Normal values to check in abg before actually starting to interpret the abg reports, one needs to remember the following normal values, without which, it is impossible to analyze anything. If both the pco2 and hco3 are abnormal, the one which deviates most from the norm is most likely causing an abnormal ph. Interpreting an arterial blood gas abg is a crucial skill for physicians, nurses, respiratory. Describe the process for interpretation of a 12 lead ecg. Arterial blood gas abg interpretation is something many medical students find difficult to grasp weve been there. There are many creative ways to teach arterial blood gas interpretation.
Blood gas analysis takes a stepbystep approach and practice. Arterial blood gas abg interpretation for medical students, osces and mrcp paces this section presents how to interpret arterial blood gases. Jun 04, 2014 the stewart approach, based on physicochemical principles, is a robust physiological concept that can facilitate the interpretation and analysis of simple, mixed, and complex acidbase disorders, thereby allowing better diagnosis of the cause of the disturbance and more timely treatment. Is there a mixedcomplex acid base disturbance table 4. Pdf a practical approach to understanding acidbase. Abgs made easy for nurses w tic tac toe method for. This is also known as the fenclstewart approach, the strongion approach or the physicochemical approach. Interpreting an arterial blood gas abg is a crucial skill for physicians, nurses, respiratory therapists, and other health care personnel. Creative ways to teach arterial blood gas interpretation. Explains the basic physiological ph abnormalities and more to understand. A simplified approach to the interpretation of arterial. Abg interpretation online course due to the increase in patient dependency it is no longer unusual for nurses to be caring for patients who need frequent abg analysis. A new approach to abg interpretation article nursingcenter. Woodruff, msn, rnbc, cns, cmsrn, cen 6 easy steps to.
The very low bicarbonate clearly indicates that the acidosis is, at least in part, metabolic. A case study approach is specially for all the emergency medicine rotatorsexplains all the essentials from basics to the most difficult casesnow you can download the book. Dr fiona smith, dr juliana dong agesmokerhigher fi02 i. But it is often encountered that many students dont know how to read abg, and thats why we are providing arterial blood gas. Interpreting an abg is a crucial skill for health care professionals, and it is especially important in critically ill patients this guide will focus on a commonly used sevenstep process, which helps ensure a complete interpretation of every abg in addition, provided is a list of commonly encountered acidbase disorders many guides exist to aid the interpretation of the abg, some. The classic method used in the usa is the hendersonhasselbalch misspelled on my. Emcrit podcast 50 acid base part iv choose the solution based on. The following sixstep process helps ensure a complete interpretation of every abg. Interpretation of arterial blood gases abgs david a. The 6 easy steps to abg analysis are listed below for easy reference and will be.
Dec 30, 2011 approach to abg acidosis or alkalosis. Physiological approach to assessment of acid base disturbances. This tictactoe technique involves a few charts to help you visualize abgs. Facing acidbase disorders in the third millennium the. Abg quick interpretation parameter acidosis normal alkalosis reflects ph 7. Nurses are often the first members of the health care team to see abg results and an understanding of their significance and the ability to decide when medical staff need to be. Interpreting an arterial blood gas abg is a crucial skill for physicians, nurses. If your patient is mechanically ventilated, good abg interpretation skills can guide clinicians in adjusting the ventilator settings to meet the patients needs. Body will not overcompensate when it comes to acidbase balance so. Arterial blood gas sampling society for acute medicine. If your patient is mechanically ventilated, good abg interpretation skills can guide clinicians in adjusting the. It provides explanations for why acid base disorders occur in human pathophysiology.
The body needs to keep blood ph in a very tight range, 7. Overview of abg analysis analysis of arterial blood gases abg is an essential investigation in the management of. Arterial blood gas analysis abg represents the ultimate test to be used in clinical practice in the. Pulmonary function tests american family physician 1. Although abg interpretation can be arduous, it is essential that critical care nurses master this skill, because accurate interpretation can be life determining. The cause of the acidosis is the p a co 2, which is the respiratory component of the abg results. This guide provides a structured approach to abg interpretation, including several worked examples to put your interpretation skills to the test. A new approach to abg interpretation wong, frankie w. Once youve mastered this technique, youll be doing actual abg interpretation. The stewart approach, based on physicochemical principles, is a robust physiological concept that can facilitate the interpretation and analysis of simple, mixed, and complex acidbase disorders, thereby allowing better diagnosis of the cause of the disturbance and more timely treatment. Arterial blood gas interpretation, abg analysis, rules for rapid abg analysis, anion gap, approach to mixed disorders introduction arterial blood gas abg analysis is an essential part of diagnosing and managing a patients oxygenation status and acidbase balance. Interpretation of the arterial blood gas selflearning packet. Abg interpretation method simple method of acid base balance interpretation a. This video tutorial is on how to setup arterial blood gas problems using the tic tac toe method.
