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ABG

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General discussion about ABG

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ABG

  1. 1. ARTERIAL BLOOD GASES By Nafees Ahmad Residency From Mount Sinai School of Medicine, New York
  2. 2. 1) We started ICU in December 2014. 2) We have so far received 505 patient 3) Majority of patient are from Medical ward but we have received from Surgery, Orthopedic, OBGYN as well. 4) I will like to thank all consultants who have sent patient to ICU but especially Medical consultants 5) I will also thank Dr Ghias and Dr Ishaq 6) Last but not the least Prof. Dr Najib Ul Haq
  3. 3. HE RECOVERED AFTER SPENDING ONE MONTH ON VENTILATOR MACHINE.
  4. 4. 1) SITE 2) COLLECTION 3) TRANSPORT 4) PRIMARY ACID BASE DISORDERS 5) COMPENSATION
  5. 5. DEFINATION An arterial blood gas (ABG) is a test that measures 1) oxygen tension (PaO2) 2) carbon dioxide tension (PaCO2) 3) acidity (pH), 4) bicarbonate (HCO3) concentration
  6. 6. PH 7.35 – 7.45 PCO2 40 PO2 80-100 HCO3 24
  7. 7. INDICATIONS FOR ABG: Indications for ABG sampling include the following : 1- Identification of respiratory, metabolic, and mixed acid-base disorders 2-Measurement of the partial pressures of respiratory gases involved in oxygenation 3-Monitoring of acid-base status, as in patient with diabetic ketoacidosis (DKA) on insulin infusion 4-Assessment of the response to therapeutic interventions such as mechanical ventilation in a patient with respiratory failure 5-Determination of arterial respiratory gases during diagnostic evaluations (e.g., assessment of the need for home oxygen therapy in patients with advanced chronic pulmonary disease)
  8. 8. SITE ?
  9. 9. SITE: Radial artery( ideal) Brachial artery Femoral Artery
  10. 10. MODIFIED ALLEN TEST
  11. 11. APPLY PRESSURE AT PUNCTURE SITE AFTER TAKING ABG
  12. 12. USE 3 ML SYRINGE AND FLUSH IT WITH 0.5 ML HEPARIN DO NOT USE EXCESSIVE HEPARIN IN THE SYRINGE BECAUSE IT CAUSE DILUTIONAL EFFECT. EXCESSIVE HEPARIN CAUSES DECREASE IN PCO2 AND HCO3
  13. 13. WHY WE NEED HEPARIN ?
  14. 14. IF THERE ARE AIR BUBBLES IN THE SYRINGE ????
  15. 15. AIR BUBBLES IN SYRINGE Ensure that there are no AIR BUBBLES in the syringe It is presumed that AIR BUBBLES contain PO2 150 and PCO2 0 AIR BUBBLES + BLOOD = PO2 GOES UP + PCO2 GOES DOWN If air bubbles are present, then remove the air bubbles otherwise discard the syringe
  16. 16. HOW ARTERIAL BLOOD SHOULD BE TRANSPORTED TO ABG MACHINE????
  17. 17. ABG Syringe should be transported to LAB via cold chain at earliest Changes in values every 10 minutes UNICED SAMPLE AT 37 DEGREE ICED SAMPLE AT 4 DEGREE PH 0.01 0.001 PCO2 1 0.1 PO2 0.1% 0.01%
  18. 18. HOW MUCH BLOOD WE NEED FOR ABG ????
  19. 19. WHICH SYRINGE SHOULD BE USED ???? A)PLASTIC B) GLASS
  20. 20. INTERPRETATION OF ABG
  21. 21. 1- METABOLIC ACIDOSIS 2- METABOLIC ALKALOSIS 3-RESPIRATORY ACIDOSIS 4-RESPIRATORY ALKALOSIS
  22. 22. METABOLIC ACIDOSIS 1) PH decreased 2) Body produces excessive quantities of acid or Kidney are not removing enough acid from the body When there is metabolic acidosis, always calculate AG
  23. 23. 16 12 ANION GAP
  24. 24. Normal Anion Gap Metabolic acidosis: Diarrhea, RTA, Anhydrase inhibitor High Anion Gap Metabolic Acidosis: M- methanol U- Uremia D- Dka P- paraldehyde I-Infection E-Ethylene Glycol S- salicyclates
