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| Question | Answer |
|---|---|
| PAO2: Alveolar Air Equation (alveolar PO2) | PAO2 (PB - PH2O)FiO2 - PaCO2/R |
| Calculate the alveolar PO2 for a patient on 60% O2 with a PaO2 of 55 and the barometric pressure is 760 torr. | (760-47)0.60 - 55/0.8 359.05 |
| A-aDO2: A-a Gradient | PAO2-PaO2 |
| A-a gradient interpretation | 25-65: normal, 66-300: V/Q mismatch, >300: Shunting |
| Calculate the A-aDO2 for a patient on 60% O2 with a PaCO2 of 55, PaO2 of 72 and barometric pressure of 760 torr. | PAO2 (760 - 47)0.60-55/0.8, A-aDO2 359 - 72 278, V/Q mismatch |
| CaO2: arterial oxygen content | CaO2 (Hb x 1.34 x SaO2) + (PaO2 x 0.003), norm: 17-20 vol% |
| Calculate the CaO2 for a patient whose PaO2 is 85, SaO2 is 96%, and Hb is 14. | (14 x 1.34 x 0.96) + (85 x 0.003) 18.3 vol% |
| CvO2: mixed venous oxygen content | CvO2 (Hb x 1.34 x SvO2) + (PvO2 x 0.003) norm:12-16 vol% |
| Calculate the CvO2 for a patient whose PvO2 is 40, SvO2 is 70% and Hb is 14. | (14 x 1.34 0.70) + (40 x 0.003) 13.3 vol % |
| what would a decreasing PvO2 indicate? | decreased cardiac output |
| C(a-v)O2: arterial-venous oxygen content difference | C(a-v)O2 CaO2 - CvO2 Norm: 4-5 vol% |
| C(a-v)O2: ABG--pH 7.39, PaCO2 40, PaO2 88, SaO2 96%, Hb 15; VBG--pH 7.36, PvCO2 45, PO2 40, SvO2 70%, Hb 15 | CaO2 (15 x 1.34 x 0.96) + (88 x 0.003) 19.56, CvO2 (15 x 1.34 x 0.70) + (40 x 0.003) 14.19 C(a-v)02 19.56 - 14.19 5.37 vol% |
| what would an increasing C(a-v)O2 indicate? | CvO2 is decreasing and indicates decreasing cardiac output |
| QT: cardiac output | VO2 / C(a-v)O2 (10) norm: 4-8 L/min |
| what would the cardiac output be for a patient with an oxygen consumption of 250 mL/min and C(a-v)O2 of 6 vol%? | QT 250 / 6(10) 4.2 L/min |
| VO2: oxygen consumption | VO2 QT x C(a-v)O2 x 10 |
| How can arterial oxygen saturation (SaO2) be estimated? | SaO2 can be estimated by adding 30 to the PaO2 value. |
| If the analyzer temperature is lower than the body temperature (patient has a fever), how will the results measure? | lower PaCO2 and PaO2, higher pH |
| If the analyzer temperature is higher than body temperature (hypothermia), how will the results measure? | higher PaCO2 and PaO2, lower pH |
| VD/Vt: deadspace to tidal volume ratio | PaCO2 - PECO2 / PaCO2 x 100 |
| VD: deadspace | VD/Vt x Vt VD |
| Calculate the VD/Vt ratio for a patient whose PaO2 is 50, the pH is 7.35 and PECO2 is 25. | 50-25 / 50 x 100 50% |
| what does the servinghaus electrode measure? | PCO2 |
| what does the clark electrode measure? | PO2 |
| what does the sanz electrode measure? | pH |
| what ABG values are calculated? | SaO2, HCO3 |
| How is the pH calibrated in a blood gas analyzer? | a low pH solution is injected to see if the accurate value is read. if not, its adjusted using the balance control |
| formula for calibrating gas for the PCO2 | (BP - 47) x % or calibration gas x 7 |
| calculate the low calibrating gas for the PCO2 using 5%, barometric pressure 760. | (760 - 47) x 0.05 35 or 5 x 7 35 |
| what are the two commercially prepared quality controls? | blood-based and aqueous/fluorocarbon based control |
| what are the three levels of quality controls commonly used? | acidotic, normal and alkalotic |
| how often is each quality control level ran? | at least one time per day |