Interpreting the information obtained from an abg result, combined with the patients history and our knowledge of normal pathophysiology as it applies to acidbase balance will help us to plan how to resolve the problem lippincott, 2012. Abg interpretation a guide to understanding abgs geeky. Orlando health is an approved provider of continuing nursing education by the florida board. Weve created this guide, which aims to provide a structured approach to abg interpretation whilst also increasing your understanding of each results relevance. That makes the interpretation of these abg results is uncompensated respiratory acidosis. If an acidaemia is present then an acidosis must be present if an alkalaemia is present then an alkalosis must be present. A stepwise approach to the interpretation of pulmonary. Analysis of arterial blood gases a comprehensive approach. Arterial blood gas interpretation, abg analysis, rules for rapid abg. Arterial blood gas abg interpretation for medical students. Abg is knowledge of basic physiology in relation to ventilation, oxygenation and acid base status. Arterial blood gas analysis is an essential part of diagnosing and managing a patients oxygenation status and acidbase balance. Oakes abg pocket guide and oakes abg instructional guide will enable you to learn complete abg interpretation versus basic classification in a stepbystep approach. Analysis of arterial blood gases a comprehensive approach japi.
Analyze the ph the first step in analyzing abgs is to look at the ph. The three widely used approaches to acidbase physiology are the hco3 in. Podcast 96 acid base in the critically ill part v enough with the bicarb already. Interpretation of arterial blood gas pubmed central pmc. It explains each component in turn followed by clinical examples to work through. This article illustrates the use of the stepwise approach, tables, figures, case studies, illustrations, computerbased learning modules, and the tictactoe approach.
The most important points when assessing a patient are the history, examination and basic observations. Clinical examination a comprehensive collection of clinical examination osce guides that include stepbystep images of key steps, video demonstrations and pdf mark schemes. The anion gap is normal, pointing us in the direction of a limited. Confusion often begins with trying to remember many random rules and lacking a standardized approach to abgs. Arterial blood gas abg interpretation can be a difficult and daunting concept for students and new critical care nurses to grasp. Continuous regular abg monitoring and recording for trends. Interpreting and using the arterial blood gas analysis. Using a fivestep approach to abg interpretation can identify an acidbase disorder quickly and accurately so you can intervene appropriately. Discuss a systematic approach to rhythm interpretation. What i describe is the latest iteration of an approach we first described over 10 years ago4 and is built on the efforts of others. Possible dialysis to remove excess lactate, manipulation of ventilation settings to adjust co 2 levels, but always maintaining tissue perfusion. Mar 01, 2014 a stepwise approach to the interpretation of pulmonary function tests a more recent article on spirometry is available. In this guide, we will teach you the eight 8 steps on how to interpret and analyze arterial blood gas abg results using the tictactoe method.
Abg interpretation is especially important in critically ill patients. Abg interpretation a guide to understanding abgs geeky medics. The 6 easy steps to abg analysis are listed below for easy reference and will be explained in more detail in the sections that follow. Therefore, the 6 easy steps to abg analysis was developed to provide nurses with an accurate and systematic method of easily interpreting arterial blood gases. The net deviation in ph will indicate whether an acidosis or an alkalosis is present guidelines. Woodruff, msn, rnbc, cns, cen nurses often have difficulty interpreting arterial blood gases abgs. The usefulness of this diagnostic tool is dependent. Fourstep method of interpreting arterial blood gas analysis. A primer on arterial blood gas analysis by andrew m. In this article, the basic physiology behind abg analysis and a stepwise approach to interpreting abg analysis will be discussed in detail. Accurate and timely interpretation of an acidbase disorder can be lifesav ing, but the establishment of a correct diagnosis may be challenging. There is a different, more quantitative approach to acid base that takes a lot more into account the effects of chloride, lactate and the strong ion difference. This is called the stewart approach and was popularized by peter stewart back in the 1980s.
Arterial blood gas primer clinical respiratory diseases. A simplified approach to the interpretation of arterial blood gas analysis p. The present article is an attempt for the simplified approach for the bedside interpretation of abg. Blood gas data should always be integrated in light of the full clinical and. Johnson, md, mph, tripler army medical center, honolulu, hawaii. If metabolic acidosis high ag or normal ag is the compensation adequate rule out mixed disorders 8.
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