Mark Klimek Lecture Notes
LECTURE 1: Acid Base Balance & Ventilator
Interpreting blood gases
(remember the rules of the B’s)
ï‚· If the pH and the
... [Show More] bicarb are both in the same direction then it’s metaBolic
(Bicarb Both Bolic), if they are in different directions then it is respiratory
ï‚· If bicarb is normal and the pH is low or high then its respiratory
ï‚· You will be given 8 values for arterial blood gas, always first look at the pH
and the bicarb first
ï‚· 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
ï‚· As the pH goes up so does my patient
o If the pH goes up, every system in your body gets more
irritable/hyperexcitable
ï‚· As the pH goes down so does my patient
o If the pH goes down, systems in your body shut down
ï‚· Except for potassium- When pH goes down, potassium goes up
ï‚· If the pH goes up (alkalosis): you will find irritability, hyperreflexia (3&4),
tachypnea, tachycardia, borborygmi (increased bowel sounds), seizure (need
suctioning at the bed side because they can seize and aspirate)
ï‚· 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
ï‚· MACkussmal- compensatory and respiratory pattern for only acid base
disorder: MAC- Metabolic ACidosisRespiratory Acidosis multiple choice example: What would you see with a
patient who is in respiratory acidosis?
a. +1 reflex,
b. diarrhea,
c. adynamic ileus (no movement),
d. spasm,
e. urinary retention,
f. paraxysmol atrial tachycardia,
g. second degree lovitz, type 2 heart block (impulse is being slowed),
h. 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!!!
ï‚· 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.
ï‚· The first question you should ask yourself if the scenario involves a lung
problem.
o Is it a respiratory problem? BUT remember it can still be respiratory
acidosis/alkalosis…
 Next question you ask yourself…
o is the client overventilating or underventilating?
o If the patient is overventilating pick alkalosis
o If they are underventilating pick acidosis
ï‚· If the client is overventilating.. it has an attachment to the word- alkalosis
(because they are both OVER)… ventilating OVER becomes respiratory
ALKALOSISï‚· If the client is undeventilating.. it has an attachment to the word- acidosis
(because they are both UNDER)- ventilating UNDER becomes respiratory
ACIDOSIS
Examples:
1) A woman is overzealously using her breathing techniques during labor, what
acid base disorder will she exhibit? Overventilation
o Respiratory Alkalosis
2) A child is near drowning, what acid base disorder would it be?
Underventilating
o Respiratory Acidosis
3) Your patient has emphysema, what acid base disorder would it be?
Underventilating
o Respiratory Acidosis
Ventilating does not mean respiratory rate.. respiratory rate is irrelevantventilation has to do with gas exchange!! [Show Less]