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Arterial Blood Gases

ABGs are used to

Indentify a patients :

Oxygenation
Adequacy of gas exchange in the lungs
Acid-base status
Bodys ability to regulate pH
Underlying cause of the imbalance

How do we draw ABGs?


Direct arterial puncture
Arterial line

What will the ABGs show?


pH: 7.35-7.45- normal level
PaO2: 80-100-normal level
SaO2: 92%-100%- normal level
CO2: 35-45- normal level
HCO3: 22-26- normal level
Base excess: + or 2 normal level

pH

Measures the hydrogen ion concentration in


the body fluids.

PaCO2

The partial pressure of carbon dioxide in


arterial blood and is a reflection of the
depth of pulmonary ventilation.

PaO2
Partial pressure of oxygen in arterial blood.
PaO2 less than 60 leads to anaerobic
metabolism, resulting in lactic acid
production and metabolic acidosis.

Oxygen Saturation

Saturation is the point at which hemoglobin


is saturated by oxygen.

Base Excess
Amount of blood buffer that exists
(hemoglobin and bicarbonate)
High Value (Alkalosis)
Low Value (Acidosis)

Bicarbonate
Major renal component of acid-base balance
Kidneys excrete and retain bicarb to
maintain a normal acid-base environment.

How to interpret ABGs


Look at each number individually and label
Evaluate Oxygenation
Determine Acid-Base Status
Determine whether Primary Acid-Base
Disorder is Respiratory or Metabolic
Determine whether any form of
compensation response has occurred

4 possible Acid-Base
Imbalances
Respiratory Acidosis: CO2 is high and pH is
low
Respiratory Alkalosis: CO2 is low and pH is
high
Metabolic Acidosis: HCO3 is low and pH is
low
Metabolic Alkalosis: HCO3 is high and pH is
high

HINT
Respiratory
Opposite
Metabolic
Equal

Practice 1
pH : 7.20
CO2: 52
pO2: 66
O2 sat..: 89%
HCO3: 24

Step by Step!

Practice 2
pH: 7.58
CO2: 39
pO2: 81
O2 sat: 93%
HCO3: 31

Step by Step!

Causes of Respiratory
Acidosis
Hypoventilation
CNS depression
Trauma
COPD
Acute airway obstruction

Clinical manifestations of
Respiratory Acidosis
Drowsiness, disorientation, dizziness,
headache
Low BP
Hypoventilation with hypoxia

Causes of Respiratory
Alkalosis
Anxiety, fear
Pain
Fever
Stimulants
Excessive ventilatory support

Clinical Manifestations of
Respiratory Alkalosis
Lethargy, light-headedness, confusion
Tachycardia
Hyperventilation

Causes of Metabolic
Acidosis
DKA
Renal Failure
Lactic Acidosis
Drug overdose

Diarrhea

Clinical manifestations of
Metabolic Acidosis
Low BP
Warm, flushed skin
Nausea, vomiting
Deep, rapid respirations

Causes of Metabolic
Alkalosis
Excess ingestion of antacids
Excess administration of sodium
bicarbonate

Vomiting
Nasogastric Suctioning

Clinical Manifestations of
Metabolic Alkalosis
Dizziness, irritability, nervousness,
confusion
Tachycardia
Muscle cramps

Questions?

Lets practice a few more problems.