This document provides information on arterial blood gas (ABG) analysis, including indications, contraindications, sampling procedures, normal values, terminology, and how to interpret ABG results. It discusses assessing adequacy of oxygenation, classifying acid-base disturbances as metabolic or respiratory, evaluating compensation and identifying mixed acid-base abnormalities. Key steps in ABG interpretation are outlined, such as using the anion gap and osmolal gap to identify causes of metabolic acidosis.
ABG is the important diagnostic tools in Pulmonary & Critical Care setting. Here how to interpret its stepwise and significance each of the components of ABG in both Blood gas and acid base abnormality
By
Dr. Anirban Saha
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
ABG is the important diagnostic tools in Pulmonary & Critical Care setting. Here how to interpret its stepwise and significance each of the components of ABG in both Blood gas and acid base abnormality
By
Dr. Anirban Saha
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
2. Indications
Assess the adequacy of ventilation and oxygenation
Diagnosis of severity of respiratory failure
Assess prognosis in critically ill
Cardiopulmonary surgery
Sleep studies
Exercise testing
3. CONTRAINDICATIONS
Negative results of a modified Allen test
Arterial puncture should not be performed through a lesion or
through or distal to a surgical
femoral punctures should not be performed outside the
hospital
A coagulopathy or medium-to-high-dose anticoagulation (eg,
heparin or coumadin, streptokinase, and TPA but not aspirin)
a relative contraindication for arterial puncture
Distal to AV fistula
4. Sampling
Steady state of oxygenation
10 min (healthy)
20 min (COPD)
Site (order of choice) (Don’t forget to apply LA)
Radial (check for collateral)
Dorsalis pedis
Bracheal
Femoral
Arterialized ear lobe samples: in neonate/small children
AARC Clinical Practice Guideline. RESPIRATORY CARE [Respir Care 1992(8);37:891–897]
5. Arterial or venous
Sampling
arterial
Person who draw sample Blood pulsate in syringe
syringe plunger rise on its own
Pao2/O2 conc >40/>75%
Calculate the value of H+ using equation and compare it with ABG values
6. Sampling
Excess heparin cause (keep <8 units) (Rinse)
a drop in PaCO2 (dilutional)
Rise in PaO2 (dilutional)
No change in PH
.
Arterial blood gas syringe including filter member United States Patent 5807344
7. Sampling
The pH, remains unchanged because of the vast buffering
potential of oxyhemoglobin and plasma proteins;
for a hemoglobin concentration of 15 grams per dl, 1.62
X107 nm of hydrogen are required to lower the pH from
7.40 to 7.15.
Arterial blood gas syringe including filter member United States Patent 5807344
8. Air bubble
If sample PaO2<160 – rise
If sample PaO2>160 – fall
Delay in running the sample
Decrease in PaO2
At 0 deg C- stable for 1 hr
Acceptable- 10-15 min at room temp
The PaO2 from subjects with elevated WBC dec
very rapidly. Immediate chilling is necessary
Arterial Blood Gas Analysis by Susan Blonshine, BS, RRT, RPFT. AARC Tımes February 1999
Sampling
9. Volume of blood requirement: a
blood sample of 2-4 mL be drawn
After drawing the sample firm
pressure must be applied for at
least 2 min
Sampling
AARC Clinical Practice Guideline. RESPIRATORY CARE [Respir Care 1992(8);37:891–897]
10. FREQUENCY:
depend on the clinical status of the
patient and the indication for
performing the procedure
Arterial line placed if>4 sample
drawn/day
not on an arbitrarily designated time
or frequency.
Sampling
AARC Clinical Practice Guideline. RESPIRATORY CARE [Respir Care 1992(8);37:891–897]
Browning JA, Kaiser DL, Durbin CG. The effect of guidelines on the appropriate use of arterial blood gas analysis in the intensive
care unit. Respir Care 1989; 34:269-276.
12. Documentation in record
When a sample is obtained,
date,
time,
patient's body temperature,
position,
activity level,
respiratory rate,
sample site,
results of Allen test,
inspired oxygen concentration
mode of supported ventilation.
