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ABG’s. Indications Technique Complications Analysis Summary. Indications. Respiratory illness Critical illness Unwell patients Other circumstances. Technique. Right pt? Any artery : commonly radial Allens test Preparation pre test Monitoring Caution Don’t loose it

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ABG’s

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Abg s

ABG’s


Abg s

  • Indications

  • Technique

  • Complications

  • Analysis

  • Summary


Indications

Indications

  • Respiratory illness

  • Critical illness

  • Unwell patients

  • Other circumstances


Technique

Technique

  • Right pt?

  • Any artery : commonly radial

  • Allens test

  • Preparation pre test

  • Monitoring

  • Caution

  • Don’t loose it

  • Arterial lines and monitoring of IABP


Complications

Complications

  • Bleeding

  • Bruising

  • Thrombosis

  • AV fistula

  • Complication of arterial lines


Analysis

Analysis

  • pH

  • PaCO2

  • PaO2

  • HCO3

  • O2 sats

  • Electrolytes

  • Lactate

  • Hb, Meth Hb, Carboxy Hb


Normal values

Normal values

  • pH: 7.35 – 7.45

  • PaCO2: 4.7 – 6 kPa

  • PaO2: 11 – 13 kPa

  • HCO3: 22 – 26 mEq/L

  • Lactate: <2

  • O2 sats: >96%


Step wise analysis

Step wise analysis

  • What is the pH?

  • Normal: 7.35 – 7.45

  • Acidosis: < 7.35( more acid ie H+)

  • Alkalosis: > 7.45( less acid ie H+)


What is the paco2

What is the PaCO2

  • Normal: 4.7 – 6.0

  • Hypercapnoea: > 6 ( more CO2)

  • Hypocapnoea: < 4.7( less CO2)


What is pao2

What is PaO2

  • Normal?

  • High: > 13 on room air

  • Low: < 11 on room air


What is the hco3

What is the HCO3

  • Normal: 22 – 26

  • Low: < 22

  • High: > 26


Is it metabolic or respiratory

Is it metabolic or respiratory?


Is there compensation

Is there compensation?

  • Respiratory pathology the compensation is renal

  • Renal pathology the compensation is respiratory


Is there compensation1

Is there compensation?


Anion gap

Anion gap

  • Na – ( Cl+HCO3)

  • Normal 12

  • Metabolic acidosis with normal anion gap

  • Metabolic acidosis with increased anion gap


Respiratory acidosis

Respiratory acidosis

  • Airway obstruction
- Upper
- Lower: COPD, asthma

  • CNS depression

  • Sleep disordered breathing

  • Neuromuscular impairment

  • Ventilatory restriction

  • Increased CO2  production: shivering, rigors, seizures, malignant hyperthermia, hypermetabolism

  • Incorrect mechanical ventilation settings


Respiratory alkalosis

Respiratory alkalosis

  • CNS stimulation: fever, pain, fear, anxiety, CVA, cerebral edema, CNS infection

  • Hypoxemia or hypoxia: lung disease, profound anemia, low FiO2

  • Stimulation of chest receptors: pulmonary edema, pleural effusion, pneumonia, pneumothorax, pulmonary embolus

  • Drugs, hormones: salicylates, catecholamines, medroxyprogesterone, progestins

  • Pregnancy, liver disease, sepsis, hyperthyroidism

  • Incorrect mechanical ventilation settings


Metabolic alkalosis

Metabolic alkalosis

  • Hypovolemia with Cl- depletion

  • GI loss of H+Vomiting, gastric suction, villous adenoma, diarrhea with chloride-rich fluid

  • Renal loss H+Loop and thiazide diuretics

  • Renal loss of H+:  edematous states (heart failure, cirrhosis, nephrotic syndrome), hyperaldosteronism, hypercortisolism, excess ACTH, exogenous steroids, severe hypokalemia bicarbonate administration


Metabolic acidosis with elevated anion gap

Metabolic acidosis with elevated anion gap

  • M

  • U

  • D

  • P

  • I

  • L

  • E

  • S


Metabolic acidosis with normal anion gap

Metabolic acidosis with normal anion gap

  • GI loss of HCO3-Diarrhoea, ileostomy, proximal colostomy

  • Renal loss of HCO3-proximal RTA

  • carbonic anhydrase inhibitor (acetazolamide)

  • Renal tubular disease, ATN, Chronic renal disease, Distal RTA, NaCl infusion


Metabolic acidosis with elevated anion gap1

Metabolic acidosis with elevated anion gap

  • Methanol intoxication

  • Uremia

  • Diabetic ketoacidosis, alcoholic ketoacidosis, starvation ketoacidosis

  • Paraldehyde toxicity

  • Isoniazid

  • Lactic acidosis

  • Ethanol

  • Salicylate intoxication


Abg s1

ABG’s


Abg s

  • What is the abnormality?

  • What might this patient have?


Abg s2

ABG’s


Abg s

  • What is the abnormality?

  • What might this patient have?


Abg s3

ABG’s


Abg s

  • What is the abnormality?

  • What might this patient have?


Abg s4

ABG’s


Abg s

  • What is the abnormality?

  • What might this patient have?


Abg s5

ABG’s


Abg s

  • What is the abnormality?

  • What might this patient have?

  • What other blood tests may you want to do?


Abg s6

ABG’s


Summary

Summary

  • Systematic approach in analysis of ABG’s

  • Can help you in difficult situations

  • Always co relate clinically

  • Should not be abused

  • Get slick at it


Thanks

Thanks


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