Examines the utility of both arterial and venous blood gas analysis in critical illness
Edward Omron MD MPH FCCP
Pulmonary, Critical Care, and Internal Medicine
Morgan Hill, CA 95037
www.docomron.com
Ventilatory management in obstructive airway diseasesVitrag Shah
Presentation on ventilatory management in COPD & Asthma
Updated information till 26/5/16
For powerpoint format, contact dr.vitrag@gmail.com
http://www.medicalgeek.com/presentation/36441-ventilatory-management-obstructive-airway-diseases-presentation.html
Examines the utility of both arterial and venous blood gas analysis in critical illness
Edward Omron MD MPH FCCP
Pulmonary, Critical Care, and Internal Medicine
Morgan Hill, CA 95037
www.docomron.com
Ventilatory management in obstructive airway diseasesVitrag Shah
Presentation on ventilatory management in COPD & Asthma
Updated information till 26/5/16
For powerpoint format, contact dr.vitrag@gmail.com
http://www.medicalgeek.com/presentation/36441-ventilatory-management-obstructive-airway-diseases-presentation.html
ABGs or VBGs interpretation made simple straight forward easy to remember and easy to apply. The presentation is designed to help the residents and junior ER physicians. The second part will discuss the oxygenation and the third part will review the "Stewart Approach" while fourth and last part is meant for the Experts.
ABGs or VBGs interpretation made simple straight forward easy to remember and easy to apply. The presentation is designed to help the residents and junior ER physicians. The second part will discuss the oxygenation and the third part will review the "Stewart Approach" while fourth and last part is meant for the Experts.
Mechanical ventilation ppt including airway, ventilator, tubings and connections, nursing management, trouble shooting common problems and issues, suctioning etc.
These presentation is about the weakness of superheroes . There are weakness of villains also but there is weakness of superheroes also . You can't understand the weakness of superheroes , Yes , you are right it is about weakness of superheroes .
Anesthesia machine and equipment -Q & A -Part II Selva Kumar
This presentation is a continuation of the same title. You can download and give transition effect to the answers, so that this presentation can be used as a quiz material.
09.12.08(b): An Introduction to Blood Gas Analysis Open.Michigan
Slideshow is from the University of Michigan Medical School’s M2 Respiratory sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Resp
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
Intra-operative bronchospasm is a deadly complication during general anaesthesia especially immediately after intubation. This presentation is a guide to tackle such a situation.
The questions asked in the Anaesthesiology viva examination are presented in this presentation which will be useful for the post-graduates appearing for the M.D-Anaesthesia examination.
Anesthesia machine and equipment Q & A Part -ISelva Kumar
It is a question & answer type of presentation on the anaesthetic machine and anaesthetic equipment. This presentation shall be used for conducting anaesthetic quiz for post-graduate students.
Evolution of Boyle's Anaesthesia apparatusSelva Kumar
The machine which is used to give general anaesthesia is generally called as Boyle's machine even though there are many other names for that machine.This presentation tries to trace the development of the Boyles machine from 1846.
It is a guide for Dissertation/Thesis writing in medical field.
Post graduate students can get the necessary guidelines for writing a dissertation which should be submitted for getting a Masters degree from any reputed university.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Arterial blood gas analysis in respiratory disorders
1. ARTERIAL BLOOD GAS ANALYSIS IN
RESPIRATORY DISORDERS
Dr.R.Selvakumar
Professor of Anaesthesiology
K.A.P.Viswanatham Govt Medical College,
Trichy-Tamilnadu-India
2. A knowledge about basics and
patient’s clinical history
is important in reading ABG..
just like ECG….
3. WHAT DO YOU MEAN BY
PARTIAL PRESSURE?
@ @
@
@
@
$ $
$
@ @
@
@
@ $
$
IN A MIXTURE OF GASES,THE PRESSURE EXERTED BY EACH GAS
IS THE SAME AS THAT WHICH IT WOULD EXERT IF IT ALONE
OCCUPIED THE CONTAINER
$
5 PSI 3 PSI 8 PSI
4. DALTON’S LAW OF PARTIAL PRESSURE
THE PROPORTION OF THE PRESSURE EXERTED BY A GAS
IN THE TOTAL PRESSURE IS EQUATED WITH THE VOLUME
IT OCCUPIES
@ @
@
@
@
$
$
$
PRESSURE OF @ GAS = 5 PSI
PRESSURE OF $ GAS = 3 PSI
TOTAL PRESSURE = 8 PSI
What is the % contribution of pressure of @ gas
in the total pressure?
