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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
Respiratory System Response: when is the respiratory system stimulated?
When there is imbalance in [H+] concentration.
26
Respiratory System Response: what does hyperventilation indiacte/do?
the body is attempting to get rid of excess acid
27
Respiratory System Response: what does hypoventilation indicate?
The body is trying to retain acid.
28
Equilibrium in lungs: Hypoventilation vs hyperventilation responses?
Hypoventilation = retain acid Hyperventilation = eliminate acids.
29
If CO2 production increases, what will also increase?
Bicarb
30
For every 10 mmHg increase in PaCO2, the HCO3 increases by how much?
1mmol/L
31
For every 10mmHg decrease in PaCO2, does HCO3 decrease by 1mmol/L?
No, they decrease by 2.
32
Is the Respiratory System Response fast or slow?
Very fast.
33
Why isn't the Respiratory System Response efficient by itself?
When [H+] concentration reaches normal, the stimulus to the respiratory response stops. They only adjust 50-75% of the [H+]
34
What assists the Respiratory System Response?
The kidney and buffering systems act to restore balance
35
Renal system = what?
Kidney response for the regulation of acids that cannot be "breathed" out. i.e lactic acid
36
What are 2 types of acids that cannot the Respiratory System Response can't get rid of?
Volatile or fixed acids.
37
Generally, how are Volatile acids dissociated?
They're turned into free [H+] which are excreted by the kidneys?
38
What are the 2 renal system responses for regulation?
Acidosis and Alkalosis.
39
Alkalosis
Method to retain HCO3 by excreting more [H+] ions
40
Alkalosis
Method to retain [H+] by excreting HCO3
41
Is the renal response fast or slow?
Slow could take hours or days.
42
Why is pH deviation dangerous?
deterioration of enzyme systems and cellular function.
43
2 acid-base disorders?
Respiratory (ventilation) Metabolic (non-respiratory)
44
What do respiratory disorders indicate?
Altered PaCO2
45
What do metabolic disorders represent?
Abnormalities in plasma HCO3 or other acid/bases
46
Henderson-Hasselbalch equation represents what?
The relationship between acid-base disorders and blood pH
47
Low pH indicated what?
Acidosis?
48
High pH indicates what?
alkalosis
49
High and low pH indicate what responses?
high = irritating low = sedating.
50
Normal ABG values?
51
What is Ventilation defined by?
PaCO2 and pH (circulation of air and corresponding blood pH)
52
What is ventilation determined by?
Alveolar minute ventilation (RR x VT)
53
if PaCO2 increases, what does pH do?
pH decreases 10 mmHg increase = pH decrease by 0.06
54
if PaCO2 decreases, what happens to pH?
pH Increases 10 mmHg decrease = pH increase by 0.10
55
What is a buffer?
[neutralize/stabilize] A solution that can resist pH change upon the addition of an acidic or basic component. such as...[H+]
56
What is a buffer?
[neutralize/stabilize] A solution that can resist pH change upon the addition of an acidic or basic component. such as...[H+]
57
What is oxygenation determined by? *hint* Hb is accounted for.
Spontaneously breathing: FiO2 Positive pressure ventilation: FIO2 and mean airway pressure.
58
How do you calculate arterial oxygen content [CaO2]?
CaO2=(1.34xHgb)SaO2+0.003(PaO2)
59
How do you calculate Delivered Oxygen [DO2]?
CaO2 x CO (cardiac output)
60
Normoxemic?
PaO2 = 80-100mHg
61
Mild Hypoxemia?
60-79mmHg
62
Severe Hypoxemia?
Anything below 40mmHg
63
Normal SaO2?
95-100%
64
What does Base Excess [BE]?
Measure of changes in total blood buffer base above or below normal.
65
[BE] is a pure measure of what component of the acid-base balance?
Metabolic
66
Why is [BE] taken into account ?
HCO3 isn't the only buffer in the blood, so [BE[] is used to better understand blood buffers.
67
What does not affect [BE]?