| ABG graph shows that all the values vary about the mean in a regular manner | in control |
| ABG graph shows 1 point of 15 falling outside the + or -2 standard deviation | random error |
| ABG graph shows: the plotted points all fall within the + or - 2 SD range, but the mean value shifts from where it was at the onset of data | shift |
| ABG graph shows: a steadily increasing trend that is moving outside the + or -2 SD range | out-of-control |
| list the three arteries in order they should be chosen for an ABG sample | radial, brachial, femoral |
| What value from a heel stick capillary sample will not correlate well with an actual ABG? | PO2 |
| 5 hazards that may occur while drawing an ABG | hematoma, clotting, vessel spasm, tissue trauma, bleeding |
| normal ABG values | PCO2: 35-45, PO2: 80-100, pH: 7.35-7.45, SO2: 95-100%, HCO3: 22-26, BE: -2 - +2, HB: 12-16, CaO2/CvO2: 17-20 |
| interpretation and response to PaCO2 above 45 | patients not ventilating, ventilate or increase ventilation |
| interpretation and response to PaCO2 below 35 | patient is over-ventilating, add deadspace (PO2 is acceptable) |
| interpretation and response to PaO2 below 80 and FiO2 .21-.59 | hypoxemia due to: poor ventilation(high PCO2) or V/Q mismatch(normal PCO2), increase ventilation, increase FiO2 |
| interpretation and response to PaO2 below 80 and FiO2 0.60 | hypoxemia due to shunting, start CPAP if patients is breathing spontaneously or PEEP if patient is on a vent |
| interpretation and response to PaO2 above 100 and FiO2 .22-1.0 | hyperoxemia due to over oxygenation, decrease FiO2 PEEP or CPAP |
| response to abnormal PCO2 with normal pH | don't change ventilation (chronic patient, COPD) |
| interpretation of pH below 7.35 | Acidosis- non-compensated (due to increase CO2 or low HCO3) |
| interpretation of pH above 7.45 | Alkalosis- uncompensated (due to increased HCO3 or low CO2) |
| partial compensation | abnormal pH, CO2 and HCO3 in same direction |
| pH: 7.30, PCO2: 62, PO2: 70, FiO2: .21 | Uncompensated Respiratory Acidosis, patient should be ventilated |
| pH: 7.38, PCO2: 42, PO2, 60, FiO2: 0.21 | Normal ABG with V/Q mismatch, increase FiO2 |
| pH: 7.48, PCO2: 31, PO2: 46, FiO2: 0.60, Hb: 14 | Uncompensated Respiratory alkalosis, shunting, CPAP |
| pH: 7.51, PCO2: 48, PO2: 76, FiO2: 0.21, HCO3: 30, Hb: 13 | partially compensated metabolic alkalosis, administer KCI |
| pH: 7.31, PCO2: 32, PO2: 128, HCO3: 17, FiO2: 0.35, Hb: 6 | partially compensated metabolic acidosis, administer bicarb and blood |
| pH: 7.43, PCO2: 42, PO2: 250, HCO3: 23, FiO2: 0.21, Hb: 14, PB: 760 | Too much oxygen, recheck FiO2 and redo ABG |
| pH: 7.35, PCO2: 54, PO2: 68, FiO2: 0.21, Hb: 8, HCO3: 37 | Compensated respiratory acidosis, low FiO2 and administer blood |
| pH: 7.40, PCO2: 40, PO2: 110, FiO2: 0.21, Hb: 14, HCO3: 24 | CO poisoning, 100% O2 and hyperbaric chamber |
| pH: 7.40 PCO2: 40 PO2: 98 FiO2: 0.21 Hb: 14 HCO3: 24 | Normal |
| pH: 7.30 PCO2: 80 PO2: 88 FiO2: .40 Hb: 12 HCO3: 36 | Partially Compensated Respiratory Acidosis, to much O2 for COPD patient, decrease FiO2 |
| pH: 7.31 PCO2: 30 PO2: 82 FiO2: 0.21 Hb: 12 HCO3: 16 | Partially compensated metabolic acidosis, administer bicarb |
| pH: 7.22 PCO2: 51 PO2: 64 FiO2: 0.21 Hb: 12 HCO3: 18 | Mixed acidosis |
Created by:
RRTstudyme