Acid & Base

Question 1

pH 7.28
Co2 50
HCO3 > 25

what do you order?

Answer 1

ph: acidotic
co2: high

respiratory acidosis

lethargic,not breathing, overdose

tx: increase rate of breathing
increase rate on ventilator
narcan

Question 2

Respiratory alkalosis

Answer 2

pH: high
co2: low
serum HCO3 low if chronic

shallow rapid respirations

decrease rate on ventilator
breathe into bag

Question 3

metabolic acidosis

Answer 3

low serum HCO3**

if anion gap increased, the clinical situation is generally more acute

Question 4

What causes increased anion gap

Answer 4

• DKA
• alcoholic KA
• drug or chemical anion

Question 5

metabolic acidosis with normal anion gap causes

Answer 5

• diarrhea
• ileostomy
• renal tubular acidosis
• recovery from DKA

Question 6

Treatment of metabolic acidosis with increased gap

Answer 6

• underlying disorder treated
• fluids resuscitation
• hco3 generally not indicated if acidosis is d/t hypoxia or dka
• hco3 indicated if significant hyperkalemia present***

Question 7

Metabolic Alkalosis

Answer 7

HCO3: high
ph: high
compensatory CO2 rarely exceeds 55
if pCO2 is > 55 superimposed respiratory acidosis is likely

Question 8

metabolic acidosis

Answer 8

pH: low
Bicarb: low

Question 9

cdiff sets pt up for what?

Answer 9

metabolic acidosis because losing base

Question 10

Metabolic alkalosis causes

Answer 10

post-hypercapnia alkalosis
NG suction
Vomiting
Diuretics

Question 11

Management of Metabolic Alkalosis

Answer 11

• correct volume deficit with NaCl and KCL
• dc diuretics
• H2 blockers in patients with diuretics
• acetazolamide IV if volume replacement is contraindicated

Question 12

Labs and diagnostics of Metabolic Alkalosis

Answer 12

pH >7.45
HCO3 >26
pCO2 > 45 and < 55
K and Cl decreased
may see increased gap

Question 13

R-O-M-E

Answer 13

respiratory opposite

metabolic equal

Question 14

Rule of 9s

Answer 14

each arm 9%
each leg 18%
front and back chest 18%
Head 9%
neck 1%
perineum/genitals 1%

Question 15

Fluid resuscitation in burns

Answer 15

-4ml/kg x TBSA first 24 hours
-1/2 given first 8 hours
-other 1/2 in next 16 hours
resuscitation begins at time of burn not when they arrive to ed

Question 16

Fluids for burns

Answer 16

crystalloid, no colloids

Question 17

what do you monitor for in burn patients in the first 24-48 hours?

Answer 17

-hyperkalemia

Question 18

what do you monitor for after first 24-48 hours in a burn patient

Answer 18

hypokalemia around 3 days post burn

Question 19

what are 3 indications to intubate with a burn patient?

Answer 19

• burns to face
• singed nares or eyebrows
• dark soot/mucous from nares and/or mouth

Question 20

Burn pearls:

Answer 20

submerge clean water

• no ice, lotions, lard, butter
• wrap in clean wet towel
• sterile NS initial treatment
• maintain normal temp**
• pain management
• tar burn injury: use petroleum based product to remove burning tar
• silvadene to treat 2nd and 3rd degree burns