PaCO2
68
A positive [BE] indicates which 2 things?
excess base OR Excessive loss of acid
69
A negative [BE] indicates which 2 things?
excess acid OR excessive loss of base.
70
Fully compensated disorder
The primary disorder accounts for the initial movement out of range, the opposing system works to pull the pH back into range
71
What is a primary respiratory problem opposed by?
The renal system
72
A primary metabolic respiratory system is counteracted by
A respiratory system
73
Combined disorder?
indicates both respiratory and metabolic components
74
Primary causes for a respiratory disorder?
Change in PaCO2 If PaCO2 is abnormal and opposite direction of the pH, it is the cause.
75
Normal PaCO2 = 35-45 What happens when PaCO2 is less than 35?
pH increase (alkalemia)
76
Normal PaCO2 = 35-45 What happens when PaCO2 is greater than 45?
77
What is the primary cause for a metabolic disorder
When HCO3 is abnormal and in the same direction of pH.
78
Normal HCO3: 22 - 26mmol/L What happens when HCO3 is less than 22?
pH drops (acidemia) [BE] decreases
79
Normal HCO3: 22 - 26mmol/L What happens when HCO3 is greater than 26?
pH increases (alkalemia) [BE] increases
80
How do you know when a response is compensated?
when the body is trying to maintain a normal pH.
81
How does the metabolic system compensate for a respiratory problem?
Either increasing or decreasing HCO3 in order to correct pH
82
Where does a metabolic response orginate?
Kidneys: either excreting or retaining bicarbonate
83
How does the respiratory system respond to a metabolic problem?
Increasing or decreasing minute volume. The goal is to increase/decrease PaCO2.
84
Does the body over-compensate?
No.
85
General characteristics: uncompensated (acute) respiratory acidosis?
PaCO2 is high -> low pH HCO3- is normal
86
general description for a acute respiratory acidosis
a condition in which carbon dioxide builds up very quickly, before the kidneys can return the body to a state of balance.
87
General characteristics: Partially compensated respiratory acidosis
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
General characteristics: Fully compensated (chronic) respiratory acidosis
pH is within normal range PaCO2 is high HCO3 is high (and successfully brought pH back to normal range)
89
Potential sources of respiratory acidosis (8)
CNS Neuromuscular junction Metabolism (tissue/cells) O2 excess Lungs Drugs Mechanical Ventilation Muscle fatigue
90
General characteristics: Uncompensated (acute) respiratory alkalosis
PaCO2 is low->high pH HCO3 is nomral
91
General characteristics: Uncompensated (acute) respiratory alkalosis
PaCO2 is low->high pH HCO3 is normal
92
General characteristics: Partially compensated respiratory terminology
PaCO2 is low->high pH HCO3 is low in a attempt ot bring pH back to norm (but not yet)
93
General characteristics: Fully compensated (chronic) respiratory alkalosis
pH is normal PaCO2 is low HCO3 is low (but pH is normal)
94
Potential sources for a respiratory alkalosis (6)
CNS Cardiovascular system Thoracic cage Lungs Drugs Mechanical ventilation
95
Return and add slides 48 to 58
also add slide 59
96
Co-oximetry
Measures the oxygen carrying state of hemoglobin (the types in the blood)
97
Co-oximetry measurement evaulate hemogoblin dowb by types via blood gas analysis, what are 4 hemoglobin types?
Metheglobin Carboxyhemoglobin fetal hemoglobin sulfhemoglobin
98
Add slides 61 - 62
99
Combined Respiratory and Metabolic Acidosis
pH is low Both the PaCO2 and HCO3- are contributing (high PaCO2 and low HCO3-)
100
Combined Respiratory and Metabolic Alkalosis
pH is high Both the PaCO2 and HCO3- are contributing (low PaCO2 and high HCO3-)
101
Methemoglobin
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
Carboxyhemoglobin
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
Sulfhemoglobin
Rare Increased sulfur atom blocks heme Caused by some chronic drug use

PA 1 (RESP 214) (11 decks)

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