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CVPR 322 Physiologic assesment > Blood Gases 1 > Flashcards

Blood Gases 1 Flashcards

1
Q

Arterial/venous blood gases/ Circuit arterial/venous blood gases are an invaluable tool in assessingthe following 3 things?

A
  • ventilation
  • acid-base balance
  • oxygenation
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2
Q

Arterial Blood Gas It is an invasive procedure, it helps to differentiate oxygen deficiencies from

A

primary ventilatory deficiencies from

primary metabolic acid-base abnormalities

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3
Q

PaO2

A

partial pressure of oxygen dissolved in the plasma only. 90 - 100

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4
Q

SaO2

A

measured degree to which oxygen is bound to hemoglobin.

> 95%

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5
Q

PaCO2

A

-partial pressure of carbon dioxide dissolved in the plasma. - The rest is inside the red blood cells on a hemoglobin molecule 35 - 45

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6
Q

HCO3

A

Bicarbonate buffer 24 + or - 2

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7
Q

pH

A

Negative logarithm of the number of hydrogen ions (H+) in a solution, expressed as a number between 1 and 14 7.35 - 7.45

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8
Q

BE

A

Base Excess (-2) - (+2)

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9
Q

Acid/Base Relationship is critical for homeostasis, Significant deviations from normal pH ranges are

A

poorly tolerated and may be life threatening

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10
Q

Acid/Base Relationship is Achieved by ?

A

Respiratory and Renal systems

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11
Q

There are two buffers that work in pairs that are linked to the Respiratory and Renal compensatory system

A

H2CO3 Carbonic acid NaHCO3 base bicarbonate

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12
Q

Respiratory Component

A

H2CO3 Carbonic acid CO2 + H2O = H2CO3

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13
Q

Approximately 98% normal metabolites are in the form of ?

A

CO2

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14
Q

Metabolic Component Function of the kidneys

A

Na HCO3 base bicarbonate

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15
Q

carbonic anhydrase

A

an enzyme that accelerates hydration/dehydration CO2 in renal epithelial cells

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16
Q

active exchange of Na+ for H+ happens between the ____ ___ and the _____ ______.

A

tubularcells and glomerular filtrate

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17
Q

6 Normal ABG values

A

pH 7.35 – 7.45 PCO2 35 – 45 mmHg PO2 80 – 100 mmHg HCO3 22 – 26 mmol/L BE -2 - +2 SaO2 >95%

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18
Q

pH < 7.35 PCO2 > 45 HCO3 < 22

A

Acidosis

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19
Q

pH > 7.45 PCO2 < 35 HCO3 > 26

A

Alkalosis

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20
Q

Think of CO2 as an acid, failure of the lungs to exhale adequate CO2 results in what ?

A

Respiratory Acidosis

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21
Q

pH < 7.35 PCO2 > 45

A

Respiratory Acidosis

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22
Q

CO2 + H2CO3 =

A

decrease in pH

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23
Q

5 Non CPB Causes of Respiratory Acidosis

A
  • emphysema - drug overdose - narcosis - respiratory arrest - airway obstruction
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24
Q

2 Causes of Respiratory Acidosis while on CPB?

A
  • Gas flow rate - Sweep rate
25
Q

5 Non CPB Causes of Metabolic Acidosis

A
  • renal failure - diabetic ketoacidosis - lactic acidosis - excessive diarrhea - cardiac arrest
26
Q

1 Cause of Metabolic Acidosis while on CPB?

A

Poor perfusion

27
Q

too much CO2 exhaled (hyperventilation) causes what ?

A

Respiratory Alkalosis

28
Q

pH > 7.45 PCO2 < 35

A

Respiratory Alkalosis

29
Q

What are 6 Causes of Respiratory Alkalosis

A
  • hyperventilation - panic d/o - pain - pregnancy - acute anemia - salicylate overdose
30
Q

pH > 7.45 HCO3 > 26

A

Metabolic Alkalosis

31
Q

3 Causes of Metabolic Alkalosis Non CPB ?

A

• Increase loss of acid from stomach or kidney • hypokalemia • excessive alkali intake Tums overdose

32
Q

1 cause of Metabolic Alkalosis while on CPB?

A

Too much Bicarb

33
Q

Step 1 in ABG interpretation, Examine the PaO2 & SaO2 to determine ?

A

oxygenation status

34
Q

Low PaO2 (<80 mmHg) & SaO2 means what?

A

hypoxia

35
Q

NL/elevated oxygen means

A

adequate oxygenation

36
Q

Step 2 in ABG interpretation, evaluate the ___?

A

PH

37
Q

Step 3 in ABG interpretation, evaluate whether its a ___ or ___ component?

A

Respiratory / Metabolic

38
Q

Step 4 in ABG interpretation, determine if there is a ?

A

compensatory mechanism working to try to correct the pH.

39
Q

What is the main functional substance of RBCs.

A
  • Hemoglobin, consists of 4 heme molecules. responsible for blood’s red color - Contain iron in the Ferrous state
40
Q

Male normal hgb ? hct ?

A

13-16 gm/dl 42-50%

41
Q

Female normal hgb ? hct ?

A

12-15 gm/dl 40 -48%

42
Q

Hemoglobin makes up _____ of the dry weight of RBC’s

A

95 %

43
Q

destruction of red blood cell membrane.

A

Hemolysis

44
Q

When the RBC membrane ruptures Hb is released into the plasma these subunits can block the ____ of ____ __ ____causing impairment/failure of these organs..

A

micro vasculature of kidneys and lungs

45
Q

3 Primary forms of CO2 Transport

A
  • 5% dissolved in plasma -15% combine w/ Hb (Carbamino hemoglobin -80% enters the RBC and converted to H2CO3
46
Q

80% of CO2 enters the RBC and is converted to?

A

H2CO3

47
Q

15% of CO2 combines with _____ as it enters the blood stream?

A

Hb (Carbamino hemoglobin)

48
Q

5% of CO2 is dissolved in ___ as it crosses the capillary wall?

A

Plasma

49
Q

The “Haldane Effect”

A

Increase in CO2 Displaces oxygen from the hemoglobin which causes an increase in O2 delivery.

50
Q

The reverse “Haldane Effect”

A

binding of O2 to hemoglobin tends to displace CO2 from the blood

51
Q

combination of O2 and HB in the lungs causes

A

Hb to become a stronger acid.

52
Q

combination of O2 and HB in the lungs causes Hb to become a stronger acid, this displaces CO2 from the blood and into the aveoli in 2 ways.

A
  • Acidic Hb is less likely to form carbaminoHb - Acidic Hb releases excess H+ ions, these bind to bicarb, this dissociates to CO2 & H2O
53
Q

2 Compensatory Mechanisms

A
  • Respiratory Compensation - Renal compensation
54
Q

Pink Urine ?

A

Concern for breaking of the RBC.

55
Q

Normal value of pO2 on CPB ?

A

150 - 250 mmHg

56
Q

pO2 value on CPB is 100 mmHg. What will your actions as a perfusionist be ?

A

Increase my FiO2 to reach pO2 values between 150 - 250 mmHg.

57
Q

A Base Excess > -2 indicates what ?

How would you the perfusionist treat this on CPB?

A

Metabolic Acidosis.

Treat by increasing pump flow.

58
Q

A pH of 7.3 & a pCO2 of 52 mmHg on CPB means what?

How would you the perfusionist correct this ?

A

Respiratory Acidosis

Correct by turning up the Sweep.

59
Q
A

CVPR 322 Physiologic assesment (11 decks)

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