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Blood Gas Interpretation Review For Pandemic
Blood Gas Interpretation Review For Pandemic
for Pandemic
Blood Gases
• Important diagnostic tool
• Reveals:
1. acid-base balance
2. oxygenation status
**arterial gases only**
3. abnormalities of ventilation
2
Acid- base balance
• The body is designed for optimum performance at a
specific pH level
• Cell division
• Metabolism
3
Components of Acid- Base Balance
• pH- measures the bloods acidity
– Normal range 7.35- 7.45
– Overall H+ from both respiratory and metabolic factors
• pCO2- partial pressure of carbon dioxide in the blood
– Normal range 35-45 mmHg
– Snapshot of adequacy of alveolar ventilation
• HCO3- the amount of bicarbonate in the blood
– Normal range 22- 26 mEq/L
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Acid – Base Balance
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Acid – Base Balance
• Lungs • Kidneys
• Respiratory • Metabolic
• CO2 (acid) • HCO3 ( base/alkaline)
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Making sense of it…
pH
7.35 – 7.45
Respiratory Metabolic
CO2=Acidosis HCO3=Acidosis
CO2=Alkalosis HCO3=Alkalosis
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Interpretation: 4 steps
• Normal Values
– pH 7.35 – 7.45
– pCO2 35 – 45 mmHg
– HCO3 22 - 26 mEq/L
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Step 1…
9
Step 2…
35 40 45
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Step 3…
22 24 26
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Step 4…
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ABG Analysis
pH pCO2 HCO3
Resp. Acidosis A A N
(<7.35) (>45) (22-26)
Resp. B B N
Alkalosis (>7.45) (<35) (22-26)
Metabolic A N A
Acidosis (<7.35) (35-45) (<22)
Metabolic B N B
Alkalosis (>7.45) (35-45) (>26)
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Let’s practice…
pH pCO2 HCO3
A A N Respiratory Acidosis
7.26 55 23
B N B Metabolic Alkalosis
7.54 43 39
N N N Normal
7.39 41 25
B B N Respiratory Alkalosis
7.51 29 24
A N A Metabolic Acidosis
7.29 40 17
A A A Mixed Acidosis
7.28 61 18
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Compensation
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Understanding Compensation
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Understanding Compensation
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Understanding Compensation
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Let’s Practice Compensation…
pH pCO2 HCO3
Metabolic Alkalosis partially
B A B compensated
7.51 49 40
A A N Respiratory Acidosis uncompensated
7.29 53 22
Metabolic Acidosis fully compensated
N B A
7.37 25 18
N A B Respiratory Acidosis fully compensated
7.35 65 28
Respiratory Alkalosis partially
B B A compensated
7.46 22 20 Respiratory Acidosis partially
A A B compensated
7.34 52 27
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A Final Step…
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Respiratory Acidosis
21
Respiratory Acidosis
• Clues
– Confusion, restlessness
– Headache, dizziness
– Lethargy
– Dyspnea
– Tachycardia
– Dysrhythmias
– Coma leading to death
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Respiratory Acidosis
• Solutions
– Improve ventilation
• Ensure adequate airway; positioning,
suctioning
• Encourage deep breathing and coughing
• Frequent repositioning
• Chest physio/ postural drainage
• Bronchodilators
• Decrease sedation/analgesia
• Oxygen therapy
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Respiratory Alkalosis
24
Respiratory Alkalosis
• Clues
– Light headedness
– Confusion
– Decreased concentration
– Tingling fingers and toes
– Syncope
– Tetany
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Respiratory Alkalosis
• Solutions
– Decrease respiratory rate and depth
• Sedation/analgesia as appropriate
• Rebreather mask
• Paper bag
• Emotional support/encourage patient to slow
breathing
• Calm, soothing environment
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Metabolic Acidosis
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Metabolic Acidosis
• Clues
– Stupor
– Restlessness
– Kussmaul’s respirations (air hunger)
– Seizures
– Coma leading to death
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Metabolic Acidosis
• Solutions
– Replace HCO3 while treating underlying cause
– Monitor intake and output
– Monitor electrolytes, especially K+
– Seizure precautions
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Metabolic Alkalosis
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Metabolic Alkalosis
• Clues
– Weakness, dizziness
– Disorientation
– Hypoventilation
– Muscle twitching
– Tetany
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Metabolic Alkalosis
• Solutions
– Control vomiting
– Replace GI losses
– Eliminate overuse of antacids
– Monitor intake and output
– Monitor electrolytes
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