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blood.
To assess the effectiveness of gas exchange by
providing measurements of the partial pressures of O2 and CO2 in arterial blood. Po2 = partial pressure of O2 Pao2 = partial pressure of O2 in arterial blood -- PaCO2 is controlled by ventilation and the level of ventilation is
adjusted to maintain PaCO2 within tight limits.
Po2 is not the amount of O2 in blood but is the driving force for saturating Hb with O2.
When Hb approaches maximal O2 saturation, futher increases in Po2 do not significantly increase blood O2 content.
Both oxygenation and CO2 elimination depend on alveolar ventilation : impaired ventilation causes PaO2 to fall and PaCO2 to rise.
FiO2 = percentage of O2 in the air we breathe in. FiO2 in room air = 21% (can be increased)
The exact FiO2 requirement varies depending on how severely oxigenation is impaired and will help to determine the choice of delivery device
Low Haemoglobin
90-74
75-89
<75
High PaCO2 (hypercapnia) and due to inadequate alveolar ventilation The ABG in different patterns
PaCO2 ACUTE CHRONIC HCO3 pH
ACUTE ON CHRONIC
PaO2 TYPE 1
PaCO2 /
HCO3
ACUTE TYPE 1
CHRONIC TYPE 2*
Respiratory mechanisms --- PaCO2--Renal (metabolic) mechanisms ---- HCO3 --*If our system is overwhelmed, leading to a change in
blood pH, the other usually adjusts, automatically, to limit the disturbance (e.g. if kidneys fail to excrete metabolic acids, ventilation is increased to exhale more O2)
PaCO2 raised = Respiratory acidosis PaCO2 low = Respiratory alkalosis HCO3 raised = Metabolic alkalosis HCO3 low = metabolic acidosis
When face with such an ABG, how can we tell which is the primary disturbance and which is the compensatory process?
Overcompensation does not occur.
HCO3
Vomitting, potassium depletion, Cushing s
syndrome Respiratory compensation ( PaCO2) occurs to limit the resulting alkalaemia but is limited by the need to avoid hypoxaemia
PaCO2 (
Ph)
Respiratory alkalosis
Na : 135 145 mmol/L K : 3.5-5 mmol/L Cl : 95-105 mmol/L iCa : 1.0-1.25 mmol/L Glucose : 3.5-5.5 mmol/L
SaO2 : > 96 in room air HCO3 act : 22-28 mmol/L BE : -2 to 2+ Lactate : 0.4-1.5 mmol/L Hb : 13-18g/dl men , 11.5-16g/dl women
NORMAL
NORMAL LOW
NORMAL
NORMAL HIGH
H/x: 25/M/gentleman
KNMI + Fever, + productive cough, + worsening
breathlessness x2/7 o/e : T= 39.3 C PR: 104 BP: 118/70 RR:30 Sao2 RA : 89%
NORMAL RANGE Ph Pco2 Po2 Bicarb BE SPo2 Lactate : K : Na : CI : iCa+ : Hb : Glocose : 7.50 3.74 kPa 28.1 mmHg 7.68 kPa 57.8 mmHg 23.9 0.5 mmol/L 88.7% 1.2 (0.4 1.5) 3.7 mmol/L (3.5 5) 138 mmol/L (135 145) 99 mmol/L (95 105) 1.2 mmol/L (1 1.25) 15 g/dL (13 18) 5.4 mmol/L (3.5 5.5) (7.35 7.45) (4.7 6.0) (35 45) (> 10.6) (> 80) (22 28) ( 2 +2) (> 98%)
H/x: 34/M/women
Morbidly obese female with a body mass index of
49 has an ABG sample taken as part of her preoperative assessment for weight reduction surgery Otherwise well and has no respirotary symptom. Apart from morbid obesity and type 2 diabetis. Otherwise well and has no respirotary symptom.
NORMAL RANGE Ph Pco2 Po2 Bicarb BE SPo2 Lactate : K : Na : CI : iCa+ : Hb : Glocose : 7.35 7.3 kPa 54.8 mmHg 9.6 kPa 72.2 mmHg 29 mmol/L +3.8 mmol/L 96% 1 (0.4 1.5) 4.7 mmol/L (3.5 5) 134 mmol/L (135 145) 102 mmol/L (95 105) 1.2 mmol/L (1 1.25) 13 g/dL (13 18) 9 mmol/L (3.5 5.5) (7.35 7.45) (4.7 6.0) (35 45) (> 10.6) (> 80) (22 28) ( 2 +2) (> 98%)
H/x: 24/M/women
Nursing student - sudden-onset breathlessness. May have a pulmonary embolism. No pleuritic pain, haemopathysis or leg swelling,
no past history of lung disease and non smoker. PR: 104 BP: 124/76 Sao2 RA : 95%
NORMAL RANGE Ph Pco2 Po2 Bicarb BE SPo2 Lactate : K : Na : CI : iCa+ : Hb : Glocose : 7.51 3.90 kPa 29.3 mmHg 10.3 kPa 77.0 mmHg 25.0 mmol/L +0.7 mmol/L 93.7% 1.0 (0.4 1.5) 4.3 mmol/L (3.5 5) 141 mmol/L (135 145) 101 mmol/L (95 105) 1.2 mmol/L (1 1.25) 13 g/dL (13 18) 4.6 mmol/L (3.5 5.5) (7.35 7.45) (4.7 6.0) (35 45) (> 10.6) (> 80) (22 28) ( 2 +2) (> 98%)
H/x: 75/M/gentleman
Brought into the emergency department by his
family. He has a long history of chronic obstructive pulmonary disease. Over the last 3 days his breathing has worsened considerably and he has expectorated increase volume of sputum. Struggling for breath and appears extremely distressed.
NORMAL RANGE Ph Pco2 Po2 Bicarb BE SPo2 Lactate : K : Na : CI : iCa+ : Hb : Glocose : 7.40 4.9 kPa 36 mmHg 5.8 kPa 44 mmHg 23 mmol/L 1.2 mmol/L 80% 1.0 (0.4 1.5) 4.1 mmol/L (3.5 5) 137 mmol/L (135 145) 99 mmol/L (95 105) 1.1 mmol/L (1 1.25) 16.5 g/dL (13 18) 3.8 mmol/L (3.5 5.5) (7.35 7.45) (4.7 6.0) (35 45) (> 10.6) (> 80) (22 28) ( 2 +2) (> 98%)