*ABG Flashcards
(122 cards)
1
Q
what is the pH scale
A
power (logarithmic) scale that shows the inverse relationship of hydrogen ions
-low pH/acid =pH lots of H
2
Q
buildup of CO2
A
acid
3
Q
what is Co2 regulation a function of
A
CO2 regulation is a function of minute folume
minute volume = tidal volume (Vt) x RR (F)
4
Q
CO2 if hypoventilation
A
high Co2 over 45.
acidic
5
Q
CO2 under 35
A
alkalosis
high pH
6
Q
CO2 if alkalosis
A
under 35
7
Q
how does pH and bicarbonate move
A
opposite directions
22 is acidotic
26 is alkalosis
8
Q
pH if too much bicarb
A
bicarb is alkalotic
over 26 bicarbonate
9
Q
pH if too little bicarbonate
A
under 22
acidosis
10
Q
under 22 bicarb
A
too little bicarbonate
bicarb and pH move in teh same direction
alkalosis
11
Q
what is base excess/deficit
A
the amount of excess or deficit amount of base present in blood
12
Q
base deficit where you would consider blood transfusion
A
base deficit of
13
Q
base deficit where death is likely
A
over -19
14
Q
replacement formula for bicarbonate
A
0.1 x (-base excess) x weight in kg = bicarb needed
15
Q
SaO2 at PaO2 90
A
100%
16
Q
SaO2 at pO2 60
A
90%
17
Q
SaO2 at pO2 30
A
60%
18
Q
SaO2 at pO2 27
A
50%
19
Q
what does pulse ox measure
A
SaO2
20
Q
left shift affinity
A
increased
21
Q
right shift mneumonic
A
Right = RAISe
alkalosis, temp, 2,3-DPG, PCO2
22
Q
CO2 & pH
A
Co2 is an acid so it makes ABG more acidotic
left shift
23
Q
Bicarbonate & pH
A
bicarb is a base so makes ABG more alkalotic
right shift
24
Q
CO2 follows pH
A
respiratory
25
bicarbotate follows pH
metabolic
26
compensated respiratory acidosis
compensated by bicarbonate
27
compensated metabolic alkalosis
compensated by CO2 (acid)
28
pH/resp/metabolic are all ouside of normal range
partially compensated
29
pH is normal, resp/metaboliic are ousided normal range
fully compensated
30
critical pH for intubation
pH under 7.2
31
pH under 7.2
intubate b/c critical
32
pCO2 over 55
intubate b/c critical
33
critical pCO2 to intubate
over 55
34
critical pO2 to intubate
under 60
35
pO2 under 60
intubate
36
acid/base if vomiting/NG/suction/dieuretics/diamox/antacid poisioning
metabolic alkalosis
37
causes of metabolic alkalosis
vomit/NG/suction/dieuretics/diamox/antacid overdose
38
causes of m. acidosis
lactic acidosis, ketones, hyperthermia/fever, seizures, rhabdo
39
bicarb in m. alkalosis
over 26
40
bicarb in m. acidosis
under 22
41
acid base in antacid poisioning
m. alkalosis
42
acide base in sepsis
m. acidosis
43
acid base in rhabdo
m. acidosis
44
acid base in hyperthermia
m. acidosis
45
acid base in seizures
m. acidosis
46
Co2 in r. alkalosis
low CO2 under 35
47
acid base if hyperventilating
r. alkalosis
48
acid base in hypoermetabolic staes
resp alkalosis
49
acid base in high altitudes
r. alkalosis
50
acid base in ASA poisioning
r. alkalosis (CO2 less than 35) b/c it is a respiratory system stimulant
51
what happens in ASA poisioning
respiratory system stimulant so r. alkalosis a
| hyperventilation
52
hyperventilation
r. alkalosis
| Co2 under 35
53
Co2 in hyperventilation
under 35
| alkalosis
54
CO2 in hypoventilation
over 45
| acidosis
55
when is minute ventilation increased
increased to blow off CO2 (Vt x RR)
in hyperthmic states like malignant hyperthermia
limited ability to remove by hgb
56
every ___ in pH, expect change in bicarbonate by ___ in ___ direction
0.15 pH
10 bicarb
same direction
57
physiology of the pH & K relationship
*every 0.1 change in pH, K shifts 0.6 in the opposite direction
*as pH lowers, K shifts outside the cell giving a falsely elevated K level.
when correct imbalance by raising pH, K shifts intracellulary so life threatening low K
58
every change in ___ ETCO2, expect pH to change by ___ in the ___ direction
10 mm hg ETCO2
0.08
opposite direction
59
every change in ___ CO2, K shifts ___ in teh ___ direction
10 CO2
K 0/5
same direction
60
pH & K relationship
VERSUS
CO2 & K
every change in 0.1 pH, the K shifts 0.6 in the opposite direction
every change in 10 CO2, K shifts 0.5 in the same direction
61
16 + age/4ll
ETT size for pediatrics
62
emergency airway for pediatricsl
needle cric if under 8l
63
3-3-2
difficult aiwary predictor
3 fingers in mouth
3 fingers between jaw and hyoid
2 fingers between hyoid and thyroid
64
Mallampati 2
tonsillar pillars hidden by tongue
65
Mallampati 3
only base of uvula is seen
66
HEAVEN
```
predictors in difficult emergent airways
Hypoxemia under 93%
extreme of size (under 8 or obese)
anatomic challenges
vomit/blood/fluid
exsanguination/anemia
neck monility
```
67
"E" in HEAVEN
exsanguination/anemia can accelerate decompensation during RSI
68
ramping
ear to sternal notch
69
problem of the supine position during intubation
```
ramp instead (ear to sternal notch)
decrease functional reserve capacity/tidal volume/preload
```
70
posterior pressure on cricoid cartiliage believed to occlude the esophagus
Sellick maneuver
71
External Laryngeal Manipulation
provider brings cords into view the the assistant holds pressure.
