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Critical Care 1 > ABG > Flashcards

ABG Flashcards

1
Q

normal bicarbonate

A

HCO3 = 22-26

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2
Q

normal base deficit/excess

A

-2 to +2

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3
Q

what is the pH scale

A

power (logarithmic) scale that shows the inverse relationship of hydrogen ions
-low pH/acid =pH lots of H

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4
Q

buildup of CO2

A

acid

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5
Q

what does high CO2 indicate

A

acid buildup
low pH
apnea/hypoventilation

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6
Q

what is Co2 regulation a function of

A

CO2 regulation is a function of minute folume

minute volume = tidal volume (Vt) x RR (F)

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7
Q

Vt on ventilator settings

A

tidal volume

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8
Q

tidal volume on ventilator settings

A

Vt

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9
Q

RR on ventilator

A

frequency = F

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10
Q

F on ventilator settings

A

RR

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11
Q

CO2 over 45

A

acid buildup

hypoventilation/apnea

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12
Q

CO2 if apnea

A

high Co2 over 45

acidosis

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13
Q

CO2 if hypoventilation

A

high Co2 over 45.

acidic

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14
Q

CO2 under 35

A

alkalosis

high pH

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15
Q

CO2 if alkalosis

A

under 35

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16
Q

Vt x R

A

minute ventilatiob = Vt x F

tidal volume x RR

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17
Q

how does pH and bicarbonate move

A

opposite directions
22 is acidotic
26 is alkalosis

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18
Q

pH if too much bicarb

A

bicarb is alkalotic

over 26 bicarbonate

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19
Q

pH if too little bicarbonate

A

under 22

acidosis

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20
Q

under 22 bicarb

A

too little bicarbonate
bicarb and pH move in teh same direction
alkalosis

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21
Q

what is base excess/deficit

A

the amount of excess or deficit amount of base present in blood

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22
Q

base deficit of -4

A

indicator for blood transufusion

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23
Q

base deficit where you would consider blood transfusion

A

base deficit of

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24
Q

base deficit where death is likely

A

over -19

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25
Q

replacement formula for bicarbonate

A

0.1 x (-base excess) x weight in kg = bicarb needed

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26
Q

SaO2 at PaO2 90

A

100%

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27
Q

SaO2 at pO2 60

A

90%

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28
Q

SaO2 at pO2 30

A

60%

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29
Q

SaO2 at pO2 27

A

50%

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30
Q

what does pulse ox measure

A

SaO2

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31
Q

left shift affinity

A

increased

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32
Q

left shift mneumonic

A

Left = LOW

acidosis, temp, 2,3-DPG, pCO2

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33
Q

right shift mneumonic

A

Right = RAISe

alkalosis, temp, 2,3-DPG, PCO2

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34
Q

what 5 things change in left/right shift

A 
LEft = LOW
Right = Raise
\+H
temperature
PCO2
2,3-DPG
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35
Q

CO2 & pH

A

Co2 is an acid so it makes ABG more acidotic

left shift

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36
Q

Bicarbonate & pH

A

bicarb is a base so makes ABG more alkalotic

right shift

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37
Q

CO2 follows pH

A

respiratory

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38
Q

bicarbotate follows pH

A

metabolic

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39
Q

how to tell if the ABG is compensated

A

the compensatory mechanism is teh opposite of the primary problem

  • respiratory acidosis is compensated by bicarb
  • metabolic alkalosis is compensated by CO2
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40
Q

compensated respiratory acidosis

A

compensated by bicarbonate

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41
Q

compensated metabolic alkalosis

A

compensated by CO2 (acid)

