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Clin Lab Med > ABG > Flashcards

ABG Flashcards

1
Q

What does you use the Allen test for?

A

To ensure there is adequate circulation in the ulnar artery so that blood flow to the hand isn’t compromised when ABG is performed on the radial artery

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2
Q

What artery is typically used for ABG?

A

Radial artery

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3
Q

An ABG will tell you what? (3)

A
  1. Oxygenation
  2. Ventilation
  3. Acid-base balance
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4
Q

pO2 is used to determine what?

A

How well a pt is oxygenating (not used in determination of acid-base disturbances)

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5
Q

Is pO2 from pulse ox or ABG more reliable?

A

ABG

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6
Q

If pCO2 is high (>45) do you have acidosis or alkalosis?

A

Acidosis

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7
Q

If pCO2 is low (<35) do you have acidosis or alkalosis?

A

Alkalosis

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8
Q

If HCO3 is high (>26) do you have acidosis or alkalosis?

A

Alkalosis

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9
Q

If HCO3 is low (<22) do you have acidosis or alkalosis?

A

Acidosis

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10
Q

Is an ABN pCO2 reflective of a respiratory or metabolic problem?

A

respiratory

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11
Q

Is an ABN HCO3 reflective of a respiratory or metabolic problem?

A

metabolic

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12
Q

What is the tx for acid-base disturbance?

A

Treat the underlying disease causing the imbalance

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13
Q

Will the body be able to fully compensate for the disorder causing a pH imbalance?

A

No (won’t restore pH back to 7.4)

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14
Q

Are the lung or kidneys quick to respond to pH imbalance?

A

Lungs

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15
Q

How do the lungs compensate for a metabolic acid-base disturbance?

A

If pH is low (acidic), lungs will hyperventilate to blow of more pCO2 (blow off acid)

If pH is high (basic), lungs will hypoventilate to retain CO2 (retain acid)

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16
Q

Are the kidneys fast or slow to respond to respiratory acid-base imbalance?

A

Slow

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17
Q

How do the kidneys compensate for a respiratory acid-base disturbance?

A

If pH is low (acidic) will retain HCO3 (basic)

If pH is high (basic) will increase excretion of HCO3

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18
Q

What does it mean when you have an uncompensated state?

A

Primary defect in pCO2 or HCO3 WITHOUT a change in the other parameter

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19
Q

What does it mean when you have a compensated state?

A

Primary defect in pCO2 or HCO3 WITH a change in the other parameter
*pCO2 and HCO3 move in the same direction

20
Q

What does a “partial” or “full” compensation refer to?

A

pH

21
Q

What is a “full” compensation?

A

pH is restored to 7.35-7.45 (pt is compensating well)

22
Q

What is a “partial” compensation?

A

pH is outside to 7.35-7.45 (pt is not compensating well)

23
Q

When do you calculate an Anion gap?

A

If pt has a metabolic acidosis

24
Q

What is your first step in determining if there is an acid-base disturbance?

A

Look at pH

25
Q

Once you determine pt has acid or base disturbance by evaluating pH, what do you look at next?

A

HCO3 and PCO2 to determine what is the main cause

26
Q

Respiratory acidosis will be due to pulmonary retention/impaired CO2 excretion. What are some of the major causes? (5)

A
  1. Lung/pleural disease (ex: COPD, airway obstruction, PE, pneumonia)
  2. Neuromuscular diseases (Gillian-Barre, Myasthenia gravis, spinal cord injury)
  3. Chest wall dysfunction
  4. Drug induced hypoventilation (opioids, benzos)
  5. CNS event, trauma
27
Q

Pt presents with acute onset of dyspnea and in respiratory distress. On exam you find mental status changes, somnolence, hemodynamic instability. This presentation of sx is consistent with what? What acid-base disturbance are you concerned about?

A

Presentation of sx = hypercapnia

Concerned for respiratory acidosis

28
Q

What is the tx for respiratory acidosis?

A

BiPAP (Bilevel Positive Airway Pressure) and respiratory support

29
Q

Anxiety, fever, pain, sepsis, pregnancy, salicylate intoxication and high altitude can all cause what acid-base disturbance?

A

Respiratory alkalosis (hyperventilation)

30
Q

Pt presents with tachypnea, palpitations, lightheadedness, and paresthesia’s. What acid-base disturbance are you concerned about?

A

Respiratory alkalosis

31
Q

What is the range for a normal anion gap?

A

8-12 mmol/L

32
Q

MUDPILES is the pneumonic for what? What does is stand for?

A

Elevated anion gap

Methanol
Uremia (from renal failure)
DKA (ketoacidosis)
Propylene glycol
Iron/isoniazid
Lactate (lactic acidosis)
Ethylene glycol
Salicylate/starvation
33
Q

Bicarbonate loss from: diarrhea, pancreatic drainage, GI fistulas, and renal tubular necrosis will have what effect on anion cap?

A

Will not effect anion gap

34
Q

Pt presents with hyperventilation, tachycardia/arrhythmia and hyperkalemia. What acid-base disturbance are you concerned about?

A

Metabolic acidosis

Pt can also present with AMS

35
Q

Kussmaul breathing is associated with what acidotic condition?

A

DKA

36
Q

Treatment of underlying cause, dialysis, +/- bicarbonate therapy are tx for what acid-base disturbance?

A

metabolic acidosis

Caution w/ bicarbonate therapy. Can lead to hyponatremia and volume issues

37
Q

With what acid-base disturbance do you check a urine chloride?

A

metabolic alkalosis

38
Q

If urine chloride (metabolic alkalosis) is < 20 what do you suspect might be the cause? (2)

A
  1. GI loss (vomiting, NG suction)

2. Diuretics

39
Q

Is a urine chloride < 20 responsive to fluid and Cl replacement?

A

yes

Sx due to volume contraction/dehydration

40
Q

If urine chloride (metabolic alkalosis) is >20 what do you suspect might be the cause? (5)

A
  1. Hyperaldosteronism
  2. Cushings
  3. Renin secreting tumor
  4. Potassium depletion
  5. Citrate toxicity related to blood transfusion
41
Q

Is a urine chloride > 20 responsive to fluid and Cl replacement?

A

No. Treat underlying cause, +/- potassium

Sx due to volume expansion/overload

42
Q

Pt presents with reduced ventilatory rate, arrhythmia, hypokalemia. What acid-base disturbance are you concerned about?

A

Metabolic alkalosis

43
Q

T or F: You can both metabolic alkalosis and acidosis at the same time

A

TRUE

44
Q

T or F: you can have both respiratory alkalosis and respiratory acidosis at the same time?

A

FALSE. Can only have 1 respiratory disorder

45
Q

How many acid base disturbances can you have at one time?

A
  1. metabolic alkalosis and acidosis, and 1 respiratory disorder

Clin Lab Med (4 decks)

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