1

8|ood 0as lrlerprelal|or

Ju||e L|oyd
Resp|ralory C||r|ca| 3erv|ce Varaer
0ood lope losp|la|, 3ullor Co|dl|e|d.
2
0verv|eW
8elore you ara|ysel
Norra| rares.
0as exc|are.
- Pa0
2.
- PaC0
2.
Ac|dos|s ard a||a|os|s.
Velaoo||c d|sease.
3
Pre-ara|yl|ca| errors
3lalus ol l|e pal|erl
3arp|e corla|rer
- P|asl|c
- 0|ass
Arl|coau|arl
3arp|e co||ecl|or
- w|o
- w|ere
Type ol sarp|e
- A80
- C80
3lorae ard lrarsporl
- relaoo||sr ard |ea|ae
Rer|x|r
1
3lalus ol l|e Pal|erl
8elore you la|e l|e
o|ood as, pal|erl s|ou|d
oe:
- lr a slao|e verl||alory
cord|lor.
- Al resl lor r|r|rur ol 15
r|rules.
- supp|ererla| oxyer
30 r|rules.
5
0xyer 0|ssoc|al|or Curve
3|oWs salural|or ol lo al
var|ous parl|a| pressures ol
oxyer.
Allecled oy:
- Terperalure. n lerperalure
allecls oord oelWeer 0
2
ard
lo. T|e d|ssoc|al|or curve
s||lls lo l|e r||l.
- pl. p |r pl(n C0
2
) T|e
d|ssoc|al|or curve s||lls lo l|e
r||l.
- 0rar|c P|osp|ales. n 2,3-
0P0 s||lls curve lo l|e r||l.

Norra| Rares
2 8ase excess
22 - 2 rro|/| lC0
3
11.3 - 11.0 |Pa Pa0
2
1.Z - .0 |Pa PaC0
2
Z.35 - Z.15 pl
Z
ls l||s Pal|erl lypox|c?
11.3 - 11.0 12.9|Pa Pa0
2
Norma| Range Heasured
Pal|erl X preserls lo A& E, arler|a| o|ood ases perlorred.
Correrls p|ease?
F|0
2
= 407 - abnorma| gas exchange!
8
ls l||s Pal|erl lypox|c?
11.3 - 11.0 13.1 Pa0
2
(|Pa)
Norma| Range Heasured F|0
2
: 407
Pal|erl Y W|l| preuror|a, arler|a| o|ood ases perlorred
or l|e ward. Correrls p|ease?
Pa0
2
norma|, but |ower than |t shou|d be for 407 0
2
.
but how much |ower?
9
A|veo|ar A|r Equal|or
T|e a|veo|ar as equal|or lor ca|cu|al|r PA0
2
|s
esserl|a| lo urderslard|r ary Pa0
2
va|ue ard |r
assess|r |l l|e |urs are proper|y lrarslerr|r oxyer
|rlo l|e o|ood.
To c||r|ca||y |rlerprel Pa0
2
, you a|so reed lo |roW l|e
pal|erl's PaC0
2
, F|0
2
ard l|e P8 (oarorelr|c
pressure), a|| corporerls ol l|e equal|or lor PA0
2
:
PA0
2
= F|0
2
(P

- 47} - 1.2(Pa60
2
}.
Trad|t|ona| Un|ts!
10
For Pal|erl Y .
F|0
2
= 10 (0.1)
Assure a rorra| C0
2
(5.0|Pa)
PA0
2
= F|0
2
(P

