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ICM -- Pulmonology > Diagnostics: ABG > Flashcards

Diagnostics: ABG Flashcards

1
Q

Arterial Blood Gas testing is used to determine…

A

pH, PaCO2, PaO2

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2
Q

What is an Allen’s test used to assess?

A

Whether blood flow is patent in both the radial and ulnar arteries

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3
Q

Normal pH? Acidotic pH? Alkalotic pH?

A

Acidic – Below 7.35
Normal – 7.4
Alkalemia – Above 7.45

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4
Q

Normal PaCO2. Differences in PaCO2 indicate…

A

40.

Ventilatory Problems

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5
Q

Normal PaO2. Differences in PaO2 indicate…

A

100

Oxygenation problems

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6
Q

For teaching purposes, the HH equation can be shortened to…

A

pH = (HCO3/PaCO2)

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7
Q

Four kinds of primary acid-base disorders?

A

Metabolic/Respiratory Alkalosis/Acidosis

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8
Q

Explain compensation

A

Changes in bicarb or PaCO2 that result from the primary event.

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9
Q

Important rule about compensation

A

You NEVER over compensate

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10
Q

Explain Respiratory Alkalosis

A

A primary disorder caused by lowering PaCO2
Kidney helps control by getting rid of bicarb
Caused by Anxiety/Hyperventilation

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11
Q

Explain Respiratory Acidosis

A

Elevation of PaCO2, resulting in decreased pH
Kidneys retain bicarb to compensate
Heroin OD/Not breathing, Breathing high CO2 air

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12
Q

Explain Metabolic Acidosis

A

Loss of HCO3
Compensation by hyperventilation
Causes vary with anion gap

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13
Q

Explain Metabolic Alkalosis

A

Retention of too much HCO2
Slowed breathing rate
Contraction alkalosis, diuretics, steroids, gastric suctioning, VOMITING
Also – Cl resistant – hyperaldosterone

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14
Q

How to calculate Anion Gap

A

Na - (Cl + CO2)

The CO2 is mostly Bicarb

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15
Q

Normal Anion Gap value?

A

10-12 mEq/L

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16
Q

Causes of increased anion gap metabolic acidosis?

A

MUDPILES

Methanol, Uremia, Diabetic Ketoacidosis, Paraldehyde, Infection, Lactic Acidosis, Ethylene Glycol, Salicyclates.

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17
Q

Causes of normal anion gap metabolic acidosis

A

HARDUP
(Hyperchloraemia, Acetazolamide, Addison’s disease, Renal tubular acidosis, Diarrhea/Vomiting, Ureteroenterostomies, Pancreatoenterostomies)

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18
Q

Expanded list of respiratory acidosis causes…

A 
CNS Depression (Drug OD)
Chest Bellows Dysfunction (Guillian Barre, myasthenia)
Lung Disease (COPD, Severe Asthma, Severe Pulm. Edema)
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19
Q

Expanded list of respiratory alkalosis causes..

A

Hypoxemia
Anxiety
Sepsis
Acute Pulm. Insult (Pneumonia, Mild Asthma Attack, Early pulm edema, pulm embolism)

20
Q

In ACUTE respiratory situations, a pH drop of .08 correlated with a PaCO2 rise of…

A

10

21
Q

In CHRONIC respiratory situations, a pH drop of 0.03 is correlated with a PaCO2 rise of…

A

10

Enough time for the kidneys to compensate by retaining bicarb

22
Q

Co2 travels between the tissues and the lungs as…

A

bicarb

23
Q

What is the Haldane effect?

A

Oxygenation of Hb promotes dissociation of H+, shifting equilibrium toward CO2 formation

24
Q

What is…

FiO2, PaO2, SpO2, SaO2, Pi02

A 
FiO2 = Fraction of inspired oxygen in the air (ex. 21%)
PaO2 = Arterial oxygen conc. (dissolved)
SpO2 = Bound Oxygen % via finger probe
SaO2 = Bound Oxygen % measured directly
PiO2 = Pressure of inspired oxygen in the trachea
25
Q

First step in understanding a patient’s oxygenation failures?

A

A-a gradient

26
Q

What is an A-a gradient?

What does it mean when its high?

A

Alveolar Oxygen - Arterial Oxygen

Elevated with gas diffusion is impaired

27
Q

Expected normal A-a gradient?

A

(Patient’s Age/4) + 4

28
Q

What kinds of hypoxia have a normal A-a gradient?

A

Pure Hypoventilation

Altitude

29
Q

How do you calculate A-a gradient without Arterial Oxygen numbers?

A

PiO2 -(PaCO2/R) - PaO2

R= Ration of Co2 produced to O2 consumed (.8)

30
Q

PiO2 for folks around sea level

A

150

31
Q

To qualify the degree of diffusion impairment or hypoxemia, you need to know what two (other than A-a gradient) relationships?

A

SpO2:PaO2
PaO2:FiO2

32
Q

Oxygen Dissociation Curve Mneumonic

A

CADET, FACE RIGHT

Co2, Acidosis, 2,3 DPG, Exercise, Temperature

33
Q

PaO2 should be about __x FiO2

Normal PaO2:FiO2?

A

5X

475

34
Q

As severity of diffusion impairment increases, what happens to PaO2:FiO2 ratio?

A

The ratio decreases

35
Q

Problem with the sigmoidal nature of the oxygen dissociation curve?

A

Because the slope is so shallow at saturations above 90, large diffusion defects can happen without notice

36
Q

What to use A-a gradient vs. P:F ratio?

A

A-a gradient – Works best on room air

P:F – Works best with supplemental oxygen

37
Q

What is indicated by a decreased V/Q?

A

Areas in the lung that are better perfused then ventilated

38
Q

What is indicated by increased V/Q?

A

Areas that are better ventilated then perfused

39
Q

V/Q mismatching occurs when?

A

In normal lungs based on lung zones

40
Q

V/Q in the upper vs. lower lobes?

A

Upper – 3

Lower – 0.6

41
Q

With exercise, how does lung perfusion change in the lungs?

A

Vasodilation of apical capillaries

V/Q approaches 1

42
Q

Causes of increase in V/Q

A

Pulmonary Embolism

Trachea

43
Q

Causes of decreased V/Q

A

Emphyzema (non-functioning alveoli)
Fibrosis (Poor diffusion of air)
Secretions/Edema (Blocks diffusion of air)

44
Q

What is a shunt? What are the two types?

A

Venous blood mixes with arterial blood, bypassing circulation.
Extrapulmonary and Intrapulmonary

45
Q

Examples of extrapulmonary shunts

A

Tetralogy of Fallot, PFO

46
Q

Examples of intrapulmonary shunts

A

Blood transported thru lung w/out gas exchange.

Atelectasis, Pneumonia, Hepatopulmonary syndrome, AVM

ICM -- Pulmonology (9 decks)

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