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Respiratory Care

Respiratory Care. Arterial Blood Gas Interpretation. Reference – Egan’s Fundamentals of Respiratory Care 8 th Edition. Normal Values for ABG. pH = 7.40 pCO 2 = 40 mmHg pO 2 = 90 mmHg Bicarb = 24 mEq/L Base Excess = 0 mEq/L S a O 2 = >90%. Normal Ranges. pH = 7.35 – 7.45

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Respiratory Care

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  1. Respiratory Care Arterial Blood Gas Interpretation Reference – Egan’s Fundamentals of Respiratory Care 8th Edition

  2. Normal Values for ABG • pH = 7.40 • pCO2 = 40 mmHg • pO2 = 90 mmHg • Bicarb = 24 mEq/L • Base Excess = 0 mEq/L • SaO2 = >90%

  3. Normal Ranges • pH = 7.35 – 7.45 • pCO2 = 35 - 45 mmHg • pO2* = 80 – 100 mmHg • Bicarb = 22 - 26 mEq/L • Base Excess = 0 + 2 mEq/L • SaO2 = 90 – 100% *Normal pO2 levels decrease naturally due to age. One mmHG for each year over 60 is considered normal.

  4. 5 “types” of classification • Respiratory acidosis • Respiratory alkalosis • Metabolic acidosis • Metabolic alkalosis • Mixed state (both respiratory and metabolic involvement)

  5. Interpreting an ABG • Divided into 2 basic steps • Interpretation of the acid-base status • Interpretation of the oxygenation status

  6. Acid-Base Classification • Inspect the pH (acidemia, alkalemia, or normal) • Inspect the pCO2 (respiratory component) • Inspect the HCO3- (metabolic component) • Check for compensation

  7. Step 1 • Categorize the pH • < 7.35 = acidosis • > 7.45 = alkalosis

  8. Step 2 • Determine respiratory involvement • pCO2 is the indicator of respiratory involvement • Determine if pCO2 could have caused the abnormality by itself • If pCO2 is normal, probably metabolic

  9. Step 3 • Determine Metabolic Involvement • HCO3- is the indicator of metabolic involvement • Determine if HCO3- could have caused the abnormality by itself • If HCO3- is normal, probably respiratory

  10. Step 4 • Assess for compensation • The system NOT responsible for the imbalance usually attempts to return the pH to normal • 3 levels • Compensated (chronic) • Uncompensated (acute) • Partially Compensated

  11. Step 4 continued • In cases in which compensation has occurred (but the pH is still above/below 7.40) the component which would cause the change is generally the primary cause

  12. Oxygenation Status – pO2/SaO2 • pO2 < 80 = mild hypoxemia • pO2 < 60 = moderate hypoxemia • pO2 < 40 = severe hypoxemia • SaO2 represents the degree to which the hemoglobin is saturated with O2. • 40-50-60 70-80-90 theory • pO2 to saturation match

  13. Quick guide ↑ → ↓

  14. Respiratory Acidosis

  15. Respiratory Acidosis Example

  16. Respiratory Alkalosis

  17. Respiratory Alkalosis Example

  18. Metabolic Acidosis

  19. Metabolic Acidosis Example

  20. Metabolic Alkalosis

  21. Metabolic Alkalosis Example

  22. Let’s Do a Few

  23. pH pCO2 pO2 HCO3- SaO2 7.40 41 85 24 95 ?????

  24. pH pCO2 pO2 HCO3- SaO2 7.29 57 64 24 91 ?????

  25. pH pCO2 pO2 HCO3- SaO2 7.11 18 116 15 99 ?????

  26. pH pCO2 pO2 HCO3- SaO2 7.39 62 79 35 95 ?????

  27. pH pCO2 pO2 HCO3- SaO2 7.36 71 55 32 90 ?????

  28. pH pCO2 pO2 HCO3- SaO2 7.58 15 101 24 98 ?????

  29. pH pCO2 pO2 HCO3- SaO2 7.55 40 85 34 97 ?????

  30. pH pCO2 pO2 HCO3- SaO2 7.25 65 80 19 97 ?????

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