 0.05 PaCO 2 40 + 5 mm Hg PaO 2 80 - 100 mm Hg HCO 3 24 + 4 mmol/L O2 Sat >95 Always mention and see FIO2

AN APPROACH TO BLOOD GAS EVALUATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ABG REPORT COMPONENTS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

DEFINING SOME COMPONENTS ,[object Object],[object Object]

DEFINING SOME COMPONENTS ,[object Object]

Effect of Temperature ,[object Object],[object Object],[object Object]

The Key to Blood Gas Interpretation: 4 Equations, 3 Physiologic Processes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PaCO 2 equation: PaCO 2 reflects ratio of metabolic CO 2 production to alveolar ventilation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hypercapnia ,[object Object],[object Object],[object Object],[object Object]

Hypercapnia (continued) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical assessment of hypercapnia is unreliable ,[object Object],[object Object]

Dangers of hypercapnia ,[object Object],[object Object],[object Object],[object Object]

PCO 2 vs. Alveolar Ventilation ,[object Object]

Alveolar Gas Equation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Alveolar Gas Equation PAO 2 = PIO 2 - 1.2 (PaCO 2 ) where PIO 2 = FIO 2 (P B – 47 mm Hg) ,[object Object],[object Object],[object Object],[object Object]

P(A-a)O 2 ,[object Object],[object Object],[object Object],[object Object]

Physiologic causes of low PaO 2 ,[object Object],[object Object],[object Object],[object Object]

Ventilation-Perfusion imbalance ,[object Object],[object Object],[object Object]

SaO 2 and oxygen content ,[object Object],[object Object]

Oxygen dissociation curve: SaO 2 vs. PaO 2 Also shown are CaO 2 vs. PaO 2 for two different hemoglobin contents: 15 gm% and 10 gm%. CaO 2 units are ml O 2 /dl. P 50 is the PaO 2 at which SaO 2 is 50%. Point ‘X’ is discussed on later slide.

SaO 2 – is it calculated or measured? ,[object Object],[object Object],[object Object]

Carbon monoxide – an important cause of hypoxemia ,[object Object],[object Object],[object Object],[object Object],[object Object]

CO does not affect PaO 2 – be aware! ,[object Object],[object Object],[object Object],[object Object]

Causes of Hypoxia A General Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

How much oxygen is in the blood, and is it adequate for the patient? PaO 2 vs. SaO 2 vs. CaO 2 ,[object Object],[object Object]

How much oxygen is in the blood? PaO 2 vs. SaO 2 vs. CaO 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Acid-Base Balance Henderson Hasselbalch Equation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

pH is inversely related to [H + ]; a pH change of 1.00 represents a 10-fold change in [H + ] ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Acid base terminology ,[object Object],[object Object],[object Object],[object Object]

Acid base terminology (cont.) ,[object Object],[object Object]

Primary acid-base disorders - Respiratory alkalosis - ,[object Object],[object Object],[object Object],[object Object],[object Object]

Primary acid-base disorders - Respiratory acidosis - ,[object Object],[object Object],[object Object],[object Object],[object Object]

Primary Acid-Base Disorders - Metabolic acidosis - ,[object Object],[object Object],[object Object],[object Object],[object Object]

Primary Acid-Base Disorders - Metabolic alkalosis - ,[object Object],[object Object],[object Object],[object Object],[object Object]

Anion Gap ,[object Object],[object Object],[object Object]

Metabolic Acid-Base Disorders -- Some clinical causes -- ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Respiratory Acid-Base Disorders -- Some clinical causes -- ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Mixed Acid-base disorders are common ,[object Object],[object Object],[object Object]

T ips to diagnosing mixed acid-base disorders ,[object Object],[object Object],[object Object],[object Object],[object Object]

Tips to diagnosing mixed acid-base disorders (cont.) ,[object Object],[object Object]

Expected changes in pH and HCO 3 - for a 10 mm Hg change in PaCO 2 resulting from either primary hypoventilation (respiratory acidosis) or primary hyperventilation (respiratory alkalosis). ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Predicted changes in HCO 3 - for a directional change in PaCO 2 can help uncover mixed acid-base disorders. ,[object Object],[object Object]

Tips to diagnosing mixed acid-base disorders (cont.) ,[object Object],[object Object],[object Object]

(Summary ) Clinical and laboratory approach to acid-base diagnosis ,[object Object],[object Object]

(Summary ) Clinical and laboratory approach to acid-base diagnosis (cont.) ,[object Object],[object Object],[object Object]

The Blood Gas Report: normals… pH 7.40 + 0.05 PaCO 2 40 + 5 mm Hg PaO 2 80 - 100 mm Hg HCO 3 24 + 4 mmol/L O2 Sat >95 Always mention and see FIO2 The essentials HCO3

5 The Steps for Successful Blood Gas Analysis SUMMARY OF INTERPRETATION

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Step 1 Look at the pH Is the patient acidemic pH < 7.35 or alkalemic pH > 7.45

Step 3 If there is a primary respiratory disturbance, is it acute ? .08 change in pH ( Acute ) .03 change in pH ( Chronic ) 10 mm Change PaCO 2 =

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Step 4 cont. If there is metabolic acidosis, is there a wide anion gap ? Na - (Cl - + HCO 3 - ) = Anion Gap usually <12 If >12, Anion Gap Acidosis : M ethanol U remia D iabetic Ketoacidosis P araldehyde I nfection (lactic acid) E thylene Glycol S alicylate ,[object Object],[object Object],[object Object],[object Object]

th step Clinical correlation 5

PH <7.34 ACIDOSIS HCO3<20 mEq/L METABOLIC RESP COMPN pCO2<40mmHg pCO2>45mmHg RESPIRATORY RENAL COMP HCO3>24mEq/L >7.45 ALKALOSIS HCO3>28mEq/L PCO2<35mmHg METABOLIC RESPIRATORY RESP COMPN RENAL CMPN pCO2>40mmHg HCO3<24mmHg ABG

Resiratory acidosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CAUSES ABG TREATMENT compensation

Metabolic acidosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ABG CAUSES TREATMENT COMPENSATION

Respiratory alkalosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ABG causes TREATMENT COMPENSATION

Metabolic alkalosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ABG CAUSES TREATMENT COMPENSATION

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