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42
Q

partially compensated

A

pH outside normal range

both resp & metabolic are outside of normal range

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43
Q

pH/resp/metabolic are all ouside of normal range

A

partially compensated

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44
Q

pH is normal, resp/metaboliic are ousided normal range

A

fully compensated

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45
Q

fully compensated

A

abnormal pH

normal CO2/bicarb

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46
Q

critical pH for intubation

A

pH under 7.2

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47
Q

pH under 7.2

A

intubate b/c critical

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48
Q

pCO2 over 55

A

intubate b/c critical

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49
Q

critical pCO2 to intubate

A

over 55

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50
Q

critical pO2 to intubate

A

under 60

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51
Q

pO2 under 60

A

intubate

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52
Q

acid/base if vomiting/NG/suction/dieuretics/diamox/antacid poisioning

A

metabolic alkalosis

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53
Q

causes of metabolic alkalosis

A

vomit/NG/suction/dieuretics/diamox/antacid overdose

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54
Q

considered lactic acidosis

A

lactate over 4

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55
Q

causes of m. acidosis

A

lactic acidosis, ketones, hyperthermia/fever, seizures, rhabdo

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56
Q

bicarb in m. alkalosis

A

over 26

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57
Q

bicarb in m. acidosis

A

under 22

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58
Q

acid base in antacid poisioning

A

m. alkalosis

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59
Q

acide base in sepsis

A

m. acidosis

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60
Q

acid base in rhabdo

A

m. acidosis

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61
Q

acid base in hyperthermia

A

m. acidosis

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62
Q

acid base in seizures

A

m. acidosis

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63
Q

Co2 in r. alkalosis

A

low CO2 under 35

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64
Q

acid base if hyperventilating

A

r. alkalosis

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65
Q

acid base in hypoermetabolic staes

A

resp alkalosis

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66
Q

acid base in high altitudes

A

r. alkalosis

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67
Q

acid base in ASA poisioning

A

r. alkalosis (CO2 less than 35) b/c it is a respiratory system stimulant

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68
Q

what happens in ASA poisioning

A

respiratory system stimulant so r. alkalosis a

hyperventilation

69
Q

hyperventilation

A

r. alkalosis

Co2 under 35

70
Q

hypoventilation

A

r. acidosis

CO2 over 45

71
Q

Co2 in hyperventilation

A

under 35

alkalosis

72
Q

CO2 in hypoventilation

A

over 45

acidosis

73
Q

when is minute ventilation increased

A

increased to blow off CO2 (Vt x RR)
in hyperthmic states like malignant hyperthermia
limited ability to remove by hgb

74
Q

every ___ in pH, expect change in bicarbonate by ___ in ___ direction

A

0.15 pH
10 bicarb
same direction

75
Q

every ___ in pH, expect change in K by ___ in ___

A

0.1 pH
K shifts 0.6
oppositr direction

76
Q

physiology of the pH & K relationship

A

*every 0.1 change in pH, K shifts 0.6 in the opposite direction
*as pH lowers, K shifts outside the cell giving a falsely elevated K level.
when correct imbalance by raising pH, K shifts intracellulary so life threatening low K

77
Q

every change in ___ ETCO2, expect pH to change by ___ in the ___ direction

A

10 mm hg ETCO2
0.08
opposite direction

78
Q

every change in ___ CO2, K shifts ___ in teh ___ direction

A

10 CO2
K 0/5
same direction

79
Q

pH & K relationship
VERSUS
CO2 & K

A

every change in 0.1 pH, the K shifts 0.6 in the opposite direction

every change in 10 CO2, K shifts 0.5 in the same direction

80
Q

ABG to intubate

A

7.2 pH
CO2 over 55
PaO2 <60
*intubate even if only 1 is off

81
Q

Pediatric Assessment Triangle

A

appearance
work of breathing
circulation

82
Q

ETT size for pediatrics

A

16 + age in years
divided by
4

83
Q

16 + age/4ll

A

ETT size for pediatrics

84
Q

emergency airway for pediatricsl

A

needle cric if under 8l

85
Q

difficult airway predictors0+

A

LEMON, HEAVEN

look, evaluate w/ 3-3-2, Mallampati, obstruction, neck mobility

86
Q

3-3-2

A

difficult aiwary predictor
3 fingers in mouth
3 fingers between jaw and hyoid
2 fingers between hyoid and thyroid

87
Q

Mallampati 2

A

tonsillar pillars hidden by tongue

88
Q

Mallampati 3

A

only base of uvula is seen

89
Q

LEMON

A 
look
evaluate w/3-3-2
mallampati
obstruction
neck mobility
90
Q

HEAVEN

A 
predictors in difficult emergent airways
Hypoxemia under 93%
extreme of size (under 8 or obese)
anatomic challenges
vomit/blood/fluid
exsanguination/anemia
neck monility
91
Q

“E” in HEAVEN

A

exsanguination/anemia can accelerate decompensation during RSI

92
Q

ramping

A

ear to sternal notch

93
Q

problem of the supine position during intubation

A 
ramp instead (ear to sternal notch)
decrease functional reserve capacity/tidal volume/preload
94
Q

posterior pressure on cricoid cartiliage believed to occlude the esophagus

A

Sellick maneuver

95
Q

External Laryngeal Manipulation

A

provider brings cords into view the the assistant holds pressure.

