A 21 year-old woman presents feeling acutely lightheaded and short of breath. Shortly thereafter, the nurse walks in the room and finds him somnolent and difficult to arouse. Urea 8.5 mmol/L Case A. More information can be found on this page: The British Thoracic Society have produced guidelines which give a, Hypermetabolic states (e.g. HCO3– 34 mmol/L Some analysers won’t include potassium in their calculations therefore for them >15 constitutes a raised anion gap. They will accept the range. 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 This is the correct answer and implies a resting CO2 of 60mmHg. You are called to see a 54 year old lady on the ward. However, it is very important to have considered the other options, in particular and to have ruled out a primary respiratory pathology or infection. Cl– 117 mmol/L PO2 182 mmHg T 38.2 oC Partially compensated respiratory alkalosisB. For example, vomiting leads to a significant loss of H+, K+, and Cl- (or excessive oro/nasogastric tube decompression). PCO2 80 mmHg It is the amount of pressure a particular gas contributes to the total pressure. – thank you, Malaysian doctor-. It will be clear-cut. Try to interpret each ABG and formulate a differential diagnosis before looking at the answer. She has her final university exams next week. HCO3 33 mmol/L. Her initial Co2 on venous gases was 84mmHg. Become a Resus Member for FREE! An example is liquid water. The most common ABG abnormalities detected relate to an excess of acid. 100% oxygen makes subsets of COPD patients retain CO2, decreasing respiratory drive and worsening hypoxia and hypercapnia. Glc 3.3, A 68 yo woman with known COPD, on home oxygen, presents a little drowsy. Based on the history, anxiety hyperventilation is the most likely cause here. Arterial blood gas analysis is used to measure the pH and the partial pressures of oxygen and carbon dioxide in arterial blood. thanks for the questions. Where do these normal values come from? What best correlates best with a capillary gas? The traditional mnemonic for the causes of a metabolic acidosis with raised anion gap is ‘MUDPILES’: Copyright 2013-2019 Oxford Medical Education Ltd. 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 … This site uses Akismet to reduce spam. Get notified on all upcoming Conferences PLUS our Webcasts, Education Newsletters, and more! Education . The arterial blood gas provides information about the pulmonary component of oxygenation, specifically the PaO 2. Her initial ABG on 15 litres of oxygen shows: After initial treatment the nurse in resus calls you to review the patient. As PaO2 increases, more oxygen diffuses into the red blood cells, where it combines with hemoglobin to form oxyhemoglobin. A solid has a defined shape and volume. Cl 72 Blood gases are the dissolved gases in the bloodstream, namely oxygen and carbon dioxide. 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. 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. The knowledge you take into your shift DOES matter, Get access to Resus learning resources and learn about upcoming event. 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. 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. Fully compensated metabolic acidosisC. ABG analysis can be easy! Researchers plotted the results of the various parameters, found the collective center of the bell-shaped curve of data, and declared the resu… Awsm, you guys have no idea how much lives that you guys have saved in Malaysia. These are his venous blood gas results: Here are some answers and a few resources for you. How to Interpret Blood Gas Results: 10 Steps (with Pictures) active="false"]. [2] Metabolic problems will require respiratory compensation and this occurs rapidly - eg, by increasing ventilation to blow off CO2. This is a picture of a mixed respiratory and metabolic acidosis. Mike Cadogan; Nov 3, 2020; Home CCC. Emergency Physician, Educator. Question 3. Well done! Note that the HCO3 is raised in this patient despite the abnormal pH. Thanks. My quick query is regarding the use of the estimation of FiO2 40% = roughly 300 in calculating an AA gradient. 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. covers the basic for an undergraduate. Click here for a page detailing this, and click here for. This is an extremely worrying sign as it shows that the patient is tiring. [/toggle title="What' s the differential diagnosis of this ABG picture?" This patient has asthma, ongoing difficulty in breathing and a rising CO2 (the fact that it is in the normal range is irrelevant) . What are the 3 things that affect low accuracy in capillary gas samples? pO2 17 mmHg She is three days post-cholecystectomy and has been complaining of shortness of breath. Pyrexia points more towards pneumonia (but PE can give a mild pyrexia). Arterial Blood Gas Analysis: Example Set 2 Case A. It is an alternative to an ABG. Calculate this patient’s Aa gradient. Below are some brief clinical scenarios with ABG results. oxygen delivery). Note that despite the low pH the pCO2 is also high. What is a capillary blood gas used for? 