Part A: Interpretation

You are an intern on the surgical ward, about to take your first sip of water since you
arrived, when your second-favourite nurse asks you to review a 60-year-old male who
was admitted with shortness of breath. On your arrival, the patient appears drowsy and
is on 10L of oxygen via a mask. Your second-favourite nurse is already setting up a
trolley for ABG sampling.

You perform an ABG, which reveals the following results:

PaO2: 7.0 kPa (11-13 kPa) || 52.5 mmHg (82.5 – 97.5 mmHg)

pH: 7.29 (7.35 – 7.45)
PaCO2: 9.1 kPa (4.7 – 6.0 kPa) || 68.2 mmHg (35.2 – 45 mmHg)
HCO3–: 26 (22 – 26 mEq/L)
Base excess: +1 (-2 to +2)

QUESTION: What does the ABG show?

- O2 is low = respiratory failure – what why?
- pH is low = acidosis
- CO2 is high = respiratory acidosis
- Bicarb is within normal, as is base excess (kidneys need time to respond) hence is
acute response
- Therefore this is uncompensated

QUESTION: What type of failure does this indicate?

- Low O2 + high CO2 = Type II Respiratory Failure

QUESTION: What other signs and symptoms would you expect given the PaCO2?

- Hypercapnia is associated with

o Headache
o Confusion, drowsiness
o Reduced level of consciousness
o Asterixis
o Tachycardia
o HTN

QUESTION: What are 3 conditions that would result in this picture presented here?
- Reduced respiratory drive e.g. brain stem lesion, opiates/sedative overdose
- COPD, asthma (due to increased airway resistance)
- Neuromuscular weakness e.g. spinal cord injury, Guillain Barre syndrome, severe
fatigue
- Chest wall mechanical defects e.g. flail chest/chest trauma, severe kyphosis
- Increased dead space in lungs e.g. emphysema, PE, ARDS
- Increased CO2 load e.g. Shock, severe sepsis, malignant hyperthermia
- (endless list)