Arterial Blood Gas For Dummies!
Respiratory Side Metabolic Side
CO2 VS HCO3 (Bicarb)
Lungs VS Kidneys
Can be changed instantly VS Takes at least 24 hours to change
(Tidal volume, Inc RR)
PH: 7.35-7.45
PO2: 80-100
PaCO2: 35-45 (ACID)
BiCarb: 22-26 (BASE)
Ex 1. PH==7.30 A
CO2 == 48 A ➔ Respiratory Acidosis
HCO3== 24 N
Ex 2 PH == 7.48 B
CO2 == 43 N ➔ Metabolic Alkalosis
HCO3 == 29 B
Ex. 3 PH == 7.35 N (Yes, its normal. But on low side… So something’s compensating!!)
CO2 == 50 A
HCO3 == 29 B (Base is increasing in order to lower CO2) ➔ Compensated Resp. Acidosis
-- Perfect example of a COPD pt!!
Ex 4 PH == 7.49 B
CO2 == 30 B ➔ Respiratory Alkalosis
HCO3 == 20 A BUT ➔ Partially compensated!!!
-- If COPD pt w/ these readings got pneumonia which Increases CO2, the bicarb (kidneys) can’t immediately compensate.
SOOOO… its partially compensated.
Ex 5 PH == 7.29 A
CO2 == 50 A ➔ Respiratory & Metabolic Acidosis
HCO3 == 20 A
How to fix this: Inc. RR, Inc. TV, bicarb (as a last option)
-- Hypoxia is #1 reason for met. acidosis so INCREASE OXYGEN!!!
, Care of Ventilated Patients
Artificial Airways
- Short term
1. Oropharyngeal Airway
* Very sedated, Altered LOC, No gag reflex, no aspiration
* KEEPS AIRWAY OPEN ONLY!
2. Nasopharyngeal Airway
* Lubricate liberally with insertion!
3. Endotracheal tubes (intubation)
- Long Term
4. Tracheostomy tubes
3. Endotracheal Tubes
- Most common for SHORT TERM airway management.
- no air should be coming out of anywhere except tube!
- Pt should NOT be able to speak
- Indications
* Maintain airway patency
* Protect from aspiration (Balloon)
* Positive-pressure ventilation (creates a seal)
* Facilitate pulmonary toileting (Suctioning)
* Provide high oxygen concentrations if needed
- Naso vs. Orotracheal== Naso has increased infection risk. Orotracheal most likely unless oral trauma!
- Balloon can cause necrosis if left inflated in the throat to long—NOT OVER 2 WEEKS!
- Blue port outside of mouth also has balloon to check for patency of unseen balloon
- Size 6-7 for women; Size 7-8 for men.
- Assistance with intubation
* Equipment
- Suction setup (canister, tubing, vacuum head)
~ suck secretions before intubating so you’re not pushing them farther into lungs!
~ Check balloon patency before inserting!!
- Yaunker
- OETT
- Lubricant!!!!
- Stylet
~ a long piece of metal to help firm tube in order to help insertion. Stylet cannot pass the end
of tube or can cause perforation of lung
- Laryngoscope
- Valve-bag mask with 100% FiO2
- Continuous SaO2 monitor
- Medications
~ Sedative/paralytic necessary if intubating patient who is awake!
>Wait til doctor is READY to do procedure. Paralytic will cause pt to stop breathing
completely!
> Sedative first then paralytic (Make sure you’re allowed to push sedative!—Scope of
practice—may need an anesthesiologist)
, Endotracheal Tubes Cont.
- Confirmation of placement
* Chart how deep it is—Ex. 25 at lip
* Tip of tube should be 3 to 4 cm. above carina (where stems branch off to separate lungs)
1. Bilateral breath sounds (ER)
- None in abdomen, absence of gurgling!!
- If only one lung, then tube was put in to far!
2. CO2 detector (ER)
- goes on end of tube
- If turns yellow on exhale then correct placement!
3. CXR (BEST!!! But takes longest)
-- Not definitive BUT if you put deflated bulb syringe into end of tube and it pops open then correct placement!
Tracheostomy Tubes (Long term) Dec. infection risk!
Advantages:
1. Avoids oral, nasal, pharyngeal, and laryngeal complications/trauma/necrosis
2. Shorter with a wide diameter (SOO decreased air resistance & easier to wean)
- Compare breathing through a straw to breathing through a water hose
3. Less curved with easier secretion removal
4. Increased comfort
5. Able to eat and talk!!!!!
- Components:
* Made of plastic (MOST!) or metal
* Tube
* Cuff
* Obturator
- helps with insertion
- little piece of plastic
- holds place in case tube falls out so KEEP ONE AT BEDSIDE!!!
* Inner Cannula
- Either removable or replaceable so easier to clean!
