Anak Presentation

8/18/2019 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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