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Blood Gas Interpretation Review for Pandemic

Understand the importance of blood gas analysis for diagnosing acid-base balance and oxygenation. Learn about pH levels, respiratory and metabolic factors, and interpreting arterial gases. Practice interpreting ABG analysis and identifying compensation levels for acidosis. Discover solutions for respiratory acidosis and alkalosis, as well as metabolic acidosis, including causes, clues, and solutions. Ensure patient safety with proper management techniques.

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Blood Gas Interpretation Review for Pandemic

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  1. Blood Gas Interpretation Review for Pandemic

  2. Blood Gases • Important diagnostic tool • Reveals: 1. acid-base balance 2. oxygenation status **arterial gases only** 3. abnormalities of ventilation

  3. Acid- base balance • The body is designed for optimum performance at a specific pH level • Cell division • Metabolism

  4. 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

  5. Acid – Base Balance Bicarbonate – carbonic acid buffer equation (H+)(HCO3) (H2CO3) (CO2)(H2O) It’s not that complicated! pH 1 7 14 Acidic Neutral Alkaline

  6. Acid – Base Balance • Lungs • Respiratory • CO2 (acid) • Kidneys • Metabolic • HCO3 ( base/alkaline)

  7. Making sense of it… pH 7.35 – 7.45 Respiratory Metabolic CO2=Acidosis HCO3=Acidosis CO2=Alkalosis HCO3=Alkalosis

  8. Interpretation: 4 steps • Normal Values • pH 7.35 – 7.45 • pCO2 35 – 45 mmHg • HCO3 22 - 26 mEq/L • Evaluate each component as Acid or Base

  9. Step 1… • Evaluate pH and determine acidosis or alkalosis 7.35 7.40 7.45 Acid Normal Base AcidosisAlkalosis

  10. Step 2… 35 40 45 Base Normal Acid • Evaluate pCO2 (respiratory)

  11. Step 3… • Evaluate HCO3 (metabolic) 22 24 26 Acid Normal Base

  12. Step 4… • Determine which regulatory system is responsible for the imbalance by checking to see which component matches the pH. • If pH and pCO2 match = respiratory • If pH and HCO3 match = metabolic

  13. ABG Analysis

  14. Let’s practice… Respiratory Acidosis A A N Metabolic Alkalosis B N B Normal N N N B B N Respiratory Alkalosis A N A Metabolic Acidosis A A A Mixed Acidosis

  15. Compensation • When an acid – base imbalance exists, over time the body attempts to compensate.

  16. Understanding Compensation • Uncompensated – the alternate system has not attempted to adjust (remains within normal range), and the pH remains abnormal • Example • pH 7.30 A • pCO2 60 A • HCO3 25 N Uncompensated Respiratory Acidosis

  17. Understanding Compensation • Partial Compensation – the alternate system is trying to create a balanced environment and bring the pH back within normal limits, but hasn’t yet succeeded. • Example • pH 7.34 A • pCO2 59 A • HCO3 28 B Partially Compensated Respiratory Acidosis

  18. Understanding Compensation • Fully Compensated – the alternate system has adjusted enough to restore balance and normalize the pH • Example • pH 7.36 N (but slightly A) • pCO2 58 A • HCO3 31 B Compensated Respiratory Acidosis

  19. Let’s Practice Compensation… Metabolic Alkalosis partially compensated B A B A A N Respiratory Acidosis uncompensated Metabolic Acidosis fully compensated N B A N A B Respiratory Acidosis fully compensated Respiratory Alkalosis partially compensated B B A Respiratory Acidosis partially compensated A A B

  20. A Final Step… • Determine level of oxygenation (arterial samples only) • Normal = 80 – 100 mmHg • Mild hypoxemia = 60 – 80 mmHg • Moderate hypoxemia = 40 – 60 mmHg • Severe hypoxemia = less than 40 mmHg

  21. Respiratory Acidosis • Excessive CO2 retention • Causes • Airway obstruction • Depression of respiratory drive • Sedatives, analgesics • Head trauma • Respiratory muscle weakness resulting from muscle disease or chest wall abnormalities • Decreased lung surface area participating in gas exchange

  22. Respiratory Acidosis • Clues • Confusion, restlessness • Headache, dizziness • Lethargy • Dyspnea • Tachycardia • Dysrhythmias • Coma leading to death

  23. 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

  24. Respiratory Alkalosis • Excessive CO2 loss due to hyperventilation • Causes • CNS injury: brainstem lesions, salicylate overdose, Reye’s Syndrome, hepatic encephalopathy • Aggressive mechanical ventilation • Anxiety, fear or pain • Hypoxia • Fever • Congestive heart failure

  25. Respiratory Alkalosis • Clues • Light headedness • Confusion • Decreased concentration • Tingling fingers and toes • Syncope • Tetany

  26. 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

  27. Metabolic Acidosis • Excessive HCO3 loss, or acid gain • Causes • Diabetic ketoacidosis • Sepsis/shock • Diarrhea (fluid losses below gastric sphincter) • Renal Failure • Poison ingestion • Starvation • Dehydration

  28. Metabolic Acidosis • Clues • Stupor • Restlessness • Kussmaul’s respirations (air hunger) • Seizures • Coma leading to death

  29. Metabolic Acidosis • Solutions • Replace HCO3 while treating underlying cause • Monitor intake and output • Monitor electrolytes, especially K+ • Seizure precautions

  30. Metabolic Alkalosis • HCO3 retention, or loss of extracellular acid, • Causes • GI losses above gastric sphincter • Vomiting • Nasogastric suction • Antacids • Diuretic therapy causing electrolyte loss

  31. Metabolic Alkalosis • Clues • Weakness, dizziness • Disorientation • Hypoventilation • Muscle twitching • Tetany

  32. Metabolic Alkalosis • Solutions • Control vomiting • Replace GI losses • Eliminate overuse of antacids • Monitor intake and output • Monitor electrolytes

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