In-Depth Procedures

Question 1

Chemical Buffers

Answer 1

Works the fastest
Doesn’t last as long as other systems
Three main chemical buffers: Bicarbonate, Phosphate, Protein

Question 2

Respiratory System

Answer 2

Takes longer than chemical buffers (responds in minutes)
Lasts longer than chemical buffers (compensation still temporary)
Faster, deeper breathing = rise in pH (eliminates CO2)
Slower, shallower breathing = fall in pH (reduced CO2 excretion)
Can handle twice as many acids and bases than chemical buffers

Question 3

Renal System

Answer 3

Takes up to 24 hours before starting to restore normal pH
Long-term adjustment to pH
When blood’s acidic, kidneys reabsorb HCO3 and excrete H+
When blood is alkaline, kidneys excrete HCO3 and retain H+

Question 4

General Acidosis

Answer 4

Blood pH less than 7.35
Neurons become less excitable, don’t transmit as fast and CNS depression results.
Respiratory centers cease to function
Blood vessels dilate -> reduce BP
Decreased LOC, depressed respirations

Question 5

General Alkalosis

Answer 5

Blood pH great than 7.45
Neurons become hyper excitable
Starts with sensory changes
If severe, muscle twitches turn into sustained contractions that paralyze respiratory muscles
Localized seizure activity -> general seizure activity, decreased LOC, irregular respirations

Question 6

Respiratory Acidosis Numbers

Answer 6

pH below 7.35
PaCO2 above 45mmHg
HCO3 is normal

Question 7

Respiratory Acidosis Clinical Presentation

Answer 7

Altered LOC, tachycardia, diaphoresis, headache

Question 8

Respiratory Acidosis Cause

Answer 8

Inadequate or no respirations, COPD, overdose, pneumonia, smoke inhalation, pneumothorax, airway obstruction

Question 9

Respiratory Acidosis Treatment

Answer 9

Increase rate and depth of ventilations - ventilate them so you can get rid of some CO2 for them

Question 10

Acid Base Balance Normal Numbers

Answer 10

pH of 7.35 - 7.45
HCO3: 22-26 mEq/L
PaCO2: 35-45 mm Hg

Question 11

Respiratory Alkalosis Numbers

Answer 11

pH above 7.45
PaCO2 below 35 mmHg
HCO3 is normal

Question 12

Respiratory Alkalosis Clinical Presentation

Answer 12

Numbness or muscle twitch in fingers and toes, seizures. Respiratory alkalosis is hyperventilation (blowing off too much CO2)

Question 13

Respiratory Alkalosis Cause

Answer 13

Shock, DKA Kussmaul Respirations - deep and fast breathing (the body is trying to compensate for its metabolic acidosis by producing a respiratory alkalosis on purpose), anxiety, pain and fever

Question 14

Respiratory Alkalosis Treatment

Answer 14

Decrease rate and depth of ventilations (calm them down and/or stop ventilating so fast), give pain meds, have patient breath into NRM with no O2 (makes them rebreathe CO2 increasing blood levels)

Question 15

Metabolic Acidosis Numbers

Answer 15

pH below 7.35
PaCO2 is normal
HCO3 is below 22 mEq/L

Question 16

Metabolic Acidosis Clinical Presentation

Answer 16

Tachycardia, pulmonary edema, tachypnea, confusion or coma

Question 17

Metabolic Acidosis Cause

Answer 17

Cardiac arrest, renal failure, DKA, diarrhea for a long time, ASA or anti freeze overdose

Question 18

Metabolic Acidosis Treatment

Answer 18

Increase rate and depth of ventilations. Consider Sodium Bicarbonate (ACP) (like tums for the blood) it binds up the acid and turns it neutral.

Question 19

Metabolic Alkalosis Numbers

Answer 19

pH above 7.45
PaCO2 is normal
HCO3 is above 26mEq/L

Question 20

Metabolic Alkalosis Cinical Presentation

Answer 20

Seizures, headache, dysrhythmias

Question 21

Metabolic Alkalosis Cause

Answer 21

Diuretics can cause an excess loss of sodium or potassium or renal loss of H+, cystic fibrosis, tums overdose, overzealous bicarb administration

Question 22

Metabolic Alkalosis Treatment

Answer 22

Keep them alive long enough for their body to use up the excess bicarb. In hospital treatment includes replacing sodium and potassium

Question 23

Initial Assessment

Answer 23

Determine the patients mental status (AVPU, LOC)
Locate and manage immediate life threats involving CAB
Ensure the patient has a patent airway
If the patient has minor external bleeding, note it and move on
If major external bleeding is present, deal with it immediately
If internal bleeding is suspected, keep patient warm and administer supplemental oxygen, but remember rapid transport to hospital is necessary

Question 24

Focused History

Answer 24

Elaborate on the patients chief complaint using OPQRST mnemonic
Obtain a history of the present illness using SAMPLE
Look for signs of shock
Ask the patient about medications and any history of clotting insufficiency

Question 25

Physical Examination for a Bleeding Patient

Answer 25

Note color of bleeding -> try to determine its source
Bright red blood from a wound or the mouth, rectum, or other orifice indicates fresh arterial bleeding
Coffee ground emesis - sign of upper GI bleeding
Melena - Sign of upper GI bleeding
Hematochezia - Stool containing bright red blood ie hemorrhoids
Hematuria - blood in the urine
Nonmenstural vaginal bleeding

Question 26

Bleeding from an Artery

Answer 26

Bright red
Spurts in time with the pulse
Difficult to control
As the amount of blood circulating in the body drops, so does the patients BP and eventually the arterial spurting diminishes

Question 27

Bleeding from an Open Vein

Answer 27

Much darker
Flows steadily
Easier to manage

Question 28

Bleeding from Damaged Capillary Vessels

Answer 28

Dark red
Oozes slowly
Venous and capillary bleeding are more likely to clot spontaneously then arterial bleeding