MCRT- ABG class
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| Ideal Gas Law | PV = nRT
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| Boyles Law | P1 x V1 = P2 x V2; If Temperature remains constant, pressure will vary inversely with volume;TB
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| Charles Law | V1 / T1 = V2 / T2;If pressure is held constant, volume and temperature will vary directly;CP
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| Gay-Lussac’s Law | P1 / T1 = P2 / T2;If volume is held constant, pressure and temperature will vary directly;Vitamin G.
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| Dalton’s Law of Partial Pressure | 1)P1 + P2 + P3 ... = PTotal 2)The gases act independently of each other 3) Water vapor pressure does not follow Dalton’s law 4)% = Pp / Pbar.
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| Atmospheric Pressures at Sea Level | Oxygen 159 torr 21%; Nitrogen 600 torr 79%; Others 1 torr 0.1%
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| Alveolar Gas at Sea Level | Oxygen 13.3% or 101 torr; Nitrogen 75.2% or 572 torr; Carbon dioxide 5.3% or 40 torr; Water vapor 6.2% or 47 torr
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| Humidity | When in vapor form, water exerts a partial pressure
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| BTPS | BT = body temperature (37 C); P = atm pressure to which the body is exposed; S = saturated with maximum water vapor (47 torr).
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| Partial Pressures at BTPS | Water vapor = 47 torr (100% saturated); CO2 = 40 torr; O2 = 101 torr; N2 =572 torr; Total pressure = 760
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| The partial pressure exerted by water in the gas form is directly related to…… | Temperature
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| Diffusion | The constant random movement of gas molecules results in a net displacement from an area of higher concentration toward an area of lower concentration (passive movement).
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| Gas Solubility | When a gas molecule enters the liquid, it either exists as a gas (dissolved) or chemically combines with constituents of the liquid.
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| Henry’s Law | The amount of gas that can be dissolved in a liquid is proportional to the partial pressure of the gas to which the liquid is exposed
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| Graham’s Law | The rate of diffusion of a gas through a liquid is inversely related to the square root of the GMW of the gas.
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| Fick’s Law of Diffusion | the degree to which the gases can dissolve in the liquid depends of both the pressure gradient and the factors affecting diffusibility across the membrane; Thickness of the membrane; Cross-sectional area of the membrane
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| Different Types of Samples | Arterial Blood; Arterialized capillary blood; Mixed venous blood; Peripheral venous blood.
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| Arterialized Capillary Blood | Infants and small children; Deep puncture that produces free flowing blood; Heated;Can be correlated with arterial blood; Collected in a capillary tube.
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| Mixed Venous Blood | Final mixture of all venous blood; Pulmonary artery catheter required
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| Central venous blood can be drawn from.... | Inferior vena cava; Superior vena cava; Right atrium
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| Peripheral Venous Blood | Veins run directly adjacent to artery; Values will vary from site to site; Not a substitute for Mixed Venous Blood.
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| 2 Key Factorsfor the assessment of oxygenation | How effectively the arterial blood is oxygenated by the lungs; Blood circulation throughout the body
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| PaO2 | Indicates how effectively oxygen is made available to the blood for transport to the tissues
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| Oxyhemoglobin (HbO2) | Functional hemoglobin that is actively carrying oxygen molecules
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| Reduced hemoglobin (R-Hb) | Hemoglobin that has released its oxygen
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| Methemoglobin (MetHb) | Not capable of carrying oxygen; Reduced the capacity of blood to carry oxygen; Brown color; %MetHb
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| Carboxyhemoglobin | Oxygen sites occupied by Carbon Monoxide; %HbCO; Larger values indicate less oxygen delivery; Victim has a healthy color; Combines 210 times more easily than oxygen.
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| Total Hemoglobin | Cumulative total value for all forms; HbO2 + R-Hb + MetHb + HbCO; More Hb = more carrying capacity
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| SaO2 | (Content/capacity) x 100; Calculated by some ABG equipment; Measured directly by CO-oximetry
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| P50 | Partial pressure of oxygen that creates SaO2 of 50%
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| Blood Oxygen Content (CaO2),Arterial Content | (Hb x 1.34).SaO2 + (PaO2 x .003)
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| Typical value of CaO2 | 20 vol%
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| CvO2 | (Hg x 1.34).SvO2+(PvO2 x .003)
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| Typical value for CvO2 | 15 vol%
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| C(a-v)O2, a-v difference | Typical value 5%; CaO2 – CvO2; 20 vol% - 15 vol%
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| Transportation of Oxygen | TO2=(CaO2 x 10) x Cardiac output; 10 converts everything to Liters; Units are ml O2/min delivered to tissues.
