blood gas examples

Arterial blood gas analysis is used to measure the pH and the partial pressures of oxygen and carbon dioxide in arterial blood. The low pH in combination with the high PCO 2 tells us that the respiratory acidosis is the primary process. active="false"]. Justify your answer. What best correlates best with a capillary gas? I have a lot of questions. covers the basic for an undergraduate. Labs are drawn and reveal the following: Room air ABG: pH 7.22 Arterial Blood Gas Analysis: Example Set 1. Today his blood pressure is 90/48 and pulse rate 104. So, that’s the ROME blood gas interpretation method. She is placed on a short course of CPAP and is soon sitting out of bed eating sandwiches. These are his venous blood gas results: Some analysers won’t include potassium in their calculations therefore for them >15 constitutes a raised anion gap. Emergency Physician, Educator. I then read a... A few people had a go. Researchers plotted the results of the various parameters, found the collective center of the bell-shaped curve of data, and declared the resu… A 32 year-old man presents to the emergency department having been found collapsed by his girlfriend. A common example is ice. 100% oxygen makes subsets of COPD patients retain CO2, decreasing respiratory drive and worsening hypoxia and hypercapnia. There is an initial respiratory alkalosis due to central respiratory centre stimulation causing  increased respiratory drive. These are his venous blood gas results: pH 7.31 pCO2 39 pO2 25 HCO3- 19 BE -7 Na 108 Awsm, you guys have no idea how much lives that you guys have saved in Malaysia. Fully compensated respiratory alkalosisThe first thing you want to do is to pull from your memory bank the normal values for arterial blood g… Urea                8.5      mmol/L BP                    135/99 mmHg A solid has a defined shape and volume. Her initial Co2 on venous gases was 84mmHg. Her repeat gas shows: The management of acute asthma will be found on the respiratory sections of this website. oxygen delivery). Here are some answers and a few resources for you. – thank you, Malaysian doctor-. Lactate            1.6      mmol/L. 14. This is a compensated respiratory acidosis. gastric outlet obstruction (the classic example is pyloric stenosis in a baby). What are the 3 things that affect low accuracy in capillary gas samples? T                      38.2     oC Today his blood pressure is 90/48 and pulse rate 104. pO2 17 mmHg ARTERIAL BLOOD GAS EXAMPLES 1. pH 7.32 Pa 67 PaO 47 HCO3 37 What is this? Pyrexia points more towards pneumonia (but PE can give a mild pyrexia). Wheeze will predominate in asthma. BE -7 An arterial blood gas is drawn and reveals: pH 7.28 PCO 2 29, PO 2 85 HCO 3 - 16 On her chemistry panel, the sodium is 131, chloride 105 and HCO3- 15 I’m just wondering when it comes to the written exam if they’ll be accepting of the range of approaches / worked examples? RR                   28        /min Shortly thereafter, the nurse walks in the room and finds him somnolent and difficult to arouse. This leaves the following equation: N.B. But knowing timing is everything in these exams I’m keen to keep any calculations as brief as possible! To interpret ABGs, we first need to know the normal values for the various analytes. HR                   88        /min Become a Resus Member for FREE! Arterial Blood Gas Analysis: Example Set 2 Case A. Lifestyle advice and smoking cessation of necessary. Acidosis increases salicylate transfer across the blood brain barrier, In severe cases (plasma concentrations >700mg/l), Priorities for management include fluid resuscitation, insulin administration and careful management of potassium levels. Plasma is the fourth state of matter. Differential diagnosis of a metabolic alkalosis or alkalaemia: A seventeen year-old girl presents to the emergency department after an argument with her boyfriend. The most common acid–base imbalance seen in the paediatric population is a metabolic acidosis, secondary to infections, catabolic states or severe dehydration. Based on the history, anxiety hyperventilation is the most likely cause here. A 21 year old man is brought in by his father with a one week history of vomiting. Again, make sure you do the practice problems found in this lesson using the ROME or arrow method. Fully compensated metabolic acidosisC. This is the classic picture of aspirin overdose. The nurse on duty took her vital signs and noted the following: Temp = 100 °F; apical pulse = 95; respiration = 20 and deep. The absolute normal is 7.40. HCO3–            34       mmol/L Evaluate the patient’s response to therapy and/or diagnostic evaluation (e.g. Measurements of PaO2, PaCO2, SaO2, pH, and bicarbonate values are made with arterial blood gas (ABG) analysis in order to determine the acid-base balance and respiratory regulation. PO2                 182     mmHg He is complaining of