72
Macintosh v MIller blade
Macintosh = lifts epiglottis via vallecula
| Miller - direct displacement of the epiglottis
73
bougie size adult versus kids
```
adult = 15 Fr
kids = 10Fr
```
74
problem of supraglittic devices
blind insertion
| little protection agaisnt aspiration
75
air inflation into ETT
25mm is standard
76
what can you do when you are preparing & pretreating a pt for RSI intubation
3-5 min of passive oxygen via NC 10-15L
77
position for RSI
ear to sternal notch = ramping
| pad behind shoulder for pediatrics
78
reason for RSI pretreatment
LOAD
b/c manipulation of the hypopharynx, larynx, and trachea may cause a reflex sympathet9c response leading to catecholamine mediated increase in BP/HR/ICP
79
lidocaine as RSI pretreatment
blunts the cough reflex preventiong ICP increase
80
opiates as RSI pretreatment
blunts the pain response
81
atropine as RSI pretreatment
prevents reflexive bradycardia in infants under 1yo
82
defasciculating rx as RSI pretreatemnt
1/10 dose of Roc or VEc prior to administering Succ
83
Fentanyl as RSI analgesic
| dose, onset, duration, complication
1mcg/kg
onset 3-5 min
duration 30-60 min
low risk of chest wall rigidity
84
RSI for awake sedation
Etomidate
85
caution w/Etomidate
no analgesic
short duration (3-12 min)
use cautiously if hemodyanmically unstable
vomit when awake
NOT: if adrenal suppression, shock/Addisions/CODP/asthma
86
RSI not to use if adrenal suppression
ETomidate
87
common SE w/Etomidate
common to vomit when awake
88
best RSI for asthma/airway issues
Ketamine b/c preserves laryngeal reflexes/airway protection
89
best RSI for asthatics w/reactive airway complications
Ketamine is a potent bronchodilator
90
SE of ketamine
may hallucinate
| may cause laryngospasms
91
dose of Propofol
1-2mg/kg
| 25-50mcg/kg/min maintence
92
RSI decreases MAP/CPP
PRopofol
93
what cannot Propofol do
milk of amnesia - hyponotic BUT NO PAIN RX
94
contraindicatiosn for Propofol
Head injury & hemodynamically unstable
| *b/c decreases MAP/CPP
95
RSI rx & their complications
Fentnanyl - chest wall rigidity, hypotension
ETomidate - adrenal suppression
Ketamine preserves laryngeal function so airway protect
Propofol = decreases CPP/MAP so not for head injury or hemodyunamically unstable
96
what will you see someone on Succ do
fasciculation = muscle twitch
97
SE of SUCC - 2
high K
| malignant hyperthermia
98
what is linked to malignant hyperthermia
Succ
99
drug class of Succ
depolarizing neuromuccular agent
100
burns contraindicate dfor Succ
over 24hrs
101
contrainidcation for SUcc
```
burns over 24hr
rhabdo, high K
hx of Malignant hyperthermia
crush or eye injuries
any nervous system injury like G-B or MG
```
102
pathophysiology of Malignant Hyperthermia
defect in skeletal muscle sarcoplasmic retiulum
| *r/t problem w/Ca removal from the cell
103
treat Malignant Hyperthermia
Dantrolene
| NEVER CaChannel blockers (b/c MH is a problem w/sustained Ca removal from teh cell)
104
Rx not to give someone with Maligant Hyperthermia
Ca ChB (b/c probelm with calcium removal from the muscle_
105
s/s of Malignant Hyperthermia
```
sustINED TETANIC MUSCLE CONTRACTION
masseter spasm
trismus (lockjaw)
rapid incrase in temp up to 110F
HTN/high RR
mixed acidosis
increased ETCO2
```
106
acid base in Malignant Hyperthermia
mixed acidosis
increased ETCO2
tachycardia
107
lockjaw
trismus
108
when do you give Dantrolene
for Malignant Hyperthermia s/p gases or Succ
109
cause of Malignant Hyperthermia
induction gasses or Succ
110
dose of Succ
2.5mg/kg
111
Sugammadex
reverses Roc
112
reverses Roc
Sugammadex
113
drug class of Roc
Non-Depolarizing Neuromuscular BLocking
114
onset/duration of Roc
0.6 - 1.2 mg/kg
115
onset and duration of Roc
onset under 2 min
| lduration 30-60 moin
116
important Rx to give if induce w/vec or roc
NO pain management
117
how to dose RSI if pt is hemodynamically unstable/shock and low CO
1/2 induction. less rx is needed due to depleted catecholamine stores
double paralytic b/c low CO slowws the onset
118
RSI dose of induction agent if pt is shock/hemodynamically unstable w/ low CO
1/2 induction.
| less rx is needed due to depleted catacholamine stores
119
SALAD technique
suction assisted laryngoscopy airway decontamination
| clear airway w/ suction, plae suction in the esophagus wile the intunation tube is passed.
120
post intubation management
Fentanyl, KEtamine, Versed drip
121
failed airway algorithm
3 attemps of laryngoscopy unsuccessful
| can't intubate, ventilatie, oxygenate = CRIC
122
what type of cri to use
surgical cric over 8yo
| needle crif if under 8