5/8 x 100 = 62.5%
So, gas @ will occupy
62.5% of the total volume
5. Total atmospheric pressure -760 mm of Hg
Out of this 760, 78% is contributed by
Nitrogen and 21 % is contributed
by Oxygen
21/100 x 760 = 160
Partial pressure of Oxygen in the atmosphere
6. What do you mean by tension of a gas?
@ @
@
@
@
@ @
The gas which gets dissolved in
the water also exerts a pressure.
That, we call it as “TENSION”
SAMPLE PaO2 in mm of
Hg
PaCO2 in mm
of Hg
ARTERIAL 80 -100 35-45
VENOUS 37-42 42-50
7. What do you mean by FIO2?
•The % of O2 in the inspired gas mixture
•In room air , it is 21% or 0.21
12. What is the normal O2 content of the blood?
(Hb in gm% X 1.34 X SaO2) + ( 0.003 X paO2) = CaO2 = 20.1 ml
Oxygen in the blood combined with Hb +
Oxygen dissolved in plasma as physical solution
13. How to increase the oxygen content
of the blood?
(Hb in gm% X 1.34 X SaO2) + ( 0.003 X paO2) = CaO2 =
20.1ml
(15 X 1.34 X 99) + ( 0.003 X 100 ) = 20.1 ml%
(4 X 1.34 X 99) + (0.003 x 100 ) = 5.6 ml%
(15 X 1.34 x 99) + (0.003 x 600 ) = 21.6 ml%
Which is better?
To give 100% O2 or increase the available Hb..?
18. ALVEOLAR VENTILATION
• CO2 level in the blood depends upon
the production and excretion.
• Excretion depends upon alveolar ventilation
• Alveolar ventilation depends upon many factors
like central respiratory drive , neuronal pathways,
Anterior horn cells, respiratory muscle condition,
Respiratory mechanics, intactness of airway and
integrity of the pulmonary gas exchange system
If ventilation decreases, then CO2 level increases…..
19. OXYGENATION
ABG tells you about the status of oxygenation in the form of
paO2, SaO2, Oxygen Content, a/A ratio, (A-a)DO2
We can know the joint status of cardio-pulmonary system
20. ACID-BASE DISORDER
We can measure the pH, HCO3 level
and Base excess/deficit
We can also know about the adequacy
of compensatory mechanisms operating
in the body.
21. COMPENSATORY MECHANISMS
IN ACID-BASE DISORDER
DUE TO RESPIRATORY PROBLEMS
If CO2 accumulates, due to Hypoventilation
CO2 + H2O = H2CO3 = H+ + HCO3
1 molecule of H+ and 1 molecule of HCO3
is added to the circulation
But acidosis results….. How?
22. The impact of H+ increase is more, since
the level of H+ in body is in nanomoles
and HCO3 is in mmoles
How the body compensates for
the addition of excess H+?
It retains HCO3 through kidney.
We call it as metabolic compensation
23. COMPENSATION RULE:
HCO3 increases by 1 meq/L for every 10 mm rise of
CO2 in acute situations.
It increases by 3.5 meq/L for every 10 mm rise in
chronic situations.
Memorize plz
24. COMPENSATION RULE:
If CO2 is washed out due to hyperventilation,
HCO3 falls by 2 meq/L for every 10 mm fall in paCO2
in acute situations.
In chronic states, HCO3 falls by 5 meq/L for every
10 mm fall of paCO2.
