In-Depth Procedures Flashcards
Chemical Buffers
Works the fastest
Doesn’t last as long as other systems
Three main chemical buffers: Bicarbonate, Phosphate, Protein
Respiratory System
Takes longer than chemical buffers (responds in minutes)
Lasts longer than chemical buffers (compensation still temporary)
Faster, deeper breathing = rise in pH (eliminates CO2)
Slower, shallower breathing = fall in pH (reduced CO2 excretion)
Can handle twice as many acids and bases than chemical buffers
Renal System
Takes up to 24 hours before starting to restore normal pH
Long-term adjustment to pH
When blood’s acidic, kidneys reabsorb HCO3 and excrete H+
When blood is alkaline, kidneys excrete HCO3 and retain H+
General Acidosis
Blood pH less than 7.35
Neurons become less excitable, don’t transmit as fast and CNS depression results.
Respiratory centers cease to function
Blood vessels dilate -> reduce BP
Decreased LOC, depressed respirations
General Alkalosis
Blood pH great than 7.45
Neurons become hyper excitable
Starts with sensory changes
If severe, muscle twitches turn into sustained contractions that paralyze respiratory muscles
Localized seizure activity -> general seizure activity, decreased LOC, irregular respirations
Respiratory Acidosis Numbers
pH below 7.35
PaCO2 above 45mmHg
HCO3 is normal
Respiratory Acidosis Clinical Presentation
Altered LOC, tachycardia, diaphoresis, headache
Respiratory Acidosis Cause
Inadequate or no respirations, COPD, overdose, pneumonia, smoke inhalation, pneumothorax, airway obstruction
Respiratory Acidosis Treatment
Increase rate and depth of ventilations - ventilate them so you can get rid of some CO2 for them
Acid Base Balance Normal Numbers
pH of 7.35 - 7.45
HCO3: 22-26 mEq/L
PaCO2: 35-45 mm Hg
Respiratory Alkalosis Numbers
pH above 7.45
PaCO2 below 35 mmHg
HCO3 is normal
Respiratory Alkalosis Clinical Presentation
Numbness or muscle twitch in fingers and toes, seizures. Respiratory alkalosis is hyperventilation (blowing off too much CO2)
Respiratory Alkalosis Cause
Shock, DKA Kussmaul Respirations - deep and fast breathing (the body is trying to compensate for its metabolic acidosis by producing a respiratory alkalosis on purpose), anxiety, pain and fever
Respiratory Alkalosis Treatment
Decrease rate and depth of ventilations (calm them down and/or stop ventilating so fast), give pain meds, have patient breath into NRM with no O2 (makes them rebreathe CO2 increasing blood levels)
Metabolic Acidosis Numbers
pH below 7.35
PaCO2 is normal
HCO3 is below 22 mEq/L
Metabolic Acidosis Clinical Presentation
Tachycardia, pulmonary edema, tachypnea, confusion or coma
Metabolic Acidosis Cause
Cardiac arrest, renal failure, DKA, diarrhea for a long time, ASA or anti freeze overdose
Metabolic Acidosis Treatment
Increase rate and depth of ventilations. Consider Sodium Bicarbonate (ACP) (like tums for the blood) it binds up the acid and turns it neutral.
Metabolic Alkalosis Numbers
pH above 7.45
PaCO2 is normal
HCO3 is above 26mEq/L
Metabolic Alkalosis Cinical Presentation
Seizures, headache, dysrhythmias
Metabolic Alkalosis Cause
Diuretics can cause an excess loss of sodium or potassium or renal loss of H+, cystic fibrosis, tums overdose, overzealous bicarb administration
Metabolic Alkalosis Treatment
Keep them alive long enough for their body to use up the excess bicarb. In hospital treatment includes replacing sodium and potassium
Initial Assessment
Determine the patients mental status (AVPU, LOC)
Locate and manage immediate life threats involving CAB
Ensure the patient has a patent airway
If the patient has minor external bleeding, note it and move on
If major external bleeding is present, deal with it immediately
If internal bleeding is suspected, keep patient warm and administer supplemental oxygen, but remember rapid transport to hospital is necessary
Focused History
Elaborate on the patients chief complaint using OPQRST mnemonic
Obtain a history of the present illness using SAMPLE
Look for signs of shock
Ask the patient about medications and any history of clotting insufficiency
Physical Examination for a Bleeding Patient
Note color of bleeding -> try to determine its source
Bright red blood from a wound or the mouth, rectum, or other orifice indicates fresh arterial bleeding
Coffee ground emesis - sign of upper GI bleeding
Melena - Sign of upper GI bleeding
Hematochezia - Stool containing bright red blood ie hemorrhoids
Hematuria - blood in the urine
Nonmenstural vaginal bleeding
Bleeding from an Artery
Bright red
Spurts in time with the pulse
Difficult to control
As the amount of blood circulating in the body drops, so does the patients BP and eventually the arterial spurting diminishes
Bleeding from an Open Vein
Much darker
Flows steadily
Easier to manage
Bleeding from Damaged Capillary Vessels
Dark red
Oozes slowly
Venous and capillary bleeding are more likely to clot spontaneously then arterial bleeding