non-specific abdominal pain. This site uses Akismet to reduce spam. The radial artery on the wrist is most commonly used to obtain the sample. Respiratory acidosis partially compensated 2. pH 7.60 PaCO2 Plasma salicylate concentration (initial and repeats), Paracetamol levels (always check in any case of poisoning by anything), Renal failure (rare) sometimes other electrolyte imbalances, If dropping sats or any suspicion of ARDS (non-cardiogenic pulmonary oedema), Gastric lavage within 1h of ingestion (although no evidence for mortality reduction), In mild/moderate cases (plasma concentration 500-700mg/l), Give 225ml of 8.4% bicarbonate solution over 1hr, Ensure urine pH over 7.5 (use indicator paper), Bicarbonate will increase any pre-existing hypokalaemia – so don’t let it happen, Additional boluses of bicarbonate to maintain alkalinisation, N.B. It is used to determine the extent of the compensation by the buffer system and includes the measurements of the acidity (pH), levels of oxygen, and carbon dioxide in arterial blood. Thanks. The PaO2, on the other hand, does not correlate well. It is the amount of pressure a particular gas contributes to the total pressure. Indications: Evaluate the adequacy of ventilation, acid–base status, and oxygenation. Blood can be drawn via an arterial stick from the wrist, groin, or above the elbow. This is known as:A. Get access to Resus learning resources and learn about upcoming events SUBSCRIBE [email protected]. The arterial pH and CO2 correlate well with capillary blood gas results. You are working in the emergency room when the paramedics bring in a 45 year-old man who was found down in Pioneer Square. Blood gases are a group of tests that are performed together to measure the pH and the amount of oxygen (O 2) and carbon dioxide (CO 2) present in a sample of blood, usually from an artery, in order to evaluate lung function and help detect an acid-base imbalance that could indicate a respiratory, metabolic or kidney disorder.. A person's body carefully regulates blood pH, … Her ABG is as follows: See relevant pages in the respiratory section for further information. Question 2. Good luck. An arterial blood gas test is one of the tests used for COPD diagnosis.The test measures the oxygen (O 2) level in your blood and if carbon dioxide (CO 2) is removed properly.It can also determine the acidity (pH) of your blood. More information can be found on this page: The British Thoracic Society have produced guidelines which give a, Hypermetabolic states (e.g. Potassium is commonly left out of the equation as potassium concentrations, being very low, usually have little effect on the gap. Note that despite the low pH the pCO2 is also high. A mother is admitted to the emergency department following complaints of fever and chills. pO2 25 I know this method works really well for a lot of people. 10 arterial blood gas problems worked using the tic-tac-toe method. PATIENT 1 A 68-year-old woman is admitted with abdominal pain, which is later found to be due to a pelvic abscess causing sepsis. Get the latest updates on our Conferences PLUS our Webcasts and Education Newsletters. Your email address will not be published. Research He has been diagnosed with Hashimoto’s thyroiditis by his local doctor 4 months previously. [2] Metabolic problems will require respiratory compensation and this occurs rapidly - eg, by increasing ventilation to blow off CO2. He has emesis on his shirt. The medical registrar looks at the venous gases and doesn’t want to take the patient to the ward because of the CO2. Note this is an acidosis, not an acidaemia (pH normal, but only due to compensatory mechanisms: the high bicarbonate). ABG shows: Perfect revision for MRCP PACES, OSCES and medical student finals, Cardiac arrestClinical casesInterpreting investigationsOSCEsPACESPLABQuestionsShortness of breath, Excellent revision in quickest time. PCO2              80       mmHg With the above history this is likely to represent an acute on chronic respiratory acidosis. Question 2. As PaO2 increases, more oxygen diffuses into the red blood cells, where it combines with hemoglobin to form oxyhemoglobin. Her initial ABG on 15 litres of oxygen shows: After initial treatment the nurse in resus calls you to review the patient. Partially compensated respiratory acidosisD. An example is liquid water. Acid-base status: • The patient has a low pH (acidemia) • The PCO 2 is high (respiratory acidosis) and the bicarbonate is high (metabolic alkalosis). FiO2                0.40 The nurse says that although the patient’s respiratory rate has come down slightly she is looking more unwell. Thanks for the question. active="false"]. Click here for a page detailing this, and click here for. This is a tough one. A repeat gas shows: A normally fit and well 11 year-old boy presents with diarrhoea and vomiting. This is all uncharted territory.... Head injury