- 47} - 1.2(Pa60
2
}
PA0
2
= 0.4(101.3- .2) - 1.2(5.0)
PA0
2
= 38 -
PA0
2
= 32|Pa
Veasured Pa0
2
= 13.1 |Pa . a o| d|llerercel
3.l. ur|lsl
11
Aororra| Pa0
2
0ecreased.
lypoverl||al|or,
verl||al|or/perlus|or
r|sralc|,
A|veo|ar-cap|||ary o|oc|.
R||l lo |ell s|urls.
|ncreased.
lyperverl||al|or.
0xyer l|erapy.
Nol usua||y poss|o|e lo le|| W||c| |s caus|r l|e proo|er
W|l|oul lurl|er |rvesl|al|or.
12
lypox|a ard C0
2
1.5 - .1 2.9|Pa PaC0
2
11.3 - 11.0 9.|Pa Pa0
2
Norma| Range Heasured F|0
2
: 217
Pal|erl Z W|l| suspecled P.E. Correrl p|ease?
Pat|ent |s hypox|c and Pa60
2
|s |ow.
hypox|a st|mu|ates a|veo|ar vent||at|on, reduc|ng Pa60
2
13
uselu| T|psl
1.5 - .1 1.3|Pa PaC0
2
11.3 - 11.0 1.1|Pa Pa0
2
Norma| Range Heasured F|0
2
: 217
For a pat|ent on a|r, w|th norma| |ungs, Pa0
2
+ Pa60
2
=
approx 17kPa
Phys|o|og|ca||y d|ff|cu|t to get Pa60
2
<1kPa, therefore
va|ues of Pa0
2
>1kPa |nd|cate that pat|ent probab|y
rece|v|ng supp|ementa| 0
2
11
T|e '1Z|Pa' Ru|e
1.5 - .1 12.3|Pa PaC0
2
11.3 - 11.0 1.1|Pa Pa0
2
Norma| Range Heasured F|0
2
: 217
Pal|erl A - o|d po||o pal|erl. Correrls p|ease?
Pat|ent |s hypox|c and Pa60
2
|s very h|gh.
A|veo|ar vent||at|on |s |ow, but & Pa0
2
+ Pa60
2
= 1.4kPa
15
T|e '1Z|Pa' Ru|e
1.5 - .1 Z.1|Pa PaC0
2
11.3 - 11.0 5.1|Pa Pa0
2
Norma| Range Heasured F|0
2
: 217
Pal|erl 8 - C0P0 pal|erl. Correrls p|ease?
Pat|ent |s hypox|c and Pa60
2
|s ra|sed.
A|veo|ar vent||at|on |s |ow. |f |ungs norma|, Pa0
2
shou|d =
10kPa . but |t's not! 0ue to |mpa|red oxygenat|on.
1
Ac|dos|s & A||a|os|s
Vuc| |ess corp||caled l|ar |l l|rsl appears.
T|e pl delerr|res l|e pr|rary proo|er.
Norra| rare Z.35 - Z.15.
- Aoove Z.15, a||a|os|s (relaoo||c or resp|ralory).
- 8e|oW Z.35, ac|dos|s (relaoo||c or resp|ralory).
ll Wou|d oe exlrere|y urusua| lor e|l|er l|e
resp|ralory or rera| sysler lo overcorpersale.
1Z
Ac|d-8ase 8a|arce
CO
2
+ H
2
O H
2
CO
3
H
2
CO
3
H
+
+ HCO
3
-
pH = 6.1 + log
10
[HCO
3
-
]
[CO
2
]
Henderson-Hasselbach
carbonic
anhydrase
18
Acule Resp|ralory Ac|dos|s
PaC0
2
|s e|evaled ard pl |s |oW (ac|dol|c).
T|e decrease |r pl |s accourled lor erl|re|y oy
l|e |rcrease |r PaC0
2.
lC0
3
-
ard oase excess W||| oe |r l|e rorra|
rare oecause l|e ||dreys |ave rol |ad
adequale l|re lo eslao||s| ellecl|ve
corpersalory rec|ar|srs.
19
Acule Resp|ralory Ac|dos|s
Causes
- Resp|ralory pal|op|ys|o|oy
a|rWay ooslrucl|or, severe preuror|a, c|esl
lraura/preurol|orax
- Acule dru |rlox|cal|or
rarcol|cs, sedal|ves
- Res|dua| reuroruscu|ar o|oc|ade
- CN3 d|sease
|ead lraura
20
C|ror|c Resp|ralory Ac|dos|s
For a pr|rary resp|ralory proo|er, pl ard
PaC0
2
rove |r l|e oppos|le d|recl|or.
ll l|e PaC02 rera|rs e|evaled lor rore l|ar a
leW |ours, l|e lC03- |eve| (v|a ||dreys) lo
reslore pl lo rorra| rare.
- Corpersal|or.
Corpersal|or |s oller |rcorp|ele.
21
Exarp|e ol Corpersal|or.
1.5 - .1 8.|Pa PaC0
2
Z.35 - Z.15 Z.35 pl
22 -29 31 lC0
3
-
11.3 - 11.0 5.1|Pa Pa0
2
Norma| Range Heasured F|0
2
: 217
Pal|erl 0 - C0P0 pal|erl, 2 days posl adr|ss|or W|l|
exaceroal|or.
Pa0
2
|ow, Pa60
2
, ph wNL (just} and h60
3
-
.
22
C|ror|c Resp|ralory Ac|dos|s
Causes
- C|ror|c |ur d|sease
e.. C0P0
- Neuroruscu|ar d|sease
Vuscu|ar dyslrop|y, 0u|||ar-8arre
- Exlrere ooes|ly
P|c|W|c||ar syrdrore
- C|esl Wa|| delorr|ly
Kyp|osco||os|s
23
Acule Resp|ralory A||a|os|s
PaC0
2
|s |oW ard l|us pl |s ||| (a||a|ol|c).
T|e |rcrease |r pl |s accourled lor erl|re|y oy
l|e |oW |r PaC0
2.
lC0
3
-
ard oase excess W||| oe |r l|e rorra|
rare oecause l|e ||dreys |ave rol |ad
adequale l|re lo eslao||s| ellecl|ve
corpersalory rec|ar|srs.
21
Resp|ralory A||a|os|s
Pa|r
Arx|ely
lypoxer|a
Reslr|cl|ve |ur d|sease
3evere coresl|ve |earl
la||ure
Pu|rorary eroo||
0rus
3eps|s
Fever
T|yrolox|cos|s
Prerarcy
0veraress|ve
rec|ar|ca| verl||al|or
lepal|c la||ure
6auses
25
Velaoo||c Ac|dos|s
lr ror-resp|ralory ac|dos|s, pl & lC0
3
-
W||| oe
|oW.
LoW pl |s polerl resp|ralory sl|ru|arl.
Resp|ralory resporse |s vERY rap|d (ur|||e
relaoo||c or).
urusua| lo see a relaoo||c ac|dos|s W|l|oul
pPaC0
2.
2
Causes ol Velaoo||c Ac|dos|s
0|aoel|c Keloac|dos|s (0KA).
3evere d|arr|oea.
- lyperc||orer|c ac|dos|s due lo excess|ve |oss ol sod|ur
o|caroorale.
Lacl|c ac|d accuru|al|or.
- s|oc|, |earl la||ure, severe araer|a, pro|ored exerc|se,
se|zures, |ypo|ycaer|a , a|co|o|, ||ver la||ure, ra||rarcy,
or cerla|r red|cal|ors |||e sa||cy|ales.
0e|ydral|or.
2Z
Velaoo||c & Resp|ralory Ac|dos|s
Acule |ypercapr|c la||ure.
- urWe||.
- lypolers|or.
- Poor per|p|era| o|ood l|oW.
Velaoo||se araeroo|ca||y - producl|or ol |aclale.
T|e resp|ralory & relaoo||c ac|dos|s |oWers pl,
PaC0
2
due lo a|veo|ar |ypoverl||al|or, lC0
3
-
|s lror ror-resp|ralory ac|dos|s.
28
Exarp|e.
1.5 - .1 15.1|Pa PaC0
2
Z.35 - Z.15 .80 pl
22 -29 18 lC0
3
-
11.3 - 11.0 Z.1|Pa Pa0
2
Norma| Range Heasured F|0
2
: 1007
Pal|erl F - lypercapr|c resp|ralory la||ure
|f pure resp|ratory, Pa60
2
wou|d be assoc|ated w|th N
or h60
3
-
. |f pure metabo||c Pa60
2
shou|d be |ow.
29
Velaoo||c A||a|os|s
Vuc| rarer.
0ccurs as a corsequerce ol a |oss ol l

