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1 Arterial Blood Gas Interpretation Routine Assessment Inspection Palpation Auscultation Labs Na K Chloride CO BUN Creat Glu Arterial Blood Gases WBC 5-10K Hgb Hct Plt K ABG: The PaO mm Hg < 60 = hypoxemia > 100 =hyperoxemia ABG: The < 7.35 = acidosis > 7.45 = alkalosis 1, August 2014, Revised August 2017
2 ABG: The PaCO mm Hg Respiratory Problems Respiratory alkalosis Regulated by the lungs CO 2 TCHP Education Respiratory Alkalosis Respiratory Problems pco2 HCO CO 2 Respiratory acidosis TCHP Education Respiratory Acidosis ABG: The HCO 3 pco2 HCO meq/l Regulated by the kidneys 2, August 2014, Revised August 2017
3 Metabolic Problems Metabolic Alkalosis HCO 3 - Metabolic alkalosis pco2 HCO Metabolic Problems Metabolic Acidosis HCO 3 - Metabolic acidosis pco2 HCO Anion Gap in Metabolic Acidosis Na (Cl + HCO3) : 8-16 meq/l Compensation for Respiratory Problems Kidneys adjust HCO 3- and H + Respiratory Acidosis Respiratory Alkalosis 3, August 2014, Revised August 2017
4 Compensation for Metabolic Problems Total and Partial Compensation Disorder Primary Problem Compensation Metabolic acidosis in HCO 3 - in PaCO 2 Lungs adjust pco 2 Metabolic Acidosis Metabolic Alkalosis Metabolic alkalosis in HCO 3 - in PaCO 2 Respiratory acidosis in PaCO 2 in [HCO 3 -] Respiratory alkalosis in PaCO 2 in [HCO 3 -] Total Compensation: Between Partial Compensation: Not between Venous Blood Gases Sampling Sites Central (best) Mixed Venous Peripheral Limitations Useful to evaluate CO 2, and bicarbonate (HCO 3- ), not oxygenation Correlation with ABG s lower pco2 3-6 mm HG higher HCO 3 essentially the same Interpretation ABG Interpretation Steps po2 pco2 (teeter/totter?) HCO3 (elevator?) Practice PaO2 PaCO2 HCO3 Interpretation Practice PaO2 PaCO2 HCO3 Interpretation , August 2014, Revised August 2017
5 Problem #1 A 26 year-old man is admitted to the orthopedic department with an open fracture of the right femur in an MVA. 36 hours after admission, he experienced severe SOB and is in obvious respiratory distress. PaO PCO 2 26 O 2 Sat 68% Problem #2 A 37 yo man is admitted with severe trauma to the chest and head s/p MVA. He is unconscious and is not breathing spontaneously. He is being ventilated with RA by Ambu. PaO PCO 2 35 HCO 3 28 O 2 Sat 90% Problem #2 continued The man s airway is cleaned, he is intubated and placed on the vent at 40%. Initially his color improves, but five minutes later he becomes cyanotic. Breath sounds diminished. Heart sounds distinct. His ABG shows a PaO 2 of 43. Problem #3 A night nurse checking on a 95 yo man became alarmed at the frequency of his breathing. The man was on a 35% Venturi type oxygen mask, RR 5/min. PaO PCO 2 95 HCO 3 23 O 2 Sat 54% Problem #4 A 34 yo woman is admitted to the observation unit after taking a suspected overdose. RR 8/min, P 150, BP 180/100. PaO PCO 2 80 HCO 3 28 O 2 Sat 86% Problem #5 An 87 yo woman is admitted for hip surgery. Her post op course is complicated with bleeding and inability to wean from the vent. Her RR is 22 on the vent, P 110, BP 90/54. ABG s are on 50%: PaO PCO 2 34 O 2 Sat 90% 5, August 2014, Revised August 2017
6 Problem #6 An 18 y.o. man with a long history of asthma comes to the ER with the following ABGs: PaO PCO 2 47 HCO 3 22 O 2 Sat 91% Problem #6 continued After treatment, his RR is 8 and labored. He is becoming cyanotic and tired. His ABG s show: PaO PCO 2 55 O 2 Sat 85% Problem #7 A 63 yo man is admitted for elective knee surgery. RR 15, P 80, BP 122/84. ABG s are on room air were: PaO PCO 2 46 HCO 3 25 O 2 Sat 74% Problem #8 A 39 yo woman with alcohol-related pancreatitis is being treated on the med-surg floor. She begins to c/o SOB. Her ABG s are: PaO PCO 2 33 O 2 Sat 91% Problem #8 continued She is placed on a Venturi mask at 50%, but c/o SOB. She is dyspneic at rest, and is restless. Her PaO 2 is 50. References Japp, A., & Hennessy, I. (2016). Arterial Blood Gases Made Easy (Second ed.). Elsevier. Urden, L. D., Stacy, K. M., & Lough, M. E. (2010). Critical Care Nursing: Diagnosis and Management (6th ed.). St. Louis, MO: Mosby Elsevier. 6, August 2014, Revised August 2017
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