2. 1) We started ICU in December 2014.
2) We have so far received 505 patient
3) Majority of patient are from Medical ward but we have received from
Surgery, Orthopedic, OBGYN as well.
4) I will like to thank all consultants who have sent patient to ICU but
especially
Medical consultants
5) I will also thank Dr Ghias and Dr Ishaq
6) Last but not the least Prof. Dr Najib Ul Haq
12. DEFINATION
An arterial blood gas (ABG) is a test that measures
1) oxygen tension (PaO2)
2) carbon dioxide tension (PaCO2)
3) acidity (pH),
4) bicarbonate (HCO3) concentration
14. INDICATIONS FOR ABG:
Indications for ABG sampling include the following :
1- Identification of respiratory, metabolic, and mixed acid-base disorders
2-Measurement of the partial pressures of respiratory gases involved in
oxygenation
3-Monitoring of acid-base status, as in patient with diabetic ketoacidosis
(DKA) on insulin infusion
4-Assessment of the response to therapeutic interventions such
as mechanical ventilation in a patient with respiratory failure
5-Determination of arterial respiratory gases during diagnostic evaluations
(e.g., assessment of the need for home oxygen therapy in patients with
advanced chronic pulmonary disease)
21. USE 3 ML SYRINGE AND FLUSH IT WITH 0.5
ML HEPARIN
DO NOT USE EXCESSIVE HEPARIN IN THE
SYRINGE BECAUSE IT CAUSE
DILUTIONAL EFFECT.
EXCESSIVE HEPARIN CAUSES DECREASE IN
PCO2 AND HCO3
25. AIR BUBBLES IN SYRINGE
Ensure that there are no AIR BUBBLES in the syringe
It is presumed that AIR BUBBLES contain PO2 150 and PCO2 0
AIR BUBBLES + BLOOD = PO2 GOES UP + PCO2 GOES DOWN
If air bubbles are present, then remove the air bubbles otherwise
discard the syringe
27. ABG Syringe should be transported to LAB via
cold chain at earliest
Changes in values
every 10 minutes
UNICED SAMPLE
AT 37 DEGREE
ICED SAMPLE AT
4 DEGREE
PH 0.01 0.001
PCO2 1 0.1
PO2 0.1% 0.01%
33. METABOLIC ACIDOSIS
1) PH decreased
2) Body produces excessive quantities of acid
or
Kidney are not removing enough acid from the body
When there is metabolic acidosis, always calculate AG
35. Normal Anion Gap Metabolic acidosis:
Diarrhea,
RTA,
Anhydrase inhibitor
High Anion Gap Metabolic Acidosis:
M- methanol
U- Uremia
D- Dka
P- paraldehyde
I-Infection
E-Ethylene Glycol
S- salicyclates
36. DELTA GAP
1) Delta gap = ( Actual AG – 12) + HCO3-
2) If Delta gap is > 30, additional Metabolic alkalosis
3) If Delta gap is < 18, additional non AG Metabolic acidosis
4) If Delta gap is between 18-30, no additional metabolic problem
37. WHICH BODY SYSTEMS ARE INVOLVED IN COMPENSATION ????
COMPENSATION MEANS RESTORING NORMAL PH
45. In Metabolic Acidosis, if PCO2 level is achieved as per Winter`s formula
Expected pCO2 = 1.5 * HCO3
- + 8 +/- 2
Expected PCO2: 1.5 X 15 +8 = 30.5 +/- 2
METABOLIC ACIDOSIS
compensation
46.
47. 1) PH increases
1) Decreased hydrogen ion concentration, leading to increased
bicarbonate,
2) Alternatively a direct result of increased bicarbonate
concentrations.
METABOLIC ALKALOSIS
48. 1) Excess vomiting
2) Overuse of diuretics
3) Adrenal disease
4) Antacids
5) Accidental ingestion of bicarbonate, which can be found in baking
soda
6) Laxatives
METABOLIC ALKALOSIS CAUSES
53. Respiratory acidosis, also called respiratory failure or ventilatory
failure,
1) PH is decreased
2) Lungs can not remove enough CO2 from the body
RESPIRATORY ACIDOSIS
54. Asthma
Chronic obstructive pulmonary disease (COPD)
Acute pulmonary edema
Severe obesity (which can interfere with expansion of the
lungs)
neuromuscular disorders
Scoliosis
RESPIRATORY ACIDOSIS
57. RESPIRATORY ACIDOSIS
Acute: For every increase in PCO2 by 10 mmHg, HCO3- should increase by 1
mEq/l
Chronic: For every increase in PCO2 by 10 mmHg, HCO3- should increase by
3.5 mEq/l
COMPENSATION
63. RESPIRATORY ALKALOSIS
COMPENSATION
Acute: For every decreases in PCO2 by 10 mmHg, HCO3- should decrease by 2 mEq/L
Chronic: For every decrease in PCO2 by 10 mmHg, HCO3- should decrease by 4 mEq/L