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PA 1 (RESP 214) > Module 6 - ABG Interpretation > Flashcards

Module 6 - ABG Interpretation Flashcards

1
Q

ABG measures?

A

Acid base status

Oxygenation level in blood

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2
Q

Why arterial sample and not venus?

A

Oxygenated blood that is not carrying byproducts of metabolism

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3
Q

ABGs are mostly carried by the radial artery, what are other sites?

A

Brachial
Femoral
Pedal

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4
Q

An increase in pH indicates what?

A

A decrease in CO2

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5
Q

Acids release [H+] in solutions, if there is an increase in [H+], what happens to the solution?

A

It becomes more acidic

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6
Q

Do bases accept or release [H+]?

A

accept

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7
Q

What is a buffer?

A

[neutralize/stablize]

A solution that can resist pH change upon the addition of an acidic or basic component.

such as…[H+]

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8
Q

3 ways the body responds the acid-base balance.

A

Chemical buffer system

Respiratory response

Renal response

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9
Q

What formula is associated with the chemical buffer system

hint shifts correspond to change

A

H+ + HCO3- ↔ H2CO3 ↔ CO2 + H2O

HCO3 = bicarbonate

H2CO3 = Carbonic acid

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10
Q

What responds immediately to hydrogen ion balance?

A

Chemical buffer systems.

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11
Q

What is the purpose of chemical buffer systems?

A

Prevents excessive change in pH when either acid or base is added to the solution.

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12
Q

3 buffers in blood?

A

Bicarbonate system

Protein (hemoglobin)

Phosphate

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13
Q

[H+] + HCO3- <–> H2CO3

A

Bicarbonate system.

The most important buffer system in blood

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14
Q

Which is the most important buffer system in blood?

A

Bicarbonate system

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15
Q

[H+] + Protein <–> H.Pr

A

Protein (hemoglobin) buffer

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16
Q

[H+] + HPO4- <–> H2PO4

A

Phosphate buffer

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17
Q

Bicarbonate/Carbonic Acid Buffer System can be regulated by which systems?

A

The most important buffer for the overall regulation of pH

Regulated by both LUNGS and KIDNEYS

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18
Q

How is carbonic acid regulated?

A

Can be retained or exhaled by CO2

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19
Q

Bicarbonate management?

A

Retained or excreted by renal tubules

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20
Q

How does the Respiratory System Response regulate pH?

A

By breathing them off, altering ventilation can control acid-base levels.

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21
Q

what is a major end product of metabolism?

A

CO2 and Lactate.

CO2 is continuously inside cells.

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22
Q

CO2 diffuses out of the cells via interstitial fluid into the blood stream, what does it form when this happens?

A

Carbonic acid (H2CO3)

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23
Q

What is the average CO2 the lungs put out per minute?

A

240mL/min

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24
Q

why is carbonic acid important?

A

when it is buffered, it can be reformed back into CO2 in the lungs. From there, it is diffused into alveoli and exhaled.

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25
Q

Respiratory System Response: when is the respiratory system stimulated?

A

When there is imbalance in [H+] concentration.

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26
Q

Respiratory System Response: what does hyperventilation indiacte/do?

A

the body is attempting to get rid of excess acid

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27
Q

Respiratory System Response: what does hypoventilation indicate?

A

The body is trying to retain acid.

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28
Q

Equilibrium in lungs:
Hypoventilation vs hyperventilation responses?

A

Hypoventilation = retain acid

Hyperventilation = eliminate acids.

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29
Q

If CO2 production increases, what will also increase?

A

Bicarb

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30
Q

For every 10 mmHg increase in PaCO2, the HCO3 increases by how much?

A

1mmol/L

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31
Q

For every 10mmHg decrease in PaCO2, does HCO3 decrease by 1mmol/L?

A

No, they decrease by 2.

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32
Q

Is the Respiratory System Response fast or slow?

A

Very fast.

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33
Q

Why isn’t the Respiratory System Response efficient by itself?

A

When [H+] concentration reaches normal, the stimulus to the respiratory response stops.

They only adjust 50-75% of the [H+]

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34
Q

What assists the Respiratory System Response?

A

The kidney and buffering systems act to restore balance

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35
Q

Renal system = what?