- Indications:
* Extrapulmonary
- CNS, Neuromuscular
- Muscular
~ Action: interrupted of inhibited movement of chest wall
> Flail chest (broken ribs—unable to pull air in)
> Kyphosis (Hump back)
> Scoliosis (Twisted chest)
> COPD, end-stage asthma, emphysema (can’t exhale effectively—not enough room to
inhale)
Respiratory Side Metabolic Side
CO2 VS HCO3 (Bicarb)
Lungs VS Kidneys
Can be changed instantly VS Takes at least 24 hours to change
(Tidal volume, Inc RR)
PH: 7.35-7.45
PO2: 80-100
PaCO2: 35-45 (ACID)
BiCarb: 22-26 (BASE)
Ex 1. PH==7.30 A
CO2 == 48 A ➔ Respiratory Acidosis
HCO3== 24 N
Ex 2 PH == 7.48 B
CO2 == 43 N ➔ Metabolic Alkalosis
HCO3 == 29 B
Ex. 3 PH == 7.35 N (Yes, its normal. But on low side… So something’s compensating!!)
CO2 == 50 A
HCO3 == 29 B (Base is increasing in order to lower CO2) ➔ Compensated Resp. Acidosis
-- Perfect example of a COPD pt!!
Ex 4 PH == 7.49 B
CO2 == 30 B ➔ Respiratory Alkalosis
HCO3 == 20 A BUT ➔ Partially compensated!!!
-- If COPD pt w/ these readings got pneumonia which Increases CO2, the bicarb (kidneys) can’t immediately compensate.
SOOOO… its partially compensated.
Ex 5 PH == 7.29 A
CO2 == 50 A ➔ Respiratory & Metabolic Acidosis
HCO3 == 20 A
How to fix this: Inc. RR, Inc. TV, bicarb (as a last option)
-- Hypoxia is #1 reason for met. acidosis so INCREASE OXYGEN!!!
, Care of Ventilated Patients
Artificial Airways
- Short term
1. Oropharyngeal Airway
* Very sedated, Altered LOC, No gag reflex, no aspiration
* KEEPS AIRWAY OPEN ONLY!
2. Nasopharyngeal Airway
* Lubricate liberally with insertion!
3. Endotracheal tubes (intubation)
- Long Term
4. Tracheostomy tubes
3. Endotracheal Tubes
- Most common for SHORT TERM airway management.
- no air should be coming out of anywhere except tube!
- Pt should NOT be able to speak
- Indications
* Maintain airway patency
* Protect from aspiration (Balloon)
* Positive-pressure ventilation (creates a seal)
* Facilitate pulmonary toileting (Suctioning)
* Provide high oxygen concentrations if needed
- Naso vs. Orotracheal== Naso has increased infection risk. Orotracheal most likely unless oral trauma!
- Balloon can cause necrosis if left inflated in the throat to long—NOT OVER 2 WEEKS!
- Blue port outside of mouth also has balloon to check for patency of unseen balloon
- Size 6-7 for women; Size 7-8 for men.
- Assistance with intubation
* Equipment
- Suction setup (canister, tubing, vacuum head)
~ suck secretions before intubating so you’re not pushing them farther into lungs!
~ Check balloon patency before inserting!!
- Yaunker
- OETT
- Lubricant!!!!
- Stylet
~ a long piece of metal to help firm tube in order to help insertion. Stylet cannot pass the end
of tube or can cause perforation of lung
- Laryngoscope
- Valve-bag mask with 100% FiO2
- Continuous SaO2 monitor
- Medications
~ Sedative/paralytic necessary if intubating patient who is awake!
>Wait til doctor is READY to do procedure. Paralytic will cause pt to stop breathing
completely!
> Sedative first then paralytic (Make sure you’re allowed to push sedative!—Scope of
practice—may need an anesthesiologist)
, Endotracheal Tubes Cont.
- Confirmation of placement
* Chart how deep it is—Ex. 25 at lip
* Tip of tube should be 3 to 4 cm. above carina (where stems branch off to separate lungs)
1. Bilateral breath sounds (ER)
- None in abdomen, absence of gurgling!!
- If only one lung, then tube was put in to far!
2. CO2 detector (ER)
- goes on end of tube
- If turns yellow on exhale then correct placement!
3. CXR (BEST!!! But takes longest)
-- Not definitive BUT if you put deflated bulb syringe into end of tube and it pops open then correct placement!
Tracheostomy Tubes (Long term) Dec. infection risk!
Advantages:
1. Avoids oral, nasal, pharyngeal, and laryngeal complications/trauma/necrosis
2. Shorter with a wide diameter (SOO decreased air resistance & easier to wean)
- Compare breathing through a straw to breathing through a water hose
3. Less curved with easier secretion removal
4. Increased comfort
5. Able to eat and talk!!!!!
- Components:
* Made of plastic (MOST!) or metal
* Tube
* Cuff
* Obturator
- helps with insertion
- little piece of plastic
- holds place in case tube falls out so KEEP ONE AT BEDSIDE!!!
* Inner Cannula
- Either removable or replaceable so easier to clean!
- Indications:
* Extrapulmonary
- CNS, Neuromuscular
- Muscular
~ Action: interrupted of inhibited movement of chest wall
> Flail chest (broken ribs—unable to pull air in)
> Kyphosis (Hump back)
> Scoliosis (Twisted chest)
> COPD, end-stage asthma, emphysema (can’t exhale effectively—not enough room to
inhale)
