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.
Presentation by Dr. Mishal Saleem on Topic: Step wise approach to abgs interpretation.
Use of delta ratio and delta gap
Use of Anion Gap
Use of Urinary anion gap
- 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
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Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
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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.
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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.
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Stay informed, stay safe, and get your flu shot today!
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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
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.
Arterial Blood Gases (ABG) interpretation, a simplified approach
1. ABG INTERPRETATION
A SIMPLIFIED PRACTICAL APPROACH
DR ADEL HAMADA
Assistant Consultant Pulmonary Medicine (KAMC)
Lecturer of Pulmonary Medicine (Zagazig University, EGYPT)
MD Chest Diseases
European Diploma in Intensive Care Medicine
2. Accurate and timely interpretation of an acid–base disorder
can be lifesaving.
Establishment of correct diagnosis of acid base
status (specially in mixed acid base disorders)
may be challenging.
In spite of that
3. By the end of this presentation we will:
Know the basic principles of ABG interpretation
Correlate the ABG data to the clinical context of the
patients.
Consider the concept of mixed acid base disorders and
how to detect.
Apply all these concepts to our clinical practice
4. What are the data the ABG Provide???
Oxygenation
Acid base Status
Ventilation
Hb, Glucose , Electrolytes
lactate
5. pH 7.38 – 7.42
Pa Co2
38 – 42 mmHg
HCo3
22 – 26 m mol/L
Normal ABG
Pa O2 >= 80 mmHg
Spo2 >=95%
P A-a o2 (on room air) (Age/4) + 4
Lactate < 1.6 m mol/L
N Engl J Med. 2014 Oct
9;371(15):1434-45
Dynamed :( accessed 11/2017)
VBG
pH 7.36 – 7.38
Pa Co2
43 – 48 mmHg
HCo3
25 – 26 m mol/L
6. Acidemia - arterial pH below the normal range (< 7.38)
Alkalemia - arterial pH above the normal range (> 7.42)
Acidosis - a process that lowers extracellular fluid pH.
Alkalosis - a process that raises extracellular fluid pH.
Definitions
11. H + = 24 (PaCo2)/HCO3
H + = 80 – (2 digits after Decimal point in ABG)
12. Clinical importance of Henderson Equation
Assure that the ABG is consistent and accurately recorded
pH 7.38
Pa Co2
41
HCo3
23
H+= 24(41)/23= 42
H+= 80-38 = 42
So ABG is consistent and
accurately recorded
pH 7.42
Pa Co2
39
HCo3
20
H+= 24(39)/20= 46.8
H+= 80-42 = 38
So ABG is inconsistent and
inaccurately recorded
Can be interpreted Cant be interpreted
15. History and Physical Examination
Check consistency of ABG
pH:
Pa Co2 and HCo3
Compensation
AG and Other GAPs
Primary
Disorder
Degree of Compensation.
Presence of Other Primary
(mixed) disorders
16. History and Physical
Examination
Underlying medical conditions.
Vitals.
Consciousness.
Signs of infection.
Respiratory status.
GIT symptoms ( Vomiting and Diarrhea).
Medications
Signs of Intoxication.
17.
18. Acid Base Disorder pH Pa Co2 HCo3
Respiratory Acidosis
Acute
Respiratory Acidosis
Chronic
Respiratory Alkalosis
Acute
Respiratory Alkalosis
Chronic
Metabolic Acidosis
Metabolic Alkalosis
21. +10 +1
-10 -2
+10 +3.5
-10 -5
Acute respiratory acidosis
Acute respiratory alkalosis
Chronic respiratory acidosis
Chronic respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Delta HCo3
From 24
Delta PaCo2
From 40
-10 -10
+10 +15
Chest Seek TM 2014
It is a simple alphabetical
calculation
22. Anion Gap
Must be calculated even in apparently normal ABG.
Represent Unmeasured Anions
AG= Na –(Hco3+ Cl )= 8-12
23. In patients with low albumin (chronic illness, starvation, cancer,……)
anion gap should be corrected according to the Figge equation
AG= Na –(Hco3+ Cl )= 8-12
Anion Gap
Emerg Med Clin North Am 2014 May;32(2):403.
24. Delta Ratio
Delta Ratio =
Delta AG( increase above 12)
Delta Hco3 ( decrease below 24)
Emerg Med Clin North Am 2014 May;32(2):403.
