Arterial blood gas test

We're obviously going to put a pulse ox on this child if they appear to be having respiratory distress so we can understand what their oxygen saturation is at.

And then ABGs.

Again, anything where we're talking about the lower airway and an inability for the alveoli to exchange gas, we're going to want to see if there are any kind of respiratory acidosis.

All right.

We do want to get an x-ray here just to rule out pneumonia.

Also look to see if the they do have any hyperinflation occurring, any infiltration, any atelectasis, right? We're going to get a chest x-ray.

ABGs, again, we're concerned about respiratory acidosis.

They're not fully getting out the CO2 in their body.

That's just like when you make a peep change and you're interested if you know, for whatever reason, you're sending an arterial blood gas rather than looking at the pulse oximeter.

But if you're interested in that, you shouldn't just, you know, make a PEEP change and set an ABG 10 minutes later.

You really should give it time to see what the actual effect is going to be down the road.

All right, take home points, and then we'll do three practice questions to see if we've learned anything, and then everybody can go about their day.

Okay.

Oh, I'm on the ward and somebody needs like an ABG.

It's a simple doctor get, but you get it.

right it's it's taking advantage of these kind of experiences that you have to grab them right again even if you're in training no one's going to hand these to you on a plate right no one's just going to say to you i'm going to teach you about this

We're going to monitor complete blood cell count, especially if we suspect maybe a respiratory infection like pneumonia or something else where the fluid is happening to back up into the lungs.

When we're looking at any kind of respiratory issue, we're always concerned with our ABGs.

We're always concerned with electrolytes, of course, when we have an INO issue.

So again, these are all kind of just standard lab panels that we would be looking at with this patient.

But there's sometimes you actually do need the ABG because it gives you the data that you need.

I feel like ABGs are like my diagnostic besties so we can figure out what is the source here.

So if I feel like I can't trust, if the clinical situation is not matching the vital signs I'm seeing, then I want the respiratory therapist to help us with an ABG.

I am not one that pushes to intubate people early on.

We've seen the charts.

We've seen the ABGs.

We've seen their history and their medical background.

We know that they need it and that it will help them.

We train to work as a lab man.

So we are equipped with things like for ABG, electrolytes, lactate, cardiac markers, coagulation, organ function panels, CBC.

Of course, now we also have portable ultrasounds.

On top of that, in the very near future, we are expecting to complete X-ray training and receive necessary equipment.

So in this situation, it's important to calculate the serum ionized calcium level to get a better understanding of the patient's true calcium balance.

You can use an online calculator to do this, or you can obtain an ionized calcium from the ABG without having to do any calculations.

Now, the most common causes of hypercalcemia are hyperparathyroidism and cancer.

Hypocalcemia can occur for a lot of different reasons, including large volume fluid resuscitation, and that would be due to hemodilution, and in massive blood transfusions.

Okay, now let's talk about CO2.

On the basic metabolic panel, carbon dioxide is an indirect measure of bicarbonate, which tells us about acid-base balance.

So don't confuse this with the PaCO2, which is a direct measure of carbon dioxide and obtainable from the ABG.

Elevated CO2 levels in the serum are associated with metabolic alkalosis and severe vomiting and diarrhea, while decreased levels are associated with metabolic acidosis, renal failure, and diabetic ketoacidosis, of course, among others.