PULMONARY UNIT PULMONARY UNIT

ARTERIAL BLOOD GAS RESULT ARTERIAL BLOOD GAS RESULT

Name: ________________________________ Age: ________ Sex: __________ Name: ________________________________ Age: ________ Sex: __________
Room: ___________ Date of Admission: __________ Room: ___________ Date of Admission: __________
Time Specimen taken: _____________ Result release: ______________ Time Specimen taken: _____________ Result release: ______________
Requesting M.D. :__________________ Attending M.D.: __________________ Requesting M.D. :__________________ Attending M.D.: __________________
Vital Signs : BP: _______ HR/CR: ________ Temp: ______ Hgb: ______________ Vital Signs : BP: _______ HR/CR: ________ Temp: ______ Hgb: ______________
FiO2 given: __________ Delivery System: ____________ FiO2 given: __________ Delivery System: ____________
Normal values Results
PH : 7.35-7.45 ____________ Normal values Results

PCO2 : 35-45 mmHg ____________ PH : 7.35-7.45 ____________

PO2 : 80-100 mmHg ____________ PCO2 : 35-45 mmHg ____________

HCO3 : 22-26 mmol/L ____________ PO2 : 80-100 mmHg ____________

B.E : -/+2 mEq/L ____________ HCO3 : 22-26 mmol/L ____________

O2 Sat : 95-100% ____________ B.E : -/+2 mEq/L ____________

O2 Sat : 95-100% ____________

Interpretation:
_________________________________________________________________ Interpretation:

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_____________________ _______________________
Pulmonary Staff Pulmonary Physiologist _____________________ _______________________
Pulmonary Staff Pulmonary Physiologist

HMWCH-CPL-FR-40256 HMWCH-CPL-FR-40256