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One night in A+E. Topics for discussion Acid Base Balance and Disorders Arterial Blood Gas Measurement Lung volumes Cardiac Cycle.

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Presentation on theme: "One night in A+E. Topics for discussion Acid Base Balance and Disorders Arterial Blood Gas Measurement Lung volumes Cardiac Cycle."— Presentation transcript:

1 One night in A+E

2 Topics for discussion Acid Base Balance and Disorders Arterial Blood Gas Measurement Lung volumes Cardiac Cycle

3 Objectives Understand the basic principles of Acid Base Balance Use a systematic approach to interpret ABGs Interpret and name lung volumes on a graph Understand the difference between Obstructive and Restrictive patterns of lung disease Be able to name and understand the curves on a cardiac cycle diagram

4 https://www.youtube.com/watch?v=ERj9N7TY CSE https://www.youtube.com/watch?v=ERj9N7TY CSE

5 You are a junior doctor on your very first day working in the A&E department at the Royal Free. 2021??

6 Them Values pH PaCO 2 Normal range: kPa or mmHg HCO 3 - Normal range: mmol/L

7 What is an “arterial blood gas” (ABG)? What does it measure? Turn to your colleague…

8 Volatile acid Non volatile acids? CO 2 + H 2 O H 2 CO 3 H + + HCO3 -

9 Buffering

10 Compensation CO 2 + H 2 O H 2 CO 3 H + + HCO3 -

11 With this background knowledge in mind, you proceed to meet your first patient!

12 Mr. Jones You meet a 60-year-old male with a history of chronic obstructive pulmonary disease. He is obviously unwell, with severe shortness of breath, pyrexia (fever) and productive cough. His ABGs are shown below: pH7.20 PaCO 2 9.3kPa (or 70 mmHg) HCO mmol/L pH PaCO kPa or mmHg HCO mmol/L

13 How not to kill someone – an approach to ABGs pO2 (determine oxygenation) pH (acidosis/alkalosis) PaCO2 HCO3- What’s the primary disturbance? Is there any compensation? Is it appropriate?

14

15 Mr. Jones You meet a 60-year-old male with a history of chronic obstructive pulmonary disease. He is obviously unwell, with severe shortness of breath, pyrexia (fever) and productive cough. His ABGs are shown below: pH7.20 PaCO 2 9.3kPa (or 70 mmHg) HCO mmol/L pH PaCO kPa or mmHg HCO mmol/L

16 Jim Your next patient is an 18 year-old male. He has been vomiting for the last 24 hours and feels unwell. His ABGs are shown below: pH7.49 PaCO 2 6.3kPa (or 47 mmHg) HCO mmol/L pH PaCO kPa or mmHg HCO mmol/L

17 Ben You next meet an 8 year-old male who appears lethargic and has a strangely “fruity” smell to his breath. He has a previous history of polyuria (increased frequency and volume of urination), polydipsia (increased thirst) and weight loss. pH7.30 PaCO 2 3.3kPa (or 25 mmHg) HCO mmol/L pH PaCO kPa or mmHg HCO mmol/L

18 Ronald Your next patient is a 20 year-old with Duchenne muscular dystrophy admitted with urinary tract infection (UTI). He has a temperature of 39 o C, feels warm and peripherally vasodilated with a blood pressure of 90/60. pH7.28 PaCO 2 6.3kPa (or 47 mmHg) HCO mmol/L pH PaCO kPa or mmHg HCO mmol/L

19 As you begin to rest your heavy head… https://www.youtube.com/watch?v=ERj9N7TY CSE https://www.youtube.com/watch?v=ERj9N7TY CSE

20 OMG The paramedics have brought in a 50 year-old man suspected of having an upper GI bleed. His BP is 90/40. pH7.30 PaCO 2 3.3kPa (or 25 mmHg) HCO mmol/L Lactate5 mmol/L (normal: ) pH PaCO kPa or mmHg) HCO 3 - About 24mmol/L (Normal range: mmol/L)

21 On your way out at 8am, you decide to revise some Year 1 physiology..

22

23

24 Obstructive almostadoctor.co.uk

25 Restrictive almostadoctor.co.uk

26 Any Questions?


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