in the anticoagulated patient can be a challenge. An arterial blood gas is performed and reveals: pH 7.37, PCO 2 57, PO 2 70, HCO 3-32. What is this patient’s resting CO2? For example, vomiting leads to a significant loss of H+, K+, and Cl- (or excessive oro/nasogastric tube decompression). Creator resus.com.au. This is one of the cases where having an old ABG from a previous admission can be useful. pCO2 74 mmHg pH                  7.22 I had a great case just over a... ADRENALINE AND CARDIAC RESUSCITATION How much to use, when to use it and when not to use it. Where do these normal values come from? Raised JVP, ankle swelling, fine basal creps: more likely oedema. These gases are measured by taking a sample of blood from an artery, usually the wrist and measuring the partial pressure of the dissolved gases in the sample. Blood gases are the dissolved gases in the bloodstream, namely oxygen and carbon dioxide. My quick query is regarding the use of the estimation of FiO2 40% = roughly 300 in calculating an AA gradient. What does this ABG show and what is the differential diagnosis? The arterial blood gas provides information about the pulmonary component of oxygenation, specifically the PaO 2. The PO2 is low with a low CO2. Creatinine       95       umol/L In the later stages a metabolic acidosis develops along side the respiratory alkalosis as a result of direct effect of the metabolite salicylic acid and more complex disruption of normal cellular metabolism. A blood gas test measures the amount of oxygen and carbon dioxide in the blood. Each hemoglobin molecule contains four atoms of iron and therefore can combine with four molecules of oxygen. Cl 72 A 21 year-old woman presents feeling acutely lightheaded and short of breath. The knowledge you take into your shift DOES matter, Get access to Resus learning resources and learn about upcoming event. 15. A venous blood gas shows: A 22 year-old lady with a known history of asthma presents to the emergency department with difficulty in breathing. Recently at the EM Core we discussed headache and the red eye. infection or fever). K 6.2 Calculate this patient’s Aa gradient. They will accept the range. This is a picture of a mixed respiratory and metabolic acidosis. Calculate this patient’s Aa gradient. Let’s apply volume loss to another classic example – “ … blood work. Rather it reflects a compensation for a chronic respiratory acidosis secondary to chronic pulmonary disease. 16. This can either be as a result of the lungs not working properly (called respiratory acidosis) or from a build-up of acid from metabolic causes, usually as a result of tissues being starved of oxygen (called a metabolic acidosis). He is complaining of non-specific abdominal pain. This loss of volume causes the distal nephron to retain sodium by wasting H+ ions. Glc 3.3, A 68 yo woman with known COPD, on home oxygen, presents a little drowsy. The traditional mnemonic for the causes of a metabolic acidosis with raised anion gap is ‘MUDPILES’: Copyright 2013-2019 Oxford Medical Education Ltd. What is this patient’s resting CO2? The accompanying alkalosis is a response, due to the patient blowing off CO2 due to her likely high respiratory rate. Note that the HCO3 is raised in this patient despite the abnormal pH. [/toggle title="What' s the differential diagnosis of this ABG picture?" Solving gases like this is relatively simple. Oxygen administration in this group is a complicated issue. The most common ABG abnormalities detected relate to an excess of acid. ABG analysis can be easy! My concern is in another question this difference might move an answer from “within normal limits” to abnormal. blood gas interpretation for the acem fellowship exam 25 worked examples, as one of the most energetic sellers here will completely be along with the best options to review. Given the history of diabetes and ankle swelling, renal failure is a unifying diagnosis with pulmonary oedema contributing to a respiratory acidosis whilst the failure to clear acids causes a metabolic acidosis. This patient has asthma, ongoing difficulty in breathing and a rising CO2 (the fact that it is in the normal range is irrelevant) . Target Blood Gas in Neonates * * Goldsmith and Karotkin, Assisted Ventilation of the Neonate, 4 th edition, Saunders 50-80 80-120 50-70 45-65 PaO 2 55-65 30-40 45-55 45-55 PaCO 2 7.35-7.45 7.30-7.50 ≥ 7.25 ≥ 7.25 pH Infant with BPD … HCO3- 19 What is arterial blood gas? What is a capillary blood gas used for? Learn how your comment data is processed. Reference range usually 7–16 mEq/L (but varies between hospitals, some using 3-11). A 62 year-old woman with a history of diabetes and a long smoking history presents to the emergency department with worsening shortness of breath. K+                    4.1      mmol/L This is within normal limits for this patient. He has not been able to keep any food down. You are