ABG for Dummies

Working in Emergency department require you to capable do most of the procedure include reading Arterial Blood Gases Value.

Got problem with it?

Here, I will explain in a very easy way..My way..LOL..

First, to detect the abnormalities,we must knew the normal value.

Blood PH ------>7.35 - 7.45        

PaCO2----------> 35 - 45 ( mmHg )

HCO3 ---------->22-26 mEq / L

PaO2------------>80 - 100 mmHg

SaO2 ------------>95% -100%

BE -------------> -2  to +2

explanation:

PH, PaCo2, and HCo3 tell us about acid base balance

SaO2 and PaO2 indicates oxygenation status.

BE Indicates the amount of excess or insufficient level of sod.Bicab in the system.

Important in calculation of Dose Sodium Bicab Need to be given.

PH

If less than 7.35 its acidic and more than 7.45 is alkali .

PaCo2 

Less than 35 - alkali

More than 45 - acidic

HCo3

The calculated value of amount sodium bicabarbonat in blood stream.

Less than 22 - acidic

More than 26 - alkali

BEFORE WE PROCEED, BEAR IN MIND :

Co2 ---->  Lung ( Respiratory) problem

HCo3 ----> Kidney (metabolic ) problem

ANALYZING ABG

STEP 1 - PH  acidic or alkali ?

STEP 2 -Co2  acidic or alkali ?

STEP 3 - HCo3 acidic or alkali?

e.g

PH        7.48  ------->  alkali
Co2       48 ----------> acidic
HCo3    28 ----------> alkali

Well, Seems like alkali wins right? Which system got prob? Kidney the winner right?

So, its Metabolic Alkalosis

Okay, How if the PH is normal ?? It could happen...

e.g

PH        7.38  ------->  Normal
Co2       48 ----------> acidic
HCo3    28 ----------> alkali

Alright, here we look at the normal range of the blood PH.

Its 7.35 to 7.45

Just take single value in between of that two value -----> its 7.4

So, everything give you below than 7.4 consider as acidic and above 7.4 is consider alkali.

Problem solve?

So, try intepret the ABG value above.....what is it?

Answer : 

PH        7.38  ------->  Normal ( more to acidic )
Co2       48 ----------> acidic
HCo3    28 ----------> alkali

So its Respiratory Acidosis  

wink* wink*

Now we have to know whether the compensation between kidney and lungs did happen or not.

How do we know??

Well I make it Easy for you..

There is three type of compensation

1. Fully compensated
2. Partially Compensated
3. No Compensation

FULLY COMPENSATED

In this condition, both lung and kidney do their job well..so,the BLOOD PH will maintained in NORMAL range.KIDNEY and LUNG exhausted because working hard.So,their value both out of normal range in opposite way ( means, if kidney alkali lung will be acidic and vice versa)...because they give and take.

PARTIALLY COMPENSATION

Well in this situation, Kidney and lung do their best but still cannot maintain the PH in normal Value. After trying so hard,their stopped.Three of them all in bad shape.All out of normal range..

NO COMPENSATION

In this situation, Blood PH is out of normal range.

Here got two situation :

1.  Kidney or lung still in normal value. One of them in bad shape though...LOL
   its like this : kidney abnormal and lung normal or vice versa.
2. Or both of them goes in same way...both acidic or both alkali.

HERE :

e.g

PH        7.48  ------->  alkali
Co2       48 ----------> acidic
HCo3    28 ----------> alkali

 metabolic alkolosis, partially compensanted

Thank You.. :)

EMERGENCY ROOM STORY

"Please, help my son! He is dying!" - a middle aged man screamed as he entered the emergency room.

I looked up and saw one little boy age of nine in his arm with so much blood on his body. The blood is whooshing from the boy's body ... at this point, I'm not sure where it's coming from. Oh, God! 

I guided the father to resuscitation room or red zone. Alerted the doctor and got help from ward's staff. Gave patient oxygen and set up all the cardiac monitor and blood pressure cuff. While doing everything I realize that there was a huge, deep, and open trauma on his back at the scapula region. I can see through it.

I instructed the hospital assistant to help me press the wound to stop the bleeding. As I helped the doctor in assisting him in intubation. At this point, I thought only a miracle can stop the bleeding. A few minutes felt like hours - "Where is the other staff?" 

"Please I need help! I need someone to set the IV cannula! This boy is losing so much blood!" After successful intubation, I gave chest compression while the father was helping in giving manual ventilation through bag ventilation mask - with a lot of tears in his eyes while the doctor is trying to get vein for IV. An RN arrived, she stepped back after seeing so much blood. "Sorry, I can't stand to see all the blood." I was shocked when the words came out from her mouth.

"Oh, My God! Help me please. Get me someone else!"

Being new RN grad and working in this small center makes me have to work on myself really hard with a little experience. On that day, I'm working afternoon shift with two hospital assistant and one medical officer and it's on a holiday! I'm putting all my knowledge and what I learn through the three years of nursing school and clinical.

The center that hired me is small but have a BIG sign of EMERGENCY 24 HOURS outside of the building with a bright light and you can saw it from 1000 meter far but the facilities and staffing is poor. That condition put my career and other patient's life in danger. 

I just graduated 8 month ago from nursing school and have only 6 months of working experience and they put me as in charge RN all by my own with one doctor and a hospital assistant who doesn't even know how to take blood pressure.

This boy could have been saved if a proper management, fluid resuscitation, and controlling the bleeding by binding and compressing the wound. When the doctor gave instructions to stop the resuscitation I couldn't hold my tears. 

Now, after four years in nursing I never forget what happened on that day. I still think about the RN who chose not enter the resuscitation room cause of the bloody body. I remember blaming the hospital management for their poor management and staffing. I even blamed myself for the lack of knowledge and experience I had. I learned from his father that his son was hit by a car while cycling in their resident area and that day was the boy's birthday.

Being a nurse and by choosing this career, we must be aware that we will be responsible for saving people. We need to accept that seeing blood is routine. Please don't sacrifice another person's life by choosing this career if you do not have the stomach for it.

For those newly graduated RN, you will be facing 1001 kind of cases and incident through your career. Some will make you feel inadequate. Never give up. It's just another way for you to learn - to become a great nurse. Go on and never stop learning!

I quit from the hospital and looking for new job at well organized center. Now, I'm in the middle of taking my Advance Emergency Medical Trauma Care certification and I never forget the incident that happen on that day. From that day, I promised myself to become the best nurse that I can be. A nurse who can handle any emergency conditions and save lives.


This is an article I copy from allnurses.com.
Hope this story can motivate the new nurses or nurse wannabe ;)

I PASS my ACLS !

I couldn't believe that I pass my megacode and I'm so happy! Yeay! maybe some of you didn't know what I'm talking about..actually its kind of test and its really important for my job..

My next challenge is :

1. EXAM this coming december
2. ATLS (arrgghhh! I thought its over..another one coming...)

I do really hope I can attend PALS.. :( I will.Someday.Soon.

I just happy..!

:)