  25. 25. DELTA GAP 1) Delta gap = ( Actual AG – 12) + HCO3- 2) If Delta gap is > 30, additional Metabolic alkalosis 3) If Delta gap is < 18, additional non AG Metabolic acidosis 4) If Delta gap is between 18-30, no additional metabolic problem
  26. 26. WHICH BODY SYSTEMS ARE INVOLVED IN COMPENSATION ???? COMPENSATION MEANS RESTORING NORMAL PH
  27. 27. 1) 2) COMPENSATION
  28. 28. Respiratory compensation is fast, it occurs in seconds to minutes
  29. 29. Renal compensation is slow
  30. 30. WHY WE NEED PH TO BE WITHIN NORMAL LIMITS ????
  31. 31. IN METABOLIC ACIDOSIS, COMPENSATION OCCUR THROUGH LUNGS METABOLIC ACIDOSIS
  32. 32. UNCOMPENSATED METABOLIC ACIDOSIS PARTIALLY COMPENSATED METABOLIC ACIDOSIS COMPENSATED METABOLIC ACIDOSIS PH 7.20 PH 7.30 PH 7.35 PCO2 40 (ACID) PCO2 33 PCO2 30.5 HCO3 15 (BASE) HCO3 15 HCO3 15 PO2 90 PO2 90 PO2 90 METABOLIC ACIDOSIS
  33. 33. In Metabolic Acidosis, if PCO2 level is achieved as per Winter`s formula Expected pCO2 = 1.5 * HCO3 - + 8 +/- 2 Expected PCO2: 1.5 X 15 +8 = 30.5 +/- 2 METABOLIC ACIDOSIS compensation
  34. 34. 1) PH increases 1) Decreased hydrogen ion concentration, leading to increased bicarbonate, 2) Alternatively a direct result of increased bicarbonate concentrations. METABOLIC ALKALOSIS
  35. 35. 1) Excess vomiting 2) Overuse of diuretics 3) Adrenal disease 4) Antacids 5) Accidental ingestion of bicarbonate, which can be found in baking soda 6) Laxatives METABOLIC ALKALOSIS CAUSES
  36. 36. IN METABOLIC ALKALOSIS, COMPENSATION OCCUR THROUGH LUNGS
  37. 37. UNCOMPENSATED METABOLIC ALKALOSIS PARTIALLY COMPENSATED METABOLIC ALKALOSIS COMPENSATED METABOLIC ALKALOSIS PH 7.55 PH 7.50 PH 7.45 PCO2 40 (ACID) PCO2 47 PCO2 51.2 HCO3 40 (BASE) HCO 40 HCO3 40 PO2 90 PO2 90 PO2 90 METABOLIC ALKALOSIS Hypoventilation
  38. 38. METABOLIC ALKALOSIS Compensation For every increase in HCO3- by 1 mEq/L, PCO2 increases by 0.7 mmHG So For increase in HCO3- by 16 mEq/L, PCO2 increase by 11.2 mmHG
  39. 39. Respiratory acidosis, also called respiratory failure or ventilatory failure, 1) PH is decreased 2) Lungs can not remove enough CO2 from the body RESPIRATORY ACIDOSIS
  40. 40. Asthma Chronic obstructive pulmonary disease (COPD) Acute pulmonary edema Severe obesity (which can interfere with expansion of the lungs) neuromuscular disorders Scoliosis RESPIRATORY ACIDOSIS
  41. 41. RESPIRATORY ACIDOSIS
  42. 42. UNCOMPENSATED RESPIRATORY ACIDOSIS PARTIALLY COMPENSATD RESPIRATORY ACIDOSIS COMPENSATED RESPIRATORY ACIDOSIS PH 7.20 PH 7.30 PH 7.35 PCO2 70 (ACID) PCO2 7 0 PCO2 70 HCO3 24 (BASE) HCO3 28 HCO3 34.5 PO2 ….. PO2 …… PO2 ….. RESPIRATORY ACIDOSIS
  43. 43. RESPIRATORY ACIDOSIS Acute: For every increase in PCO2 by 10 mmHg, HCO3- should increase by 1 mEq/l Chronic: For every increase in PCO2 by 10 mmHg, HCO3- should increase by 3.5 mEq/l COMPENSATION
  44. 44. RESPIRATORY ALKALOSIS 1) PH increases 2) Alveolar hyper ventilation leading to decreased PCO2
  45. 45. Heart attack Pain Drug use Asthma Fever Chronic obstructive pulmonary disease (COPD) Infection Pulmonary embolism Pregnancy RESPIRATORY ALKALOSIS CAUSES
  46. 46. RESPIRATORY ALKALOSIS
  47. 47. UNCOMPENSATED RESPIRATOTY ALKALOSIS PARTIALLY COMPENSATED RESPIRATORY ALKALOSIS COMPENSATED RESPIRATORY ALKALOSIS PH 7.55 PH 7.50 PH 7.45 PCO2 20 ( ACID) PCO2 20 PCO2 20 HCO3 24 ( BASE) HCO3 20 HCO3 16 PO2 90 PO2 90 PO2 90 RESPIRATORY ALKALOSIS
  48. 48. RESPIRATORY ALKALOSIS COMPENSATION Acute: For every decreases in PCO2 by 10 mmHg, HCO3- should decrease by 2 mEq/L Chronic: For every decrease in PCO2 by 10 mmHg, HCO3- should decrease by 4 mEq/L

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