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MCRT- ABG class
| Question | Answer |
|---|---|
| Ideal Gas Law | PV = nRT |
| Boyles Law | P1 x V1 = P2 x V2; If Temperature remains constant, pressure will vary inversely with volume;TB |
| Charles Law | V1 / T1 = V2 / T2;If pressure is held constant, volume and temperature will vary directly;CP |
| Gay-Lussac’s Law | P1 / T1 = P2 / T2;If volume is held constant, pressure and temperature will vary directly;Vitamin G. |
| 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. |
| Atmospheric Pressures at Sea Level | Oxygen 159 torr 21%; Nitrogen 600 torr 79%; Others 1 torr 0.1% |
| 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 |
| Humidity | When in vapor form, water exerts a partial pressure |
| BTPS | BT = body temperature (37 C); P = atm pressure to which the body is exposed; S = saturated with maximum water vapor (47 torr). |
| Partial Pressures at BTPS | Water vapor = 47 torr (100% saturated); CO2 = 40 torr; O2 = 101 torr; N2 =572 torr; Total pressure = 760 |
| The partial pressure exerted by water in the gas form is directly related to…… | Temperature |
| 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). |
| Gas Solubility | When a gas molecule enters the liquid, it either exists as a gas (dissolved) or chemically combines with constituents of the liquid. |
| 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 |
| 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. |
| 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 |
| Different Types of Samples | Arterial Blood; Arterialized capillary blood; Mixed venous blood; Peripheral venous blood. |
| 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. |
| Mixed Venous Blood | Final mixture of all venous blood; Pulmonary artery catheter required |
| Central venous blood can be drawn from.... | Inferior vena cava; Superior vena cava; Right atrium |
| Peripheral Venous Blood | Veins run directly adjacent to artery; Values will vary from site to site; Not a substitute for Mixed Venous Blood. |
| 2 Key Factorsfor the assessment of oxygenation | How effectively the arterial blood is oxygenated by the lungs; Blood circulation throughout the body |
| PaO2 | Indicates how effectively oxygen is made available to the blood for transport to the tissues |
| Oxyhemoglobin (HbO2) | Functional hemoglobin that is actively carrying oxygen molecules |
| Reduced hemoglobin (R-Hb) | Hemoglobin that has released its oxygen |
| Methemoglobin (MetHb) | Not capable of carrying oxygen; Reduced the capacity of blood to carry oxygen; Brown color; %MetHb |
| 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. |
| Total Hemoglobin | Cumulative total value for all forms; HbO2 + R-Hb + MetHb + HbCO; More Hb = more carrying capacity |
| SaO2 | (Content/capacity) x 100; Calculated by some ABG equipment; Measured directly by CO-oximetry |
| P50 | Partial pressure of oxygen that creates SaO2 of 50% |
| Blood Oxygen Content (CaO2),Arterial Content | (Hb x 1.34).SaO2 + (PaO2 x .003) |
| Typical value of CaO2 | 20 vol% |
| CvO2 | (Hg x 1.34).SvO2+(PvO2 x .003) |
| Typical value for CvO2 | 15 vol% |
| C(a-v)O2, a-v difference | Typical value 5%; CaO2 – CvO2; 20 vol% - 15 vol% |
| Transportation of Oxygen | TO2=(CaO2 x 10) x Cardiac output; 10 converts everything to Liters; Units are ml O2/min delivered to tissues. |
| Qsp/Qt | Measure of physiologic shunting (Qsp) of pulmonary blood as a fraction of cardiac output (Qt) |
| True Shunting | Result of pulmonary blood flow where there is no ventilation |
| Shunt Effect | Pulmonary blood flow with limited amount of ventilationGas exchange is incomplete. |
| Formula for shunt | (CcO2 – CaO2)/(CcO2 – CvO2) |
| PAO2 | [(Patm – 47).FiO2] – (PaCO2 x 1.25) |
| Oxygen Extraction Ratio | C(a-v)O2 / CaO2 |
| Oxygen Consumption (VO2) | (C(a-v)O2 x 10) x QT |
| 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. |
| pH | Provides a direct statement of the acid/base balance; Alkalosis- A pH value greater than normal; Acidosis-A pH value less than normal |
| 3 ways to make the pH more acidic | Increase acid; Decrease base; Combination (mixed) |
| 3 ways to make the pH more alkalotic | Increase base; Decrease acid;Combination (mixed) |
| The respiratory contribution is ... | PaCO2; The level of ventilation plays a significant role in maintaining pH |
| The metabolic contribution is ... | HCO3; Renal function plays a significant role in maintaining pH. |
| 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 |
| 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 |
| 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 |
| Vamp Blood Conservation | Arterial line; Expandable reservoir; No blood waste |
| Equipment for Arterialized Capillary Blood | Site warmer to increase local perfusion; Antiseptic agent; Lancet for skin puncture; Sterile pad; Capillary tube (heparinized) |
| 3 things measured by ABG Machine | pH, PaCO2, PaO2 |
| oxygen electrode | Clark electrode |
| CO2 electrode | Serveringhaus electrode |
| pH electrode | Sanz electrode |
| If the patient does not have a normal temperature which way do the ABG values move? | In the same direction as the patient temperature |
| Machine Maintenance | Flush after each analysis; Calibration; Proficiency Testing |
| 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. |
| 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 |
| 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. |
| Other normal ABG vallues | Hb 12 – 16; CaO2 ~20; %MetHb <1.5%; %HbCO .5 – 2% |
| Mixed venous values | pH 7.4; PvCO2 45; PvO2 40; HCO3 24; SvO2 75%; CvO2~15 |
| Intrepretations | Intrepretations |
| Acute on Chronic | Refers to an Acute condition (hyperventilation/hypoventilation) with an underlying chronic (CO2 retainer) problem |
| Baseline CO2 retainer values | pH 7.4 (normal); CO2 55 (or higher); O2 55; HCO3 30 (or higher) |
| Describe how hypoxemia can affect the acid-base balance | it can cause lactic acidosis |
| pH | -log[H] |
| 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. |
Created by:
smiddleton
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