96
Q

Macintosh v MIller blade

A

Macintosh = lifts epiglottis via vallecula

Miller - direct displacement of the epiglottis

97
Q

preferred intubation blade for pediatrics

A

Miller (direct displacement of the epiglottis)

98
Q

bougie size adult versus kids

A 
adult = 15 Fr
kids = 10Fr
99
Q

problem of supraglittic devices

A

blind insertion

little protection agaisnt aspiration

100
Q

air inflation into ETT

A

25mm is standard

101
Q

CXR confirmation of ETT placement

A

distal tip 2-4 cm above carina
level of T3-T4
confirm by visualizing Murphy’s eye where the clavicle meets

102
Q

waveform of the ETCO2

A

half square

expiration - expiratory plateau- ETCO2- inhalation- baseline

103
Q

where is ETCO2 measured on the ETCO2 waveform?

A

right side of square

104
Q

what can you do when you are preparing & pretreating a pt for RSI intubation

A

3-5 min of passive oxygen via NC 10-15L

105
Q

pretreatment for RSI

A

LOAD

106
Q

position for RSI

A

ear to sternal notch = ramping

pad behind shoulder for pediatrics

107
Q

reason for RSI pretreatment

A

LOAD
b/c manipulation of the hypopharynx, larynx, and trachea may cause a reflex sympathet9c response leading to catecholamine mediated increase in BP/HR/ICP

108
Q

RSI preteatment options

A 
LOAD
Lidocaine 
Opiates
Atropine
Defssciculating
109
Q

lidocaine as RSI pretreatment

A

blunts the cough reflex preventiong ICP increase

110
Q

opiates as RSI pretreatment

A

blunts the pain response

111
Q

atropine as RSI pretreatment

A

prevents reflexive bradycardia in infants under 1yo

112
Q

defasciculating rx as RSI pretreatemnt

A

1/10 dose of Roc or VEc prior to administering Succ

113
Q

Fentanyl as RSI analgesic

dose, onset, duration, complication

A

1mcg/kg
onset 3-5 min
duration 30-60 min
low risk of chest wall rigidity

114
Q

RSI for awake sedation

A

Etomidate

115
Q

dose for Etomidate

A

0.3mg/kg

116
Q

onset/duration for Etomidate

A

15-45sec onset

lasts 3-12 min

117
Q

caution w/Etomidate

A

no analgesic
short duration (3-12 min)
use cautiously if hemodyanmically unstable
vomit when awake
NOT: if adrenal suppression, shock/Addisions/CODP/asthma

118
Q

RSI not to use if adrenal suppression

A

ETomidate

119
Q

RSI not to use if in shock

A

Etomidate = don’t use if adrenal suippression/shock/COPD/asthma/Addisions, or if hymedynamically unstable

120
Q

common SE w/Etomidate

A

common to vomit when awake

121
Q

properties of KEtamine

A

hypnotic
analgesic
Amnesic

122
Q

benefit of Ketamine

A

has unique ability to preserve laryngeal reflex/help w/airway preotection

123
Q

best RSI for asthma/airway issues

A

Ketamine b/c preserves laryngeal reflexes/airway protection

124
Q

Ketamine dose for RSI

A

1-2mg/kg

125
Q

onset and duration of Ketamine

A 
onse = 40 -60 sec
duration = 10-20min
126
Q

best RSI for asthatics w/reactive airway complications

A

Ketamine is a potent bronchodilator

127
Q

SE of ketamine

A

may hallucinate

may cause laryngospasms

128
Q

reversal agent for Versed

A

Flumazenil 02mg

129
Q

SE of Flumazenil

A

BP

130
Q

good RSI choice if shock

A

Ketamine

131
Q

what is propofol

A

hypnotic w/ no analgesic properties

“milk of amnesia”