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| Qsp/Qt | Measure of physiologic shunting (Qsp) of pulmonary blood as a fraction of cardiac output (Qt)
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| True Shunting | Result of pulmonary blood flow where there is no ventilation
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| Shunt Effect | Pulmonary blood flow with limited amount of ventilationGas exchange is incomplete.
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| Formula for shunt | (CcO2 – CaO2)/(CcO2 – CvO2)
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| PAO2 | [(Patm – 47).FiO2] – (PaCO2 x 1.25)
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| Oxygen Extraction Ratio | C(a-v)O2 / CaO2
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| Oxygen Consumption (VO2) | (C(a-v)O2 x 10) x QT
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| Ventilation | PaCO2 – single best indicator of ventilation; CO2 diffuses 20 time easier than O2; Significant reciprocal relationship between PaCO2 and alveolar ventilation; If VA increased, then PaCO2 decreases.
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| pH | Provides a direct statement of the acid/base balance; Alkalosis- A pH value greater than normal; Acidosis-A pH value less than normal
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| 3 ways to make the pH more acidic | Increase acid; Decrease base; Combination (mixed)
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| 3 ways to make the pH more alkalotic | Increase base; Decrease acid;Combination (mixed)
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| The respiratory contribution is ... | PaCO2; The level of ventilation plays a significant role in maintaining pH
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| The metabolic contribution is ... | HCO3; Renal function plays a significant role in maintaining pH.
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| Base Excess (BE) | Provides additional information quantitating the metabolic contribution to pH; Takes into account the buffering systems for pH; Typical value: ± 2; BE and HCO3 follow the same trendsAre effected by the same influences
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| Equipment for Blood Sampling/Puncture | Antiseptic agent for skin; Sampling needle/syringe; Heparin; Vented; Sterile pad for holding pressure; Equipment is the same regardless of puncture site
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| Equipment for Blood Sampling/Art Line | Two (2) needless syringes; 1- Remove flush solution from art line; 5 or 10 ml syringe (regular); 1- ABG syringe
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| Vamp Blood Conservation | Arterial line; Expandable reservoir; No blood waste
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| Equipment for Arterialized Capillary Blood | Site warmer to increase local perfusion; Antiseptic agent; Lancet for skin puncture; Sterile pad; Capillary tube (heparinized)
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| 3 things measured by ABG Machine | pH, PaCO2, PaO2
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| oxygen electrode | Clark electrode
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| CO2 electrode | Serveringhaus electrode
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| pH electrode | Sanz electrode
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| If the patient does not have a normal temperature which way do the ABG values move? | In the same direction as the patient temperature
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| Machine Maintenance | Flush after each analysis; Calibration; Proficiency Testing
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| Modified Allen’s Test | Checks for collateral circulation; Color should return within 15 seconds; Positive result is good! You will need to explain the technique.
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| ABG puncture technique | Aseptic technique; Straight in, straight out; Flash of blood in hub of needle; If blood flow stops you have most likely punctured completely through the arteryHold pressure on wound site; Anticoagulation therapy; Anticoagulation blood disorder
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| Handling blood after puncture | Remove all air bubbles from sample; PO2 values will move toward 150; CO2 values will move toward 0; Label syringe with patient information; Place solution on Ice; Metabolism continues; Analyze ASAP.
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| Other normal ABG vallues | Hb 12 – 16; CaO2 ~20; %MetHb <1.5%; %HbCO .5 – 2%
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| Mixed venous values | pH 7.4; PvCO2 45; PvO2 40; HCO3 24; SvO2 75%; CvO2~15
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| Intrepretations | Intrepretations
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| Acute on Chronic | Refers to an Acute condition (hyperventilation/hypoventilation) with an underlying chronic (CO2 retainer) problem
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| Baseline CO2 retainer values | pH 7.4 (normal); CO2 55 (or higher); O2 55; HCO3 30 (or higher)
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| Describe how hypoxemia can affect the acid-base balance | it can cause lactic acidosis
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| pH | -log[H]
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| Describe the technique for collecting aarterialized (capillary) blood sample. | 1) Warm the site. 2) Lance the skin. 3) Collect blood into the capillary tube. 4) Hold pressure on site.
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