Anak Presentation
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Transcript of Anak Presentation
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Analisis Gas Darah
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• What Is Meant by Interpreting
Arterial Blood Gases?
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• Information needed to
interpret blood gas data?
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• The patient’s environment:
Fi! and barometri"
press#re
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$hysiologi" pro"esses
• Alveolar ventilation
• %ygenation
• A"id&base balan"e
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Four important equations
• $'! e(#ation
• • VCO2 x 0.863
• PaCO2 = -------------------
• VA
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• Alveolar as equation
• PAO2 = P!O2 -".2 #PaCO2$
• P!O2 = F!O2 #P%-&'$
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.• PaCO2 !n %loo( )tate alv. Ventilt.
• ----------------------------------------------------------• *&+ ,perapnia ,poventilation
• 3+-&+ /uapnia ormal ventilation
• 13+ ,poapnia ,perventilation
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'a#ses of lo) $a'! $*A&a+!
• Nonrespiratory • 'ardia" right&to&left sh#nt In"reased
• De"reased $I! ,ormal
• -o) mi%ed veno#s o%ygen "ontent In"reased
• Respiratory • $#lmonary right&to&left sh#nt In"reased
• .entilation&perf#sion imbalan"e In"reased• Diff#sion barrier In"reased
• /ypoventilation *in"reased $a'!+ ,ormal
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• %ygen "ontent
• CaO2 =#)aO2 x ,% x ".3&$ 0.003#PaO2$
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'a#ses of hypo%ia
• 01/ypo%aemia• A. e(ue( PaO2 4rom lun (isease
• 5.e(ue( )aO2 4rom re(ue( PaO2
• !12ed#"ed o%ygen delivery to the tiss#e• A.e(ue( ar(ia output
• 5. e4t to ri7t sstemi s7unt
•31De"reased tiss#e o%ygen #pta4e• A.ito7on(rial poisonin
• 5.e4t-s7i4te( ,% (issoiation urve
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• 'arbo%yhemoglobin
• Methemoglobin
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• The /enderson&/asselbal"h e(#ation
• • ,CO3
• p,= p9 lo ------------------
• 0.03#PaCO2$
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PaCO2 an( alveolar ventilation
• $a'! In blood 5tate alv1 .entilt1
• &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
• *&+ ,perapnia ,poventilation• 3+-&+ /uapnia ormal ventilation
• 13+ ,poapnia ,perventilation
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• VCO2 #ml:min$ x 0.863
• PaCO = --------------------------------
• VA #:min$
• VA = V/ ; V<
• VA=respirator rate x ti(al volume• V
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5A %e4ore (ru>
• A. PaCO2= 32 mm, PaO2 = '0 mm,
• 5. PaCO2 = &3 PaO2 = 80
• C. PaCO2 = +8 PaO2 = 62
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oninvasive measurement o4
PCO2
CAPOAP,?
• PetCO2
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Clinial uses o4 PetCO2
• Patient monitoring and ventilator weaning
in ICU
• Patient monitoring during general
anesthesia
• Indication of a sudden increase in dead
space and, therefore, altered ventilation-
perfusion in the lungs
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• The relationship of $a'! to
o%ygenation and a"id&base balan"e
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$a! and Alveolar&Arterial $!
Differen"e
• ean alveolar PO2 an( t7e alveolar as
equation
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• The Alveolar&arterial $! differen"e
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• The "lini"al #sef#lness of $*A&a+!
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$a!6Fi! and other indi"es of
hypo%aemia
• $a!6Fi! 7 388 A-I
• 1!88 A2D5
• PaO2:PAO2
• P#A-a$O2:PaO2
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• What is the impli"ation of an abnormal
$*A&a+! or $a!6Fi!?
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$a!9 5a! and o%ygen "ontent
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5 ! / l bi Bi di d
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5a!9 /aemoglobin Binding9 and
$#lse %ymetri
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• 'arbo%yhemoglobin and the !
disso"iation "#rve
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$#lse o%ymetri
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Cli i l 4 l t i
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Clinial use o4 pulse oxmetri
• PO does not differentiate carboxy-Hbfrom oxy-Hb
• PO does not reliably distinguish
between oxygen desaturation from alow PaO2 and from excess MetHb
• Clinically acceptable precision for
pO2 is within ! "# of the aO2$ butthe degree of precision %aries among
oximeter model
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• $ may give a false sense of security if
the patient has ade&uate oxygen
saturation but a declining PaO2
• PO may gi%e a false sense of security if
the patient has ade&uate oxygen
saturation but a rising PaCO2
• PO may be unreliable if there is poor
tissue perfusion$ %asoconstriction and
hypothermia
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• 'here are limited studies on a host of
other conditions that might interferewith PO readings
• PO can be misused by people
unfamiliar with how it wor(s and what itmeasures
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p/ ele"trolytes and A"id base
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p/9 ele"trolytes and A"id&base
stat#s
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