132
Q

dose of Propofol

A

1-2mg/kg

25-50mcg/kg/min maintence

133
Q

onset/duration of propofol

A

onset 15-45 sec

duration 5-10 minutes

134
Q

RSI decreases MAP/CPP

A

PRopofol

135
Q

what cannot Propofol do

A

milk of amnesia - hyponotic BUT NO PAIN RX

136
Q

who should not have Propofol

A

decreases CPP & MAP so not for HEad INjury or if hemodynamically unstable

137
Q

contraindicatiosn for Propofol

A

Head injury & hemodynamically unstable

*b/c decreases MAP/CPP

138
Q

RSI rx & their complications

A

Fentnanyl - chest wall rigidity, hypotension
ETomidate - adrenal suppression
Ketamine preserves laryngeal function so airway protect
Propofol = decreases CPP/MAP so not for head injury or hemodyunamically unstable

139
Q

RSI induction

A

fentanyl, etomidate, ketamine, propofol

140
Q

what will you see someone on Succ do

A

fasciculation = muscle twitch

141
Q

SE of SUCC - 2

A

high K

malignant hyperthermia

142
Q

what is linked to malignant hyperthermia

A

Succ

143
Q

drug class of Succ

A

depolarizing neuromuccular agent

144
Q

burns contraindicate dfor Succ

A

over 24hrs

145
Q

contrainidcation for SUcc

A 
burns over 24hr
rhabdo, high K
hx of Malignant hyperthermia
crush or eye injuries
any nervous system injury like G-B or MG
146
Q

pathophysiology of Malignant Hyperthermia

A

defect in skeletal muscle sarcoplasmic retiulum

*r/t problem w/Ca removal from the cell

147
Q

treat Malignant Hyperthermia

A

Dantrolene

NEVER CaChannel blockers (b/c MH is a problem w/sustained Ca removal from teh cell)

148
Q

Rx not to give someone with Maligant Hyperthermia

A

Ca ChB (b/c probelm with calcium removal from the muscle_

149
Q

s/s of Malignant Hyperthermia

A 
sustINED TETANIC MUSCLE CONTRACTION
masseter spasm
trismus (lockjaw)
rapid incrase in temp up to 110F
HTN/high RR
mixed acidosis
increased ETCO2
150
Q

acid base in Malignant Hyperthermia

A

mixed acidosis
increased ETCO2
tachycardia

151
Q

lockjaw

A

trismus

152
Q

when do you give Dantrolene

A

for Malignant Hyperthermia s/p gases or Succ

153
Q

cause of Malignant Hyperthermia

A

induction gasses or Succ

154
Q

dose of Succ

A

2.5mg/kg

155
Q

Sugammadex

A

reverses Roc

156
Q

reverses Roc

A

Sugammadex

157
Q

drug class of Roc

A

Non-Depolarizing Neuromuscular BLocking

158
Q

onset/duration of Roc

A

0.6 - 1.2 mg/kg

159
Q

onset and duration of Roc

A

onset under 2 min

lduration 30-60 moin

160
Q

important Rx to give if induce w/vec or roc

A

NO pain management

161
Q

how to dose RSI if pt is hemodynamically unstable/shock and low CO

A

1/2 induction. less rx is needed due to depleted catecholamine stores

double paralytic b/c low CO slowws the onset

162
Q

RSI dose of induction agent if pt is shock/hemodynamically unstable w/ low CO

A

1/2 induction.

less rx is needed due to depleted catacholamine stores

163
Q

RSI dose of paralytic if pt is shock/hemodynamically unstable w/low CO

A

double paralytic b/c low CO slows the onset

164
Q

SALAD technique

A

suction assisted laryngoscopy airway decontamination

clear airway w/ suction, plae suction in the esophagus wile the intunation tube is passed.

165
Q

post intubation management

A

Fentanyl, KEtamine, Versed drip

166
Q

failed airway algorithm

A

3 attemps of laryngoscopy unsuccessful

can’t intubate, ventilatie, oxygenate = CRIC

167
Q

what do you palpate for when you cric

A

feel for ht ecricothyroid membrane

168
Q

what type of cri to use

A

surgical cric over 8yo

needle crif if under 8

Critical Care 1 (14 decks)

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