abg sakshi
TRANSCRIPT
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:Moderator Dr PujaSingh :Speaker Dr Sakshi
Gupta
ARTERIARTERIABLOODBLOODGASESASES
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DEFINITIONBlood gas analysis, also called arterial blood gas (ABG)
analysis, is a test which measures the amounts ofoxygen and carbon dioxide in the blood, as well asthe acidity (pH) of the blood.
It involves puncturing an artery with a thin needle and
syringe and drawing a small volume of blood. Common sites:
Radial A Femoral A
Brachial A Dorsalis Pedis A
Axillary A
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&OBJECTIVES USES
Understand Ventilation and PerfusionMechanics
Aids in ventilator management /Improvement in acid base management allows
for optimal function of medications
Aids in establishing a diagnosis Helps guide treatment plan /Acid base status may alter electrolyte
/levels critical to patient status care Recognize Signs & Symptoms of Respiratory
Failure Analyze and Interpret Acid Base Disturbances
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Before beginning
Allen s test for radial and
ulnar artery Common errors of arterial blood
sampling :Air in sample PCO2, ,pH PO2
:Venous mixture PCO2, ,pHPO2
(Excess anticoagulant dilutionPCO2, ,pH PO2
, ,The plastic disposable syringeprefilledwith a small amount
of an appropriate type oflyophilized heparin salt is
.used
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Before beginning ollect blood gas specimens inlass syringes and ice theseamples immediately low down the metabolic rate ofhe leukocytes inimize the reduction in oxygenlevels
rterial line collection requireshat an appropriate volume beithdrawn initially to assurehat the line contains onlyncontaminated arterial bloodefore the actual sample iscollected :oc al a n e s t h e s i a t o m a k e t her te r i a l p u n c tu re e as i e r t oa c c o m p l i s h eparin is the anticoagulant ofhoice for the measurement of.as analytes
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- . -pH 7 35.7 45
PaCO2 - -35 45mmHg
PaO 2 - -80 100mmHg
HCO3 -24 + 4mmol/L %MetHb .pH 7 45
= . If pH 7 4 NormalMixed or Fully compensated
tep 2tep 2
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.tep 3 .tep 3CULPRIT?ULPRIT?HCO3METABOLIC
> .. .26 Met Alkalosis
< .22 Met Acidosis
PCO2 RESPIRATORY> .45 Resp Acidosis
HCO3 =Base
-Normal 22
26
CO2 =ACID
-Normal 3545
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If there is a primary Respiratory,disturbance
is it acute ?
. ( )08 change in pH Acute
. ( )03 change in pH Chronic
10 mmChange
PaCO2
=
Remember relation of CO2 and pH
ep 4 ep 4
p 4 continuedp 4 continued
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7.60207.5030
7.4040
7.3050
7.2060
7.1070pHaCO2
cute respiratory change
pH ast two digits 80 PaCO2
p 4 continuedp 4 continued
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IRATORY disorders
cted HCO3for a Change in CO2 ......... 1 2 3 4
.Acidosis ( )expected HCO3= .0 1 x CO
2
.Alkalosis ( )expected HCO3= .0 2 x CO2
.Acidosis ( )expected HCO3
= .0 35 x CO2
.Alkaosis
( )expected HCO
3
ute respiratory
ronic respiratory
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If it is a primary Metabolic
,disturbancewhether respiratory compensationappropriate?
:For metabolic acidosisExpected PCO2 = ( . [ 1 5 x HCO 3]) +8 +2
( )Winter s equation
:For metabolic alkalosis
= ( . ) + Expected PCO2 0 7 x HCO3 212UNCERTAIN COMPENSATION
CO2is equal to
Last two digitsof pH
:Remember If .............Suspect actual PaCO2is more than expected
...additional respiratoryacidosis
actual PaCO2 is less than expected...additional respiratory
alkalosis
tep 5tep 5
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If metabolic acidosis is there
How is anion gap? ...Is it wide- (Na Cl-+ HCO3
-) = , :If 12 Anion Gap AcidosisMethanolUremiaDiabetic KetoacidosisP
araldehydeI ( )nfection lactic acidE thylene GlycolS alicylate
ommon pediatric causes
Lactic acidosisMetabolic disorders
Renal failure
ep 5ep 5 .ont.ont
Mixed Acid BaseMixed Acid Base
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Mixed Acid-BaseMixed Acid-BaseDisorders : CluesDisorders : Clues
-- Clinical history-- ,pH normal abnormal PCO2n HCO3
-- PCO2n HCO3 moving oppositedirections-- Degree of compensation for primary
disorder is inappropriate-- Find Delta Gap
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h steph step
linical correlationlinical correlation7
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Thank you