血气分析(英文版).pptxVIP

ABG INTERPRETATIONDebbie Sander PAS-IIObjectives What’s an ABG? Understanding Acid/Base Relationship General approach to ABG Interpretation Clinical causes Abnormal ABG’s Case studies Take homeWhat is an ABGArterial Blood GasDrawn from artery- radial, brachial, femoralIt is an invasive procedure.Caution must be taken with patient on anticoagulants.Helps differentiate oxygen deficiencies from primary ventilatory deficiencies from primary metabolic acid-baseabnormalities What Is An ABG?pH [H+]PCO2 Partial pressure CO2PO2Partial pressure O2HCO3 BicarbonateBE Base excessSaO2 Oxygen SaturationAcid/Base Relationship This relationship is critical for homeostasis Significant deviations from normal pH ranges are poorly tolerated and may be life threatening Achieved by Respiratory and Renal systems Case Study No. 160 y/o male comes ER c/o SOB.Tachypneic, tachycardic, diaphoretic andCyanotic. Dx acute resp. failure and ABG’sShow PaCO2 well below nl, pH above nl, PaO2 is very low. The blood gas documentResp. failure due to primary O2 problem. Respiratory Component function of the lungs Carbonic acid H2CO3 Approximately 98% normal metabolites are in the form of CO2 CO2+ H2O?H2CO3 excess CO2 exhaled by the lungsMetabolic Component Function of the kidneys base bicarbonate Na HCO3 Process of kidneys excreting H+ into the urine and reabsorbing HCO3- into the blood from the renal tubules 1) active exchange Na+ for H+ between the tubular cells and glomerular filtrate 2) carbonic anhydrase is an enzyme that accelerates hydration/dehydration CO2 in renal epithelial cellsAcid/Base RelationshipH2O + CO2? H2CO3? HCO3+ H+Normal ABG valuespH 7.35 – 7.45PCO2 35 – 45 mmHgPO2 80 – 100 mmHgHCO3 22 – 26 mmol/LBE -2 - +2SaO2 95% Acidosis AlkalosispH 7.45PCO2 35HCO3 26pH 7.35PCO2 45HCO3 22Respiratory Acidosis Think of CO2 as an acid failure of the lungs to exhale adequate CO2 pH 7.35 PCO2 45 CO2 + H2CO3 ? ? pHCauses of Respiratory Acidosis emphysema drug ove