A

Kidney response for the regulation of acids that cannot be “breathed” out.

i.e lactic acid

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36
Q

What are 2 types of acids that cannot the Respiratory System Response can’t get rid of?

A

Volatile or fixed acids.

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37
Q

Generally, how are Volatile acids dissociated?

A

They’re turned into free [H+] which are excreted by the kidneys?

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38
Q

What are the 2 renal system responses for regulation?

A

Acidosis and Alkalosis.

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39
Q

Alkalosis

A

Method to retain HCO3

by excreting more [H+] ions

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40
Q

Alkalosis

A

Method to retain [H+]

by excreting HCO3

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41
Q

Is the renal response fast or slow?

A

Slow

could take hours or days.

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42
Q

Why is pH deviation dangerous?

A

deterioration of enzyme systems and cellular function.

43
Q

2 acid-base disorders?

A

Respiratory (ventilation)

Metabolic (non-respiratory)

44
Q

What do respiratory disorders indicate?

A

Altered PaCO2

45
Q

What do metabolic disorders represent?

A

Abnormalities in plasma HCO3

or other acid/bases

46
Q

Henderson-Hasselbalch equation represents what?

A

The relationship between acid-base disorders and blood pH

47
Q

Low pH indicated what?

A

Acidosis?

48
Q

High pH indicates what?

A

alkalosis

49
Q

High and low pH indicate what responses?

A

high = irritating

low = sedating.

50
Q

Normal ABG values?

A
51
Q

What is Ventilation defined by?

A

PaCO2 and pH

(circulation of air and corresponding blood pH)

52
Q

What is ventilation determined by?

A

Alveolar minute ventilation

(RR x VT)

53
Q

if PaCO2 increases, what does pH do?

A

pH decreases

10 mmHg increase = pH decrease by 0.06

54
Q

if PaCO2 decreases, what happens to pH?

A

pH Increases

10 mmHg decrease = pH increase by 0.10

55
Q

What is a buffer?

A

[neutralize/stabilize]

A solution that can resist pH change upon the addition of an acidic or basic component.

such as…[H+]

56
Q

What is a buffer?

A

[neutralize/stabilize]

A solution that can resist pH change upon the addition of an acidic or basic component.

such as…[H+]

57
Q

What is oxygenation determined by?

hint Hb is accounted for.

A

Spontaneously breathing: FiO2

Positive pressure ventilation: FIO2 and mean airway pressure.

58
Q

How do you calculate arterial oxygen content [CaO2]?

A

CaO2=(1.34xHgb)SaO2+0.003(PaO2)

59
Q

How do you calculate Delivered Oxygen [DO2]?

A

CaO2 x CO (cardiac output)

60
Q

Normoxemic?

A

PaO2 = 80-100mHg

61
Q

Mild Hypoxemia?

A

60-79mmHg

62
Q

Severe Hypoxemia?

A

Anything below 40mmHg

63
Q

Normal SaO2?

A

95-100%

64
Q

What does Base Excess [BE]?

A

Measure of changes in total blood buffer base above or below normal.

65
Q

[BE] is a pure measure of what component of the acid-base balance?

A

Metabolic

66
Q

Why is [BE] taken into account ?

A

HCO3 isn’t the only buffer in the blood, so [BE[] is used to better understand blood buffers.

67
Q

What does not affect [BE]?

A

PaCO2

68
Q

A positive [BE] indicates which 2 things?

A

excess base OR

Excessive loss of acid

69
Q

A negative [BE] indicates which 2 things?

A

excess acid OR

excessive loss of base.

70
Q

Fully compensated disorder

A

The primary disorder accounts for the initial movement out of range, the opposing system works to pull the pH back into range

71
Q

What is a primary respiratory problem opposed by?

A

The renal system

72
Q

A primary metabolic respiratory system is counteracted by

A

A respiratory system

73
Q

Combined disorder?

A

indicates both respiratory and metabolic components

74
Q

Primary causes for a respiratory disorder?

A

Change in PaCO2

If PaCO2 is abnormal and opposite direction of the pH, it is the cause.

75
Q

Normal PaCO2 = 35-45

What happens when PaCO2 is less than 35?

