9. SBAR and ABG

Question 1

What is the anagram of SBAR

Answer 1

S- Situation
B- Background
A- Assessment
R- Recommendation

Question 2

What should be described in the “S”

Answer 2

Who you are, where you’re calling from
Patient indentification and DOB
What ward you’re on
What you’re looking for in the consultation

Question 3

What is involved in the background situation

Answer 3

Why they are in hospital
Past medical history
Previous functional history

Question 4

What is involved in the assessment stage?

Answer 4

Observations
Treatment you’ve introduced at this point
Say what you think the problem is

Question 5

What is involved in the recommendation stage?

Answer 5

Can you see the patient (plus timeframe)

Anything I can do that can be helpful

Question 6

Why do arterial blood gas?

Answer 6

To assess respiratory function
Assess hypoxia, hypercapnia
Assess acid-base balance

Question 7

What is the most important reaction maintain pH in the body

Answer 7

Hydrogen and bicarbonate forming carbonic acid

Question 8

How does the respiratory system control pH?

Answer 8

pH is too low the body releases carbon dioxide, increasing ventilation increasing pH
pH too high the body holds onto carbon dioxide, lowering ventilation lowering pH

Takes 15-30 minutes

Question 9

How do the kidneys regulate pH?

Answer 9

Kidney can enhance excretion of acid- raises pH

Takes around 12-24 hours

Question 10

What does base excess tell you about an individuals health?

Answer 10

Base excess in the negative then metabolic acidosis or compensated respiratory alkalosis

Normal values -2. +2

Question 11

What does an increased negative base excess tell you?

Answer 11

Indicates hypoxic tissue is causing lactic acid to build up and therefore there is less base excess as it is being used to counteract it

Question 12

What is involved in a metabolic acidosis

Answer 12

High hydrogen ions
Low bicarbonate
To compensate there would be low carbon dioxide

Question 13

What would be involved in a metabolic alkalosis

Answer 13

Low hydrogen ions
High bicarbonate

Compensate decreased ventilation, more CO2

Question 14

What is involved in a repair story acidosis?

Answer 14

Hydrogen ions are high
Carbon dioxide is high
To compensate there would be increased bicarbonate

Question 15

What is involved in a respiratory alkalosis?

Answer 15

Low hydrogen ions
Low carbon dioxide levels
To compensate there would be decreased bicarbonate levels

Question 16

What causes a respiratory acididosis?

Answer 16

A build up of carbon dioxide due to poor expiratory ventilation leads to an increased pH. Causes include

Severe acute asthma
Severe pneumonia
Exacerbation of COPD
Neuromuscular disorders
CNS depression

Question 17

What causes a respiratory alkalosis?

Answer 17

Hyperventilation leading to less CO2 and decreased hydrogen ions. Causes include:

Salicylate poisoning
CNS disorders

Question 18

What causes a metabolic acidosis?

Answer 18

Caused by an increased production of organic acids or a loss of bicarbonate. Acronym of causes is described as KUSSSMALE

Question 19

What is KUSSSMALE

Answer 19

Kept-acidosis
Uraemia
Salicyte/paracetamol poisoning 
Severe bicarbonate loss (GI fistula, diarrhoea)
Starvation
Methanol
Alcohol 
Lactic acidosis
Ethylene glycol (antifreeze)

Question 20

What are the causes of metabolic alkalosis?

Answer 20

Loss of acid- vomiting, Ng suction

Loss of potassium- excess diuretics, Cushing. Liquorice ingestion, exudes alkali ingestion