Frequently Asked Questions Acid-Base Physiology Dr D. John Doyle

Frequently Asked Questions Acid-Base Physiology Dr D. John Doyle

9 Pages · 2004 · 156 KB · English

Frequently Asked Questions Acid-Base Physiology Dr D. John Doyle [email protected] November 10, 2004 [1] What are arterial blood gases? ANSWER - Arterial blood gases

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Frequently Asked Questions AcidBase Physiology Dr D John Doyle [email protected] November 10, 2004 [1] What are arterial blood gases? ANSWER Arterial blood gases (ABGs) are gases dissolved in arterial blood Their magnitudes (tensions) are usually expressed in units of mm Hg The usual gases of interest are oxygen and carbon dioxide Most ABG reports also provide information about arterial blood pH and the arterial blood bicarbonate concentration, even though, technically speaking, they are not gases (Of interest, most ABG reports do not provide information about dissolved nitrogen, even though is ordinarily the gas in highest concentration in blood) [2] Why are blood gas tensions expressed in mm Hg? ANSWER Blood gas tensions in America are expressed in mm Hg because of tradition, just like blood pressure measurements There is a strong case to be made for eventually “going scientific” on this matter and adopting the SI system, but medical traditions die hard Still, in Europe and most elsewhere in the world, the SI system is used to express blood gas tensions and blood pressure information in units of kilopascals (kPa) A pressure of 1000 pascals (1 kPa) is 102 cm H2O or 775 mm Hg Standard atmospheric pressure (760 mm Hg) is about 1000 cm H2O (1034 to be exact) or 100 kPa (1019 to be exact) To convert pressure in mm Hg to kPa, simply divide the value in mm Hg by 75 Example: 760 mm Hg = 760 / 75 kPa = 1013 kPa For more information on unit conversions of all kinds, visit the Web at http://wwwconvertmecom [3] How are arterial blood gas samples obtained? ANSWER Arterial blood gas samples obtained by sticking a needle into an artery and aspirating a blood sample Sometimes, instead of a needle, an indwelling catheter is placed into an artery so that repeated samples can be taken Either way, this can really hurt, although use of a local anesthetic and a small bore needle (eg, size 25) can help reduce the discomfort Left: Typical syringe and needle setup for arterial blood gas sampling Inside the syringe can be found a small amount of heparin to prevent the blood from clotting Usually 2 ml of blood is more than sufficient for analysis Image Credit: http://wwwvitalsignscom/products/respiratory/abgs/gaslytejpg Right: Intubated / ventilated patient in an intensive care unit (ICU) getting an arterial blood gas “stick” from the radial artery Note the use of gloves by the operator Also, note that most ICU patient will have an indwelling arterial line (catheter) placed to allow blood samples to be taken repeatedly simply by opening up a stopcock This particular arrangement also allows for continuous (beatby beat) BP measurement displayed on a patient monitor Image Credit: http://wwwukyedu/LCC/RCP/mvstick13jpg [4] Can taking an arterial blood gas sample be harmful to the patient? ANSWER All invasive procedures (indeed, some noninvasive procedures too) have the potential to harm patients Taking an ABG sample has the potential to cause direct arterial damage, to put the artery into spasm (“vasospasm”) or to impair the circulation of tissues supplied by the artery being stabbed Hematoma formation is particularly common, something especially important to think about in patients with a coagulopathy (impaired clotting system), such as patients on anticoagulants like heparin or patients with poor platelet function Also, remember that an expanding hematoma can even compress an artery to the extent that it no longer supplies blood to an extremity [5] What kinds of clinical information can one obtain from an arterial blood gas sample? ANSWER Three

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