A

pH increase (alkalemia)

76
Q

Normal PaCO2 = 35-45

What happens when PaCO2 is greater than 45?

A
77
Q

What is the primary cause for a metabolic disorder

A

When HCO3 is abnormal and in the same direction of pH.

78
Q

Normal HCO3: 22 - 26mmol/L

What happens when HCO3 is less than 22?

A

pH drops (acidemia)

[BE] decreases

79
Q

Normal HCO3: 22 - 26mmol/L

What happens when HCO3 is greater than 26?

A

pH increases (alkalemia)

[BE] increases

80
Q

How do you know when a response is compensated?

A

when the body is trying to maintain a normal pH.

81
Q

How does the metabolic system compensate for a respiratory problem?

A

Either increasing or decreasing HCO3 in order to correct pH

82
Q

Where does a metabolic response orginate?

A

Kidneys: either excreting or retaining bicarbonate

83
Q

How does the respiratory system respond to a metabolic problem?

A

Increasing or decreasing minute volume.

The goal is to increase/decrease PaCO2.

84
Q

Does the body over-compensate?

A

No.

85
Q

General characteristics:
uncompensated (acute) respiratory acidosis?

A

PaCO2 is high -> low pH

HCO3- is normal

86
Q

general description for a acute respiratory acidosis

A

a condition in which carbon dioxide builds up very quickly, before the kidneys can return the body to a state of balance.

87
Q

General characteristics:
Partially compensated respiratory acidosis

A

PaCO2 is high ->low pH

pH isn’t as low as expected for the high PaCO2

HCO3 is high in an attempt to bring pH back to normal range

88
Q

General characteristics:
Fully compensated (chronic) respiratory acidosis

A

pH is within normal range
PaCO2 is high

HCO3 is high (and successfully brought pH back to normal range)

89
Q

Potential sources of respiratory acidosis (8)

A

CNS
Neuromuscular junction
Metabolism (tissue/cells)
O2 excess
Lungs
Drugs
Mechanical Ventilation
Muscle fatigue

90
Q

General characteristics:
Uncompensated (acute) respiratory alkalosis

A

PaCO2 is low->high pH
HCO3 is nomral

91
Q

General characteristics:
Uncompensated (acute) respiratory alkalosis

A

PaCO2 is low->high pH
HCO3 is normal

92
Q

General characteristics:
Partially compensated respiratory terminology

A

PaCO2 is low->high pH
HCO3 is low in a attempt ot bring pH back to norm (but not yet)

93
Q

General characteristics:
Fully compensated (chronic) respiratory alkalosis

A

pH is normal
PaCO2 is low
HCO3 is low (but pH is normal)

94
Q

Potential sources for a respiratory alkalosis (6)

A

CNS
Cardiovascular system
Thoracic cage
Lungs
Drugs
Mechanical ventilation

95
Q

Return and add slides 48 to 58

A

also add slide 59

96
Q

Co-oximetry

A

Measures the oxygen carrying state of hemoglobin

(the types in the blood)

97
Q

Co-oximetry measurement evaulate hemogoblin dowb by types via blood gas analysis, what are 4 hemoglobin types?

A

Metheglobin
Carboxyhemoglobin
fetal hemoglobin
sulfhemoglobin

98
Q

Add slides 61 - 62

A
99
Q

Combined Respiratory and Metabolic Acidosis

A

pH is low

Both the PaCO2 and HCO3- are contributing (high PaCO2 and low HCO3-)

100
Q

Combined Respiratory and Metabolic Alkalosis

A

pH is high

Both the PaCO2 and HCO3- are contributing (low PaCO2 and high HCO3-)

101
Q

Methemoglobin

A

Iron in ferric form Fe +++ causes reduced Hb carrying capacity

Normal range 0-3%

Symptoms grey-blue tint to skin

Treated with methylene blue

102
Q

Carboxyhemoglobin

A

Normal .3-.8%

Tobacco users have higher than normal levels (3-8%)

Half life 4-6 hours in room air, as low as 35 minutes with HyperBaric Oxygen Therapy

103
Q

Sulfhemoglobin

A

Rare

Increased sulfur atom blocks heme

Caused by some chronic drug use

PA 1 (RESP 214) (11 decks)

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