13. ABG feeding
Check if required parameters correctly fed in ABG
machine
Pt. temp
Hb
Fio2
Barometric pressure
14. Normal values
blood PaCO2 pH PaO2 SpO2 Bicarb BE
arterial 35-45 7.36-7.44 80-100 >95% 22-26 ±3
venous 42-50 7.34-7.42 37-42 71-78 ±3
Normal range
Anion Gap (meq/l) 10-14
Osmolar gap (meq/l) 10
PaO2/Fio2 (%) >3
15. Terminology
Acidemia
increase in H+ and a fall in arterial pH
Alkalemia
decrease in H+ and a rise in arterial pH
Acidosis
acidifies body fluids (lowers plasma HCO3
- ) and if
unopposed leads to fall in pH
Alkalosis
alkalinizes body fluids (raises plasma HCO3
- ) and if
unopposed leads to rise in pH
16. Adequacy of oxygenation (step 1)
PaO2 (mmHg) SaO2 (%)
Normal values >80 >95
Mild hypoxemia 60-79 90-94
Moderate 40-59 75-89
Severe <40 <75
17. Adequacy of oxygenation (step 1)
New born
Pao2 – 60-90 mmHg- normal
50-59- mild hypoxemia
40-49- moderate
<40- severe
Above 60yr-normal Pao2 dec by 1mm Hg/yr from 80
mmHg.
18. Adequacy of oxygenation (step 1)
Predicted Pao2
Healthy lung 5* Fio2
COPD lung 3*Fio2
Uncorrected hypoxemia PaO2<60
Corrected 60-100
overcorrected >100
Alveolar arterial O2 Difference not affected by fiO2
19. Acidemia/alkalosis (step 2)
Classify pH: 7.4 correspond to H conc. of 40
Mild 7.3-7.34 7.46-7.5
Moderate 7.20-7.29 7.51-7.54
Severe <7.2 7.55-7.8
Incompatible with life <6.8 >7.8
20. Metabolic/respiratory (step 3)
Metabolic disorders:
Initiated by Primary changes in Bicarbonate.
If Bicarb<22/>26 = metabolic
Respiratory disorders:
Initiated by Primary changes in pCO2.
If PaCO2<35/>45 = respi
22. Compensation (step 5)
Respi acidosis High paco2 High bicarb
Respi alkalosis low paco2 low bicarb
Meta acidosis low bicarb low paco2
Meta alkalosis High bicarb High paco2
23. Compensation (step 5)
Acute respiratory acidosis
Chronic respiratory acidosis
10 inc in Paco2-1 inc in HCO3
10 inc in Paco2-4 inc in HCO3
If measured higher – coexist Malk
If low than normal- coexist Macid
Is equivalent – Comp Malk
Acute respiratory alkalosis
Chronic respiratory alkalosis
10 dec in Paco2-2 dec in HCO3
10 dec in Paco2-5 dec in HCO3
Metabolic acidosis Predicted paCO2= 1.5 HCO3 value + 8±2
If measured higher – coexisting Racid
If low – coexist R alk
Is equivalent – Comp R alk
Metabolic Alkalosis Predicted paCO2= 0.7 HCO3 value+ 21 ± 2
24. Compensation (step 5)
Respiratory compensation start in 6-12 hrs
Start in 6-12 hrs
At the level of lung
Metabolic compensation
At the level of kidney
Start in 3-5 days
Before compensation-acute
After compensation- chronic
25. Metabolic acidosis (high/normal AG)(step 6)
Anion gap or UA-UC = Na- Cl + HCO3
Normal range= 12±2 meq/l
Influence of albumin= for each gm decrease in albumin
AG decreases by 2.5
Adjusted AG= observed AG+2.5[4.5-albumin]
26. Gap-gap analysis/corrected bicarb (step 7)
AG excess/HCO3 deficit= measured AG-12/24- measured
HCO3
High anion gap GG~1-2
If >2 in High anion gap MA indicate coexistant met alkalosis
Concomitant non anion gap<0.4-0.8
Normal AG<0.4
Corrected bicarb=observed bicarb+ (AG-12)
If 24 - High AG
If >24 in High AG Macid indicate coexistant met alkalosis
If <24 Non AG Macid also present
27. Osmolal gap
difference between the plasma osmolality (POsm)
measured and that calculated
POsm (mOsm/kg) = 2Na+ + glucose/18 + BUN/2.8
Normally, measured-cal Posm <15 mOsm per kg.
If ethanol, lactate, or ketones cannot be identified in a
patient with an AG metabolic acidosis with an high
osmolal gap, the diagnosis of ethylene glycol or methanol
intoxication should be strongly suspected.
28. Base excess
Index of magnitude of metabolic contribution to an acid –base
disturbance
It is quantity of acid/base in meq needed to titrate 1 litre of blood
to a pH of 7.4 at a temp of 37 deg and PaCo2 of 40 mm Hg.
Normal range ±2 meq/l.
<-2 indicate metabolic acidosis
>+2 indicate metabolic alkalosis