Teach you to quickly judge blood gas analysis

time:2022-12-02 13:29:24source:monlittlebaby.com author:Maternal-Child Nursing
Teach you to quickly judge blood gas analysis

*For medical professionals to read and refer to the class notes - "Can't see acid-base imbalance? Teach you four-step quick judgment! "Lecturer: Wang Shengsheng Danzhou People's Hospital Blood gas analysis is an essential tool and basic skill for the diagnosis and treatment of critically ill patients, and it is also an almost compulsory content in medical examinations at all levels. How to judge the type of acid-base imbalance in blood gas analysis is even more important. Top priority. In this regard, the medical community specially invited Mr. Wang Shengsheng, the deputy chief physician from the Department of Respiratory Medicine of Danzhou People's Hospital, to produce this issue of "Can you see acid-base imbalance? Teach you four-step quick judgment! 》 course, for us to explain in detail how to perform blood gas analysis. 1. Eight important knowledge points 1. Commonly used values ​​are normal values. 2.AG=Na⁺-(Cl⁻+HCO3⁻)=Na⁺-Cl⁻-HCO3⁻. When AG>16mmol/L, it is high AG metabolic acidosis. According to whether AG is elevated, metabolic acidosis is divided into hyperchlorhydric acidosis (normal blood chlorination) and normal AG acidosis (hyperchloremic acidosis). 3. For high AG acid substitution, it is necessary to calculate: potential HCO3⁻=measured HCO3⁻+ (measured AG-12), which can also be simplified as potential HCO3⁻=Na⁺-Cl⁻-12. If the potential HCO3⁻>27mmol/L, there is a combination of metabolic alkalosis. 4. A common basic method for judging acid-base imbalance by changing directions according to PH and PaCO2. Figure 1: Determining the type of acid-base imbalance 5. Remember the compensatory limit for acid-base imbalance. Figure 2: The limit value of acid-base imbalance compensation 6. When any one index of PaCO2 and HCO3⁻ changes primary, the compensation method of the other index changes in the same direction. 7. After the primary change of any one index of PaCO2 and HCO3⁻, the other index changes in the same direction and exceeds the compensatory limit value, indicating that different acid-base poisonings of different natures are mixed. 8. PaCO2 and HCO3⁻ change in opposite directions, indicating that the same acid-base poisoning with different properties is mixed. 2. The exclusive "four-step method" for quick judgment of acid-base imbalance
  • The first step: Judging whether the acid-base imbalance is respiratory or metabolic from the changing direction of PH and PaCO2.
  • Step 2: Look at the change direction and magnitude of the corresponding compensation value from the primary abnormality.
  • Step 3: Look at the AG value.
  • Step 4: If AG is elevated, calculate "potential HCO3⁻".
Generally, only the first two steps can be used to complete the judgment in exams and clinical trials, which is definitely a veritable "second judgment". How to apply the four-step method to clinical practice? Finally, I will leave you an after-class thinking question. During the course, the teacher will teach us to practice this exclusive four-step method. Come into the course and follow the teacher to practice! Figure 3: Course case display Xiaojie has carefully prepared knowledge notes for everyone. You can use it according to the course~
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