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. The arterial pH and CO2 correlate well with capillary blood gas results. Again, make sure you do the practice problems found in this lesson using the ROME or arrow method. The drop in pH represents the normal mechanisms of compensation being over whelmed. ARTERIAL BLOOD GAS EXAMPLES 1. pH 7.32 Pa 67 PaO 47 HCO3 37 What is this? blood work. With the above history this is likely to represent an acute on chronic respiratory acidosis. pCO2 74 mmHg Question 2. Each hemoglobin molecule contains four atoms of iron and therefore can combine with four molecules of oxygen. Oxygen administration in this group is a complicated issue. laryngeal mask airway [LMA], i-Gel), click here to learn the best way to interpret ABGs, Blood Transfusion And Intravenous Infusion – Clinical Skills. A 75 year old gentleman living in the community is being assessed for home oxygen. However, the femoral artery and brachial artery can be used if necessary. 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) … DKA, lactic acidosis (produced by poorly perfused tissues), From the GI tract (diarrhoea or high-output stoma), E.g. Question 1. He is complaining of non-specific abdominal pain. An arterial blood gas is performed and reveals: pH 7.37, PCO 2 57, PO 2 70, HCO 3-32. He has emesis on his shirt. The three main states of matter are solid, liquid, and gas. He is complaining of non-specific abdominal pain. 14. 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. Creatinine 95 umol/L pH 7.25 What does this ABG show and what is the differential diagnosis? Cap refill 2 s This is the classic picture of aspirin overdose. Her ABG is as follows: See relevant pages in the respiratory section for further information. But knowing timing is everything in these exams I’m keen to keep any calculations as brief as possible! And it's FREE! I’m just wondering when it comes to the written exam if they’ll be accepting of the range of approaches / worked examples? We even provided a cheatsheet for you with that ROME chart on it that you can use as a resource. pH 7.22 Na+ 137 mmol/L BP 135/99 mmHg RR 28 /min Examples. The radial artery on the wrist is most commonly used to obtain the sample. She denies this. A common example is ice. This leaves the following equation: N.B. They mostly come from collected results of volunteers or study subjects who appear to have uncompromised lungs and gas exchange. So, that’s the ROME blood gas interpretation method. Consider which blood gas disorders could be affecting the following patients (for reference ranges see Box 2, p87). Reference range usually 7–16 mEq/L (but varies between hospitals, some using 3-11). Recently at the EM Core we discussed headache and the red eye. Acid-base status: • The patient has a low pH (acidemia) • The PCO 2 is high (respiratory acidosis) and the bicarbonate is high (metabolic alkalosis). Lactate 1.6 mmol/L. This field is for validation purposes and should be left unchanged. He has been diagnosed with Hashimoto’s thyroiditis by his local doctor 4 months previously. Justify your answer. Monitor severity and progression of a known disease process. pO2 25 A 21 year old man is brought in by his father with a one week history of vomiting. 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. A 67 year-old man with a history of peptic ulcer disease presents with persistent vomiting. You are working in the emergency room when the paramedics bring in a 45 year-old man who was found down in Pioneer Square. This would indicate that the patient normally retains CO2 and has a chronically raised HCO3. Arterial Blood Gas Sample. Practice examples. BE +10 Nothing acutely as this man does not meet the criteria for long-term oxygen therapy (LTOT). This is a compensated respiratory acidosis. 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. 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. Get the latest updates on our Conferences PLUS our Webcasts and Education Newsletters. Her arterial blood gases are as follows: pH: 7.31. A normally fit and well 11 year-old boy presents with diarrhoea and vomiting. K+ 4.1 mmol/L 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. Question 3. On auscultation of the chest there are widespread crackles and you notice moderate ankle oedema. A blood gas test measures the amount of oxygen and carbon dioxide in the blood.
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