25. Approach to metabolic acidosis
Common
causes AGMA ( KUSMALE)
Ethylene G
Ketones
Uremia
Salicylates
Alcohols
Lactate
Diabetic, Alcoholic, Starvation
Cause also respiratory alkalosis
Early: No AG and + Osm Gap.
Late: + AG and no Osm Gap
L lactate( Type A and Type B)
D lactate
With osmolar Gap
Due to acc. Of phosphate and Sulfates
26. Approach to metabolic acidosis
Common
causes Non-AGMA ( USED CARS)
Amino acids ( Arginine HCL , Lysine)
Uretrosigmoidostomy
Saline
Early renal failure
Diarrhea and pancreatic fistula
Carbonic anhydrase inhibitors
RTA
Supplements( TPN with excess Cl vs Acetate)
27.
28. Approach to metabolic acidosis
Clinical context
Internal consistency
Anion Gap
(corrected to Alb.)
Pa Co2
ABG with Met Acidosis
AGMA
NAGMA
Urine AG
Positive : Renal cause
Negative: Extrarenal
Delta
ratio
Osmolar Gap
Metabolic
alkalosis
Or Respiratory
acidosis
Normal or
High
Prim resp
acidosis
Low
+
=
-
Prim resp
alkalosis
No pr. Resp dis.comp
29. 24 Y man with DM, CKD is admitted with altered mental status and hyperglycemia
, blood ethanol negative, ketone + in urine and + opioid in urine
Case 1
pH 7.15
Pa Co2
35
HCo3
12
Pa O2
95
Na 140
Cl 112
Alb 2.5
consistency
Met acidosis
A G 16 A G c 21 d. gap 9
d. ratio 9/12= 0.7
Anion Gap Metabolic Acidosis
Non AGMA.
Respiratory acidosis
Expected
Co2
28
30. Approach to metabolic alkalosis
Common
causes
Volume depletion:
•Vomiting
•NGT loss
•Villous adenoma.
Diuretic use.
Post Hypercapnic
Hypertensive:
•Hyperaldosteronism.
•Cushing
•Exogenous mineralocorticoids
Normotensive:
•Severe hypokalemia.
•Milk alkali syndrome
31.
32. Approach to metabolic alkalosis
Clinical context
Internal consistency
ABG with Met Acidosis
Anion Gap
(corrected to Alb.)
Pa Co2
Check for
urinary
chloride
If low or normal Prim resp.
alkalosis
High Compensation
check -
=
+
No
Resp.
Disorder
Prim
resp.
acidosis
< 20 mmol/l
>20 mmol/l
Saline responsive
Saline resistant
34. Case 2
pH 7.38
Pa
Co2
41
HCo3 23
Pa O2 95
Na 143
Cl 98
A 23-year-old man presented with generalized malaise and vomiting.
His ABG showed:
consistency
Disorder
Anion Gap 22 Delta Gap 10
Delta Ratio 10/1 10
This patient has a blood sugar of 510 mg/ dl and ketones in
the urine. He had diabetic keto-acidosis responsible for his
AGMA and vomiting caused his metabolic alkalosis.
AGMA
Metabolic alkalosis
35. Case 3
pH 7.45
Pa
Co2
44
HCo3 24
Pa O2 90
Na 144
Cl 112
consistency
pH = 7.45
H+= 35
H+= 24(44)/24= 44≠
Inconsistent ABG
36. Case 4
pH 7.30
Pa Co2 60
HCo3 29
Na 144
Cl 112
consistency
Disorder
compensation
AG
yes
Respiratory
acidosis
If
Acute
If
Chronic
HCo3 = 26
HCo3 = 31
3
Acute on top of chronic respiratory acidosis.
Chronic respiratory acidosis with NAGMA
37. References
Uptodate (accessed 11/2017)
Dynamed Plus ( accessed 11/2017).
N Engl J Med. 2014 Oct 9;371(15):1434-45.
Fishman’s Pulmonary Diseases and Disorders, Fifth Edition (2015).
Emerg Med Clin North Am 2014 May;32(2):403.
Pocket ICU , second edition (2017).
Arterial Blood Gases Made Easy, second edition (2015).
Chest Seek TM 2014 (Education Product of ACCP).
38. N Engl J Med. 2014 Oct 9;371(15):1434-45.
Recommended Review for Medical Residents