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2024-10-31 07:02本頁面
【正文】 lar pulse. Room air ABG amp。,Case study No. 6,43 yo ? arrives in ER 20 minutes after a MVA in which he injured his face on the dashboard. He is agitated, has mottled, cold and clammy skin and has obvious partial airway obstruction. An oxygen mask at 10 L is placed on his face. ABG amp。,Case study No. 5,74 yo ? with hx chronic renal failure and chronic diuretic therapy was admitted to ICU comatose and severely dehydrated. On 40% oxygen her ABG amp。,Case study No. 4,27 yo retarded ? with insulindependent DM arrived at ER from the institution where he lived. On room air ABG amp。 VS:,第三十五頁，共五十六頁。,What are the compensations?,Respiratory acidosis ? metabolic alkalosis Respiratory alkalosis ? metabolic acidosis In respiratory conditions, therefore, the kidneys will attempt to compensate and visa versa. In chronic respiratory acidosis (COPD) the kidneys increase the elimination of H+ and absorb more HCO3. The ABG will Show NL pH, ?CO2 and ?HCO3. Buffers kick in within minutes. Respiratory compensation is rapid and starts within minutes and complete within 24 hours. Kidney compensation takes hours and up to 5 days.,第三十四頁，共五十六頁。,Metabolic Acidosis,pH 7.30 PaCO2 40 HCO3 15,第三十二頁，共五十六頁。,Respiratory Acidosis,pH 7.30 PaCO2 60 HCO3 26,第三十頁，共五十六頁。,Compensated,Respiratory,Acidosis,CO2,More Abnormal,Respiratory,Acidosis,CO2,Expected,Mixed,Respiratory,Metabolic,Acidosis,CO2,Less Abnormal,CO2 Change,c/w,Abnormality,Metabolic,Metabolic Acidosis,CO2,Normal,Compensated,Metabolic,Acidosis,CO2 Change,opposes,Abnormality,Acidosis,ABG Interpretation,第二十八頁，共五十六頁。,Step 4: Determine if there is a compensatory mechanism working to try to correct the pH. ie: if have primary respiratory acidosis will have increased PaCO2 and decreased pH. Compensation occurs when the kidneys retain HCO3.,Fourstep ABG Interpretation,第二十六頁，共五十六頁。 HCO3 NL metabolic irregularity if HCO3 abnl amp。,Step 3: study PaCO2 amp。 SaO2 means hypoxia NL/elevated oxygen means adequate oxygenation,第二十三頁，共五十六頁。,Fourstep ABG Interpretation,Step 1: Examine PaO2 amp。,Causes of Metabolic Alkalosis,? loss acid from stomach or kidney hypokalemia excessive alkali intake,第二十一頁，共五十六頁。,Causes of Respiratory Alkalosis,hyperventilation panic d/o pain pregnancy acute anemia salicylate overdose,第十九頁，共五十六頁。,Causes of Metabolic Acidosis,renal failure diabetic ketoacidosis lactic acidosis excessive diarrhea cardiac arrest,第十七頁，共五十六頁。,Causes of Respiratory Acidosis,emphysema drug overdose narcosis respiratory a
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