Memorize plz
25. How to read the ABG..?
PARAMETER NORMAL RANGE
paO2 80 -100 mm of Hg
paCO2 35 -45 mm of HG
HCO3 22 – 26 meq/L
Std HCO3 21 – 27 meq/L
Base Excess -2 to + 2 mmol/L
CaO2 16 – 20 ml%
a/A ratio 0.8
(A-a) DO2 10 -20 mm of Hg
FIO2 0.21
Hb 15g%
Temp 37.2 C
26. Examples….
A person choked with a coin in his throat. He is in
acute distress.. His ABG reads…
pH - 7.24
paO2 - 42
paCO2 - 72
HCO3 - 27
acidosis
Hypoxemia
FIO2 - 0.21
Acute retention
Slight rise
RESPIRATORY ACIDOSIS - ACUTE
27. Example -2
A COPD patient coming for hernia repair
pH - 7.34
paO2 - 68
paCO2- 72
HCO3 - 34
FIO2 - 0.21
BE - 12
Normal / acidosis
Mild hypoxemia
SaO2 - 95 %
Very high
High level.
High level
SaO2 is high for a low paO2
CHRONIC RESPIRATORY ACIDOSIS WITH
METABOLIC ALKALOSIS
28. pH 7.34
paO2 68
paCO2 72
HCO3 34
BE 12
SaO2 95
FIO2 0.21
• Why it is chronic?
• paO2 is 68, but SaO2 is 95%. How?
• Can it be chronic metabolic alkalosis
with compensatory respiratory acidosis?
29. RULES YOU MUST NEVER FORGET….
pH drifts towards primary acid-base disorder
Compensation never overshoots….
pH 7.34
paO2 68
paCO2 72
HCO3 34
BE 12
SaO2 95
FIO2 0.21
30. Comment about oxygenation in the first ABG…
pH 7.24
paO2 42
paCO2 72
HCO3 27
SaO2 55%
FIO2 0.21
(A-a)DO2 75
a/A ratio 0.38
Severe Hypoxia
Saturation very low
Normal -110 -90 = 20
So ,it is high
Normal 90/110 = 0.8
Very low.
31. A patient with head injury with
neurogenic hyperventilation
pH 7.51
paO2 80
paCO2 24
HCO3 20
SaO2 94
FIO2 0.21
BE -4
Alkalosis
Decreased
Decreased. ↑ Kidney
excretion
Acute Respiratory alkalosis with
Compensatory metabolic acidosis
Remember… Acidosis results either due to the
Increase of H+ ions or depletion of HCO3 ions
32. A patient living in high altitude region
pH 7.48
paO2 72
paCO2 24
HCO3 16
SaO2 96
FIO2 0.21
Mild alkalosis
Mild hypoxemia
Decreased level
Very low level. Kidney
excreted much HCO3
For a paO2 of 72,
saturation is high
Chronic respiratory alkalosis
with compensatory metabolic acidosis
33. Some more complicated ABGs…
pH 7.32
paO2 68
paCO2 69
HCO3 34
FIO2 0.21
pH 7.26
paO2 42
paCO2 78
HCO3 26
FIO2 0.40
COPD DEVELOPING
LOBAR
PNEUMONIA
More acidotic
Further lowered
Looks like normal
Chronic resp.acidosis
with compensatory met.alkalosis
Acute on Chronic resp.acidosis
with compensatory met.alkalosis
Increases further
34. Home work…. Just try it out
pH 7.4
paO2 98
paCO2 37
HCO3 24
FIO2 1
BE 0.5
SaO2 100
(A-a)DO2 467
Patient on ventilator
Can we wean him?
pH 7.41
paO2 147
paCO2 36
HCO3 23
BE -1
FIO2 0.21
SaO2 99%
Comment on this…
35. A patient with duodenal ulcer perforation given I.V
Morphine for pain relief….
pH 7.14
paO2 80
paCO2 50
HCO3 20
BE -5.2
FIO2 0.5
(A-a)DO2 198
SaO2 98%
Severe acidosis
Moderate hypoxia
Slightly elevated
Slightly lowered
Acute combined metabolic
and respiratory acidosis
36. ARDS patient on
ventilator
pH 7.37
paO2 105
paCO2 34
HCO3 22
BE -1.3
FIO2 1
(A-a)DO2 438
2 Hours after
the introduction of
PEEP 10 cm of H2O
pH 7.37
paO2 94
paCO2 32
HCO3 23.5
BE -0.3
FIO2 0.6
(A-a)DO2 239
37. Summary
Always remember the Basic physiology
Go through the clinical history and then try to read
pH sways to the primary acid-base disorder side
Compensatory phenomenon never overshoots
38. If you understand and remember the basic…
If you are methodical….
Reading ABG is a child’s play
Concluding……