called to see a 54 year old lady on the ward. Is propofol the new wonder drug for treating headaches? The blood gas (venous or arterial) has the distinct advantage of giving you a HCO3 value in 5 minutes, when it would take about an hour in most shops to get the result from a chem. PaO2 greater than 7.3 and less than 8.0 kPa when stable AND with any of: is the difference between primary measured cations (sodium and potassium) and the primary measured, Myasthenia Gravis (MG) – Neurological Examination, Questions about DVT (Deep Vein Thrombosis), Endotracheal tube (ETT) insertion (intubation), Supraglottic airway (e.g. So rounding up, will be fine. Measurement of arterial blood gas shows pH 7.37, PaO2 90 mm Hg, PaCO2 40 mm Hg, and HCO3 24 mmol/L. A review of the infant’s clinical status, previous blood gas values, and treatment measures will help determine whether this is an ongoing compensation mechanism or two independent abnormalities. Test your knowledge on the web's most interactive blood gas learning tool. A normal blood pH is 7.35-7.45. pH 7.31 Is Propofol the new wonder drug for headaches? Practice examples. really useful. Blood gas analysis is a key investigation in a patient with a suspected IMD, particularly during acute episodes of illness. It may also be used to determine the pH of the blood, or how acidic it is. pH 7.25 She denies this. Mike Cadogan; Nov 3, 2020; Home CCC. thanks for the questions. Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more! What are the abnormalities of the waveform of the JVP? An arterial blood gas is a laboratory test to monitor the patient’s acid-base balance. Sats                100%   40% O2 This is type 1 respiratory failure. We even provided a cheatsheet for you with that ROME chart on it that you can use as a resource. 6 Blood Gas Analysis ARC 124 important factor in determining the amount of oxygen bound to hemoglobin. Justify your answer. She is three days post-cholecystectomy and has been complaining of shortness of breath. Na 108 They mostly come from collected results of volunteers or study subjects who appear to have uncompromised lungs and gas exchange. A venous blood gas shows: pH: 7.12 (7.35-7.45) pO2: 11.5 (10–14) pCO2: 3.2 (4.5–6.0) HCO3: 9 (22-26) BE: -17 (-2 to +2) Lactate: 4.0; Potassium: 5.5; Glucose: 22; Other values within normal range Na+                 137     mmol/L 300 – 1.25 x 80 – 180- = 300 – 280 = 20mmHg. This field is for validation purposes and should be left unchanged. Below is the approach I use. The drop in pH represents the normal mechanisms of compensation being over whelmed. Well done! A 21 year old man is brought in by his father with a one week history of vomiting. View ABG'S examples.docx from NURSING 2550 at Georgian College. She has her final university exams next week. He says that she took lots of tablets. Key Interests: Resuscitation, Airway, Emergency Cardiology, Clinical Examination. A 65 year old patient with a history of COAD and CCF presents to your department complaining of difficulty breathing. Below are some brief clinical scenarios with ABG results. However, it is very important to have considered the other options, in particular and to have ruled out a primary respiratory pathology or infection. laryngeal mask airway [LMA], i-Gel), click here to learn the best way to interpret ABGs, Blood Transfusion And Intravenous Infusion – Clinical Skills. Question 1. Question 3. The differential diagnosis in this case is: All of these conditions can may you tachypnoeic and tachycardic. This would indicate that the patient normally retains CO2 and has a chronically raised HCO3. He has not been able to keep any food down. The three main states of matter are solid, liquid, and gas. Imbalances in the amount of oxygen, carbon dioxide, or pH can serve as a way to evaluate respiratory diseases, … Pulmonary embolus will be the only condition that will likely be normal on auscultation. A patient has the following arterial blood gas results: blood pH 7.43, PaCO2 28 mmHg, and HCO3 18 mEq/L. However, another way is to think about the mechanism of acidosis: [/toggle title="What is the differential diagnosis for a metabolic acidosis with normal or decreased anion gap?" It is an alternative to an ABG. A case of head injury that raised a few questions, Head injury and blood thinners-When to Scan, Using Adrenaline the right way in Cardiac Resuscitation, the rise in HCO3- is equal to the chronic portion of compensation and the acute portion of compensation, chronic compensation of 4mmol HCO3 per 10mmHg CO2, acute compensation of 1mmol HCO3 per 10mmHg Co2. Monitor severity and progression of a known disease process. Knowledge . HCO3 33 mmol/L. The patient hits his PCA button several times in the first hour. What are the major acid base disturbances present? Let’s talk about blood pH for a moment because if FULL compensation presents there will NOT be a tic tac toe