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Arterial blood gases

mohammed ibrahim ali obied


What is an ABG?

The Components.
pH / PaCO2 / PaO2 / HCO3 / O2sat / BE

Desired Ranges.
1. pH - 7.35 - 7.45
2. PaCO2 - 35-45 mmHg
3. PaO2 - 80-100 mmHg
4. HCO3 - 21-27
5. O2sat - 95-100%
6. Base Excess - +/-2 mEq/L
Information Obtained from an
:ABG
Acid base status •
Oxygenation •
(Dissolved O2 (pO2 –
Saturation of hemoglobin –
CO2 elimination •
Levels of carboxyhemoglobin •
pH:
! Normal pH is 7.35-7.45.

! Value <7.35 is acidosis.

! Value >7.45 is alkalosis.

! Acidosis & Alkalosis can be caused


by a problem with the respiratory system or a
metabolic cause.

! Can also have combined respiratory/metabolic


.states
Is it Respiratory or Metabolic?

1. Respiratory Acidosis
2. Increased pCO2 >50
3. Respiratory Alkalosis
4. Decreased pCO2<30
5. Metabolic Acidosis
6. Decreased HCO3 <18
7. Metabolic Alkalosis
8. Increased HCO3 >30
Signs & symptoms of
Respiratory Acidosis

Respiratory : Dyspnoea, respiratory •


.distress and/or shallow respiration
Nervous: Headache, restlessness and •
confusion. If co2 level extremely high
drowsiness and unresponsiveness
.may be noted
CVS: Tacycardia and dysrhythmias •
Management
. Increase the ventilation •
Causes can be treated rapidly •
include pneumothorax, pain and CNS
.depression r/t medication
If the cause can not be readily •
.resolved, mechanical ventilation
Respiratory alkalosis
.Psychological responses, anxiety or fear •
Pain •
Increased metabolic demands such as •
.fever, sepsis, pregnancy or thyrotoxicosis
Medications such as respiratory •
.stimulants
Central nervous system lesions •
Signs & symptoms
CNS: Light Headedness, numbness, •
tingling, confusion, inability to
.concentrate and blurred vision
Dysrhythmias and palpitations •
Dry mouth, diaphoresis and tetanic •
.spasms of the arms and legs
Management

Resolve the underlying problem •


Monitor for respiratory muscle •
fatigue
When the respiratory muscle •
become exhausted, acute
respiratory failure may ensue
Metabolic Acidosis
Bicarbonate less than 22mEq/L with •
.a pH of less than 7.35
Renal failure •
Diabetic ketoacidosis •
Anaerobic metabolism •
Starvation •
Salicylate intoxication •
Sign & symptoms
CNS: Headache, confusion and •
restlessness progressing to lethargy,
.then stupor or coma
CVS: Dysrhythmias •
Kussmaul’s respirations •
Warm, flushed skin as well as nausea •
and vomiting
Management
Treat the cause •
Hypoxia of any tissue bed will produce •
metabolic acids as a result of anaerobic
metabolism even if the pao2 is normal
Restore tissue perfusion to the hypoxic •
tissues
The use of bicarbonate is indicated for •
known bicarbonate - responsive acidosis
such as seen with renal failure
Metabolic alkalosis
Bicarbonate more than 26m Eq /L with a •
pH more than 7.45
Excess of base /loss of acid can cause •
Ingestion of excess antacids, excess use of •
.bicarbonate, or use of lactate in dialysis
Protracted vomiting, gastric •
suction,hypchoremia,excess use of
.diuretics, or high levels of aldesterone
Signs/symptoms
CNS: Dizziness, lethargy •
.disorientation, siezures & coma
M/S: weakness, muscle •
twitching, muscle cramps and
.tetany
Nausea, vomiting and •
.respiratory depression
.It is difficult to treat •
:Contraindications

Bleeding •
AV fistula •
Severe peripheral vascular disease, •
absence of an arterial pulse
Infection over site •
Why an ABG instead of Pulse
?oximetry
Pulse oximetry uses light absorption at •
two wavelengths to determine hemoglobin
.saturation
Pulse oximetry is non-invasive and •
.provides immediate and continuous data
Why an ABG instead of Pulse
?oximetry
Pulse oximetry does not assess ventilation •
.(pCO2( or acid base status
Pulse oximetry becomes unreliable when •
.saturations fall below 70-80%
Technical sources of error (ambient or •
fluorescent light, hypoperfusion, nail polish, skin
(pigmentation
Pulse oximetry cannot interpret methemoglobin •
.or carboxyhemoglobin
?Which Artery to Choose

The radial artery is superficial, has •


collaterals and is easily compressed. It
.should almost always be the first choice
Other arteries (femoral, dorsalis pedis, •
.brachial( can be used in emergencies
Preparing to perform the
:Procedure
Make sure you and the patient are •
.comfortable
Assess the patency of the radial and ulnar •
.arteries