lror l|e oody

or a a|r |r lC03
-
.
Causes.
- vor|l|r or over erl|us|asl|c rasoaslr|c (N0) sucl|or.
- A||a|| adr|r|slral|or.
- Corlracl|or a||a|os|s:
Loss ol o|caroorale-poor, c||or|de-r|c| exlrace||u|ar l|u|d, as ooserved
W|l| T||az|de d|urel|c or |oop d|urel|c l|erapy or c||or|de d|arr|oea,
|eads lo corlracl|or ol exlrace||u|ar l|u|d vo|ure.
30
A|| Roads Lead To .
R 0 H E
Resp|ratory 0ppos|te
Hetabo||c Equa|
31
Case 1
1.5 - .1 9.98|Pa PaC0
2
Z.35 - Z.15 Z.33 pl
22 -29 38. lC0
3
-
11.3 - 11.0 .10|Pa Pa0
2
Norma| Range Heasured F|0
2
: 247
Pal|erl RV. 59 year o|d ra|e. Allerded 0P Nurse-
Led c||r|c. lrcreas|r|y 308. Correrls p|ease.
E = 8.5mmo||L, hb = 18.2g|dL, 60hb = .7
32
Case 2
91 8Z 3p0
2
38. 38. lC0
3
-
1.10|Pa 9.98|Pa PaC0
2
Z.119 Z.33 pl
8.20|Pa .10|Pa Pa0
2
30m|ns Q 4L|m|n Heasured
Pal|erl JL. 51 year o|d ra|e. Allerded lor LT0T
assessrerl. lL0. Correrls p|ease.
33
Case 3
1.5 - .1 1.10|Pa PaC0
2
Z.35 - Z.15 .90 pl
22 -29 2.0 lC0
3
-
11.3 - 11.0 19.10|Pa Pa0
2
Norma| Range Heasured F|0
2
: 287
Pal|erl AT. 21 year o|d lera|e. KroWr d|aoel|c.
Allerded A&E W|l| vor|l|r. Correrls p|ease.
31
Ac|roW|edererls
0r w J K|rrear, Corsu|larl Resp|ralory
P|ys|c|ar, 0ueers Ved|ca| Cerlre, Noll|r|ar.
0r 8 0 Cooper, Corsu|larl C||r|ca| 3c|erl|sl,
ur|vers|ly losp|la|, 8|rr|r|ar.
35
0uesl|ors?