and you will have to look closely at the blood pH to determine which system is causing the issue and which system is trying to “fix” the issue (hence compensate). Arterial Blood Gas Sample. Consider which blood gas disorders could be affecting the following patients (for reference ranges see Box 2, p87). Partially compensated respiratory alkalosisB. Learnt a lot from the above case scenarios.Thanks a lot, Learnt a lot from the above case scenarios.Thanks a lot.Clarified so many things. And it's FREE! On auscultation of the chest there are widespread crackles and you notice moderate ankle oedema. Question 3. A normally fit and well 11 year-old boy presents with diarrhoea and vomiting. He has been diagnosed with Hashimoto’s thyroiditis by his local doctor 4 months previously. It will be clear-cut. You take an arterial blood gas which reveals the following results: PaO 2: 9.1 kPa (11 – 13 kPa) || 68.2 mmHg (82.5 – 97.5 mmHg) pH: 7.30 (7.35 – 7.45) PaCO 2: 8.4 kPa (4.7 – 6.0 kPa) || 63 mmHg (35.2 – 45 mmHg) HCO 3-: 29 (22 – 26 mEq/L) … A gas has neither a defined shape nor volume. Education . Blood pH has to be maintained within a tight normal range to avoid cellular death. What is the differential diagnosis for a metabolic acidosis with raised anion gap? He is somnolent but arouseable. Cl–                   117     mmol/L An Arterial Blood Gas requires the nurse to collect a small sample of blood - generally, a full 1 ml³ is preferred. On the other hand respiratory problems leading to acid-base abnormalities require renal compensation. Her arterial blood gases are as follows: pH: 7.31. Nothing acutely as this man does not meet the criteria for long-term oxygen therapy (LTOT). How to Interpret Blood Gas Results: 10 Steps (with Pictures) This is an extremely worrying sign as it shows that the patient is tiring. Examples. A 75 year old gentleman living in the community is being assessed for home oxygen. What are the most common arterial blood gas abnormalities? That was an excellent practice for learning ABG interpretation For example, we normally breathe air which at sea level has a pressure of 100kPa, oxygen contributes 21% of 100kPa, which corresponds to a partial pressure of 21kPa. Case A. However, the femoral artery and brachial artery can be used if necessary. The resuscitation... Diabetic Ketoacidosis in Children: Management →. Thankyou, this was great practice for my exam. – 60mmHg, , the chronic compensation element will be 8mmol/L HCO3-, meaning the acute fraction is 2mmol/L, yielding a change in HCO3 of 10mmol/L. blood gas analysis: Definition Blood gas analysis, also called arterial blood gas (ABG) analysis, is a test which measures the amounts of oxygen and carbon dioxide in the blood, as well as the acidity (pH) of the blood. BE                  +10 A 67 year-old man with a history of peptic ulcer disease presents with persistent vomiting. What do you think? Therefore we can assume if the resting CO2 is: – 50mmHg, the chronic compensation element will be 4mmol/L HCO3-, meaning the acute fraction is 3mmol/L, yielding a change in HCO3 of 7mmol/L. Try to interpret each ABG and formulate a differential diagnosis before looking at the answer. You persuade her to let you do an ABG: A few hours later she says she feels increasingly unwell and is complaining of ringing in her ears. A patient is brought back to the floor from the operating room on a patient controlled analgesia (PCA) pump with hydromorphone. DKA, lactic acidosis (produced by poorly perfused tissues), From the GI tract (diarrhoea or high-output stoma), E.g. Cap refill         2          s Either way, this is a raised anion gap metabolic acidosis. Thanks so much for this, it’s helped alot. His ABG is as follows: A 64 year old gentleman with a history of COPD presents with worsening shortness of breath and increased sputum production. This is slow and may need secretion of H+ ions or re… He is hypotensive and tachycardic. Asthma: Nebuliser And Inhaler Use – Respiratory Medicine, Nausea and vomiting case study with questions and answers, Low urine output case study with questions and answers. For the example “65 year old patient with a history of COAD and CCF presents to your department complaining of difficulty breathing” the answer changes from ~5 to ~20 (as 0.4 x 713 = 285). A liquid has a defined volume, but can change state. This can be achieved by buffer mechanisms which can be either renal or respiratory in nature. You will find that there will be few line balls. pCO2 39 The investigation is relatively easy to perform and yields information that can guide the management of acute and chronic illnesses.This information indicates a patient's acid-base balance, the effectiveness of their gas exchange and the state … Several exotic states also exist. This is the correct answer and implies a resting CO2 of 60mmHg.

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