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Mark Klimek Lecture Notes

LECTURE 1: Acid Base Balance & Ventilator

Mark Klimek Lecture Notes

LECTURE 1: Acid Base Balance & Ventilator

Interpreting blood gases (remember the rules of the B’s) • If the pH and the bicarb are both in the same direction then it’s metaBolic (Bicarb Both Bolic), if they are in different directions then it is respiratory

• If bicarb is normal and the pH is low or high then its respiratory

• You will be given 8 values for arterial blood gas, always first look at the pH and the bicarb first

• You get acidosis and alkalosis from the pH

LABS: ABG’s

The normal pH is 7.35-7.45 The normal bicarb is 22-26 (the bicarb years where you make all the decisions [22-26 years old], or 2+2+2=6) The normal CO2 is 35-45 (same as pH)

Signs and Symptoms with ABG’s • As the pH goes up so does my patient

• If the pH goes up, every system in your body gets more

irritable/hyperexcitable • As the pH goes down so does my patient

• If the pH goes down, systems in your body shut down

• Except for potassium- When pH goes down, potassium goes up

• If the pH goes up (alkalosis): you will find irritability, hyperreflexia (3&4), 1 / 2

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tachypnea, tachycardia, borborygmi (increased bowel sounds), seizure (need suctioning at the bed side because they can seize and aspirate)

• If pH goes down (acidosis): hyporeflexia, bradycardia, lethargy, obtunded,

paralytic ileus, coma, respiratory arrest (need bag-mask ventilation bag at bedside for respiratory arrest), +1 reflexes

• MACkussmal- compensatory and respiratory pattern for only acid base

disorder: MAC- Metabolic ACidosis

Respiratory Acidosis multiple choice example: What would you see with a

patient who is in respiratory acidosis?

• +1 reflex,
• diarrhea,
• adynamic ileus (no movement),
• spasm,
• urinary retention,
• paraxysmol atrial tachycardia,
• second degree lovitz, type 2 heart block (impulse is being slowed),
• hypokalemia

LAB: REFLEXES

0&1-hyporeflexia 2-normal 3&4- hyperreflexia

EXAMPLE: (In general what do pain meds do?

ANSWER: They sedate you, they are CNS depressants: lethargy, lucidity, reflexes at +1, hyporeflexia, obtundent

Causes of Acid Base Imbalance • Don’t get signs and symptoms mixed up with causation!!!• What causes something is the opposite of what the signs and symptoms are

o EXAMPLE: diarrhea will cause a metabolic acidosis but once you get

acidotic, it will shut your bowels down and you will get a paralytic ileus.

• The first question you should ask yourself if the scenario involves a lung problem.

• Is it a respiratory problem? BUT remember it can still be respiratory

acidosis/alkalosis… • Next question you ask yourself…

• is the client overventilating or underventilating?
• If the patient is overventilating pick alkalosis
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