Mark K 1

Normal pH range

7.35-7.45

Normal Bicarbonate range

22-26 mEq/L

Normal CO2 levels

35-45

As the pH goes (low) so goes my patient except for? & vice versa!

Potassium

What is the rule of Bs?

if pH and Bicarb move BOTH in the same direction, then the acid-base imbalance is metabolic.. otherwise it is respiratory

If the pH is alkalotic (increased pH)

The pt is going up = hyperreflexia (3+, 4+), tachypnea, tachycardia, borborygmi (moving bowels), seizure (pt needs suctioning because of aspiration risk)

What should you have at bedside for a pt who is alkalotic?

Suction because they are at risk of seizures and this aspiration since all body systems are going UP

If the pH is acidosis (low) and moving down...

The pt is also going down= hyporefelxia (0, 1+), bradypnea, bradycardia, lethargy, obtunded, paralytic ileus, coma, respiratory arrest

What should you have at bedside for a pt who is acidotic?

Ambu bag!! They may need ventilation because of respiratory arrest

Kussmaul breathing

Deep, rapid, labored breathing

Kussmaul respiration are what acid/base imbalance?

Remember, MAC Kussmaul!!

The only acid-base imbalance to cause metabolic acidosis !!

Overventilating, think lung!

respiratory alkalosis

Underventilating

respiratory acidosis

If SaO2 is low what is happening?

Underventilation

For a pt with a PCA pump, what acid/base imbalance indicates they need to come off?

Respiratory acidosis

Metabolic alkalosis cause (think not lung)

Prolonged/persistent vomiting (so now they are dehydrated and lost all their acid), suctioning (losing acid)

Metabolic acidosis (default) cause

DKA & Kussmaul breathing !!

When you don’t know what to pick: Renal failure, diarrhea, vomiting in neonate

Fully compensated ABG

-normal ph but both CO2/HCO3 will be opposite and out of normal range

Partially compensated ABG

All values are abnormal

Uncompensated ABG

pH and one other value is abnormal, the other is normal

High pressure alarm

Indicates increased resistance to airflow.

Low pressure alarm

Indicates decreased resistance or disconnection.

High pressure alarms are usually due to what?

Obstructions!! kinks, water condensation in tube, mucous secretions in airway

Low pressure alarms are usually due to what?

Disconnections like main tubing to O2 sensor tubing

What do you do if there are mucous secretions in the airway?

Change positions, turn, cough and deep breathing, then suction

What is happening in a pt on a vent who is in respiratory alkalosis?

Vent settings are too high, over ventilating

What is happening in a pt on a vent who is in respiratory acidosis?

Vent settings are too low, under ventilating

When can you wean a pt off of a vent?

Respiratory alkalosis