Professional Documents
Culture Documents
Indication
1. Monitoring of the Respiration:
a) Ventilation ( CO2 ).
How to do ABG
1) Sampling: 1. Preparation of the syringe with Heparin (fill the syringe dead space only) 2. Desinfection of the puncture aria(Radial, Dorsalis pedis, Posterior tibial, Femoral, Brachial)
How to do ABG
Brachial and femoral arteries puncture are contraindicated in patients with abnormal haemostatic mechanism.
3. Punctures technique.
4. Press the puncture site firmly for 5 minutes.
6) Complications :
a) Infection. b) Bleeding.
c) Heamatom. d) A-V fistula.
How to do ABG
2) Capillary: (Indicated in babies and small children)
1.Take a special preheparinized tube. 2.Improve the skin circulation of the puncture site (Ear, Heel). 3.Technique. (Avoid air bobbles)
Interpretation
PaCO2 : Partial tension of Carbon Dioxide in Arterial Blood.
Normal Value 35 - 45 mmHg (40)
PaCO2(Respiratory Acidosis ) 1) Decrease of excretion : a) Hypoventilation. b) Gas exchange ( COPD, ARDS ). 2) Over production ( Fever, TPN ).
Interpretation
PaCO2 ( Respiratory Alkalosis)
1) Hyperventilation:
a) Metabolic acidosis. b) Head injury. c) Psychiatric. d) Iatrogenic.
2) Decrease of production:
a) Hypothermia. b) Brian death.
Interpretation
PaO2: Partial Tension of Oxygen in Arterial blood .
Normal value : 70 - 100 mmHg
Interpretation
PaO2
1) High FIO2. 2) Hyperbaric.
PaO2
1) Respiratory failure ( ARDS, COPD, Pulmonary edema, Lung collapse etc..) 2) Congenital heart disease. 3) Low cardiac output ( Chock ). 4) Poisoning.
Interpretation
SaO2: Oxygen Saturation of Arterial blood.
The Percentage of Hemoglobin binds Oxygen
Normal value : 96 - 99 %
Interpretation
SaO2
1) High FIO2.
SaO2
1) Lung diseases. 2) Low cardiac output. 3) Increase the amount of abnormal Hb (Met Carboxy Hb). 4) R - L Shunting diseases.
Hb,
pH = - Log( H+ )
( 7.4 )
Acids and bases can be: Strong dissociate completely in solution HCl, NaOH Weak dissociate only partially in solution Lactic acid, carbonic acid
A buffer : is a solution that resist changes in (H+)concentration upon addition of stronger acid or base.
A buffer pair is a combination of weak acid with his strong base ( as salt ) . e.g. ( H2CO3 + NaHCO3 )
HCO3 + H
HCO3
Metabolic Acidosis.
1) 2) 3) 4) 5) 6) 7) Shock. Diabetic ketoacidosis. Intoxication . Hypoxia. Renal failure. Intestinal obstruction. Compensatory.
Acid-Base Imbalances
pH< 7.35 Acidemia pH > 7.45 Alkalemia The body response to acid-base imbalance is called compensation May be complete if brought back within normal limits Partial compensation if range is still outside norms.
Compensation
If underlying problem is metabolic, hyperventilation or hypoventilation can help : respiratory compensation. If problem is respiratory, renal mechanisms can bring about metabolic compensation.
Rates of correction
Buffers function almost instantaneously Respiratory mechanisms take several minutes to hours Renal mechanisms may take several hours to days
Respiratory mechanisms
Exhalation of carbon dioxide Powerful, but only works with volatile acids Doesnt affect fixed acids like lactic acid CO2 + H20 H2CO3 H+ + HCO3Body pH can be adjusted by changing rate and depth of breathing
Kidney excretion
Can eliminate large amounts of acid Can also excrete base Can conserve and produce bicarb ions Most effective regulator of pH If kidneys fail, pH balance fails
Sodium Bicarbonate ?
Increase Acidosis intracellular (co2)
Indication :
Ph < 7.1
or
BE > 10 mmol
(Slow administration )
Caution : Hypokalemia
Quiz
pH 7.60 PaCO2 30 PaO2 60 HCO3 22
What is this?
Non-compensated Alkalimia due to respiratory Alkalosis
Quiz
pH 7.28 PaCO2 28 PaO2 70 HCO3 18
What is this?
Partially compensated Acidemia due to metabolic Acidosis
Quiz
pH 7.36 PaCO2 67 PaO2 47 HCO3 37
What is this?
Completely compensated Respiratory Acidosis
Quiz
pH 7.58 PaCO2 35 PaO2 75 HCO3 50
What is this?
Non-compensated Alkalimia due to metabolic Alkalosis
Quiz
pH 7.18 PaCO2 38 PaO2 70 HCO3 15
What is this?
Non-compensated Acidemia due to Metabolic Acidosis
Thank You