医学优质课件精选ABGINTERPRETATION.ppt
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1、ABG INTERPRETATIONABG INTERPRETATION执教教师:XXXObjectives Whats an ABG? Understanding Acid/Base Relationship General approach to ABG Interpretation Clinical causes Abnormal ABGs Case studies Take homeWhat is an ABGArterial Blood GasDrawn from artery- radial, brachial, femoralIt is an invasive procedure
2、.Caution must be taken with patient on anticoagulants.Helps differentiate oxygen deficiencies from primary ventilatory deficiencies from primary metabolic acid-baseabnormalities What Is An ABG?pHH+PCO2 Partial pressure CO2PO2 Partial pressure O2HCO3 BicarbonateBE Base excessSaO2 Oxygen SaturationAci
3、d/Base Relationship This relationship is critical for homeostasis Significant deviations from normal pH ranges are poorly tolerated and may be life threatening Achieved by Respiratory and Renal systems Case Study No. 160 y/o male comes ER c/o SOB.Tachypneic, tachycardic, diaphoretic andCyanotic. Dx
4、acute resp. failure and ABGsShow PaCO2 well below nl, pH above nl, PaO2 is very low. The blood gas documentResp. failure due to primary O2 problem. Case Study No. 260 y/o male comes ER c/o SOB.Tachypneic, tachycardic, diaphoretic andCyanotic. Dx acute resp. failure and ABGsShow PaCO2 very high, low
5、pH and PaO2is moderately low. The blood gas documentResp. failure due to primarily ventilatoryinsufficiency.There are two buffers that work in pairsH2CO3NaHCO3Carbonic acid base bicarbonate These buffers are linked to the respiratory and renal compensatory system BuffersRespiratory Component functio
6、n of the lungs Carbonic acid H2CO3 Approximately 98% normal metabolites are in the form of CO2 CO2 + H2O H2CO3 excess CO2 exhaled by the lungs Metabolic Component Function of the kidneys base bicarbonate Na HCO3 Process of kidneys excreting H+ into the urine and reabsorbing HCO3- into the blood from
7、 the renal tubules1) active exchange Na+ for H+ between the tubular cells and glomerular filtrate2) carbonic anhydrase is an enzyme that accelerates hydration/dehydration CO2 in renal epithelial cells H2O + CO2 H2CO3 HCO3 + H+Acid/Base RelationshipNormal ABG valuespH7.35 7.45PCO235 45 mmHgPO280 100
8、mmHgHCO322 26 mmol/LBE-2 - +2SaO295% AcidosisAlkalosispH 45HCO3 7.45PCO2 26Respiratory Acidosis Think of CO2 as an acid failure of the lungs to exhale adequate CO2 pH 45 CO2+ H2CO3 pHCauses of Respiratory Acidosis emphysema drug overdose narcosis respiratory arrest airway obstructionMetabolic Acidos
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