ABGs Case Study #1 – Student Guide A 76-year-old man

ABGs Case Study #1 – Student Guide A 76-year-old man complained to his wife of severe sub-sternal chest pains that radiated down the inside of his left arm. Shortly afterward, he collapsed on the living room floor. Paramedics arriving at his house just minutes later found him unresponsive, not breathing, and without a pulse. CPR and electroconvulsive shock were required to start his heart beating again. Upon arrival at the Emergency Room, the man started to regain consciousness, complaining of severe shortness of breath (dyspnea) and continued chest pain. On physical examination, his vital signs were as follows: Systemic blood pressure 85 mm Hg / 50 mm Hg Heart rate 175 beats / minute Respiratory rate 32 breaths / minute Temperature 99.2oF His breathing was labored, his pulses were rapid and weak everywhere and his skin was cold and clammy. An ECG was done, revealing significant “Q” waves in most of the leads. Blood testing revealed markedly elevated creatine phosphokinase (CPK) levels of cardiac muscle origin. Arterial blood was sampled and revealed the following: pH 7.22 pCO2 30 mm Hg pO2 70 mm Hg Hemoglobin – O2 saturation 88 % HCO3- 2 meq / liter Questions: 1. What diagnosis do you think this scenario represents? What evidence supports your diagnosis? 2. How would you classify his acid-base status? Name the associated Elyte imbalance? What specifically caused this acid-base disturbance? 3. How has his body started to compensate for this acid-base disturbance? 4. What pH range is incompatible with life? Why is this range incompatible with life? 5. List some other causes of this type of acid-base disturbance: ABG Case Study #2 A 78 year old woman is in a coma after suffering a severe stroke. She is in the intensive care unit and has been placed on a ventilator. Arterial blood gas measurements from the patient reveal the following: pH 7.50 pCO2 30 mm Hg pO2 100 mm Hg Hemoglobin – O2 saturation 98% [HCO3-] 24 meq / liter Questions: 1. What test should be done before drawing ABGS? What are the steps? 2. How would you classify this patient’s acid-base status? 3. How does this patient’s hyperventilation pattern raise the pH of the blood? 4. How might the kidneys respond to this acid-base disturbance? What is the normal Base to acid ratio? 5. List some other causes of this type of acid-base disturbance: ABG Case Study #3 A 28-year-old woman has been sick with the flu for the past week, vomiting several times every day. She is having a difficult time keeping solids and liquids down, and has become severely dehydrated. After fainting at work, she was taken to a walk-in clinic, where an IV was placed to help rehydrate her. Arterial blood was drawn first, revealing the following: pH 7.50 pCO2 40 mm Hg pO2 95 mm Hg Hemoglobin – O2 saturation 97% [HCO3-] 32 meq / liter Questions: 1. How would you classify her acid-base disturbance? 2. Why might excessive vomiting cause her particular acid-base disturbance? 3. How would the kidneys compensate for this acid-base disturbance? 4. List some other causes of this type of acid-base disturbance. Additional Acid-Base Questions: Define: Kussmaul Breathing Anion Gap Chvostek sign Trousseau sign AB + 1 AB + 2 N + 2 Drugs to Know Ammonium Chloride Sodium bicarbonate Regular insulin Furosemide, Bumex, (loop diuretics), Hydrochlorothiazide (thiazide) Naloxone, Naltrexone – Albuterol Prednisone Acetylcysteine Diazepam (Valium), Lorazepam (Ativan) Promethazine (Phenergan) Potassium Chloride – Sodium Chloride (IV solutions used in DKA) Kayexalate

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