Handbook Of Blood Gas Acid Base Interpretion 2009 PDF
Preview Handbook Of Blood Gas Acid Base Interpretion 2009
Handbook of Blood Gas/Acid–Base Interpretation Ashfaq Hasan Handbook of Blood Gas/Acid–Base Interpretation 1 3 AshfaqHasan CareInstituteofMedicalSciences Banjara,Hyderabad India ISBN:978-1-84800-333-0 e-ISBN:978-1-84800-334-7 DOI10.1007/978-1-84800-334-7 BritishLibraryCataloguinginPublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary LibraryofCongressControlNumber:2008938671 #Springer-VerlagLondonLimited2009 Apartfromanyfairdealingforthepurposesofresearchorprivatestudy,or criticismorreview,aspermittedundertheCopyright,DesignsandPatentsAct 1988,thispublicationmayonlybereproduced,storedortransmitted,inany formorbyanymeans,withthepriorpermissioninwritingofthepublishers,or in the case of reprographic reproduction in accordance with the terms of licenses issued by the Copyright Licensing Agency. Enquiries concerning reproductionoutsidethosetermsshouldbesenttothepublishers. The use of registered names, trademarks, etc., in this publication does not imply,evenintheabsenceofaspecificstatement,thatsuchnamesareexempt fromtherelevantlawsandregulationsandthereforefreeforgeneraluse. Productliability:Thepublishercangivenoguaranteeforinformationabout drugdosageandapplicationthereofcontainedinthisbook.Ineveryindividual case the respective user must check its accuracy by consulting other pharmaceuticalliterature. Printedonacid-freepaper SpringerScience+BusinessMedia springer.com To my wife Simplify, simplify! – Henry David Thoreau Preface Blood gas analysis has become the ‘‘...single most helpful laboratory test in managing respiratory and metabolic disor- ders.(Itis)...imperativetoconsideranABGforvirtuallyany symptom..., sign..., or scenario... that occurs in a clinical setting,whetheritbetheclinic,hospital,orICU.’’1 For the uninitiated, the analysis of blood gas can be a daunting task. Hapless medical students, badly constrained for time, have struggled ineffectively with Hasselbach’s mod- ification of the Henderson equation; been torn between the Copenhagen and the Boston schools of thought; and lately, been confronted with the radically different strong-ion approachofPeterStewart. In the modern medical practice, the multi-tasking health provider’s time has become precious—and his attention span short.Itisthereforeimportanttoretainfocusonthoseaspects ofclinicalmedicinethattrulymatter.Inthehandlingofthose subjects rooted in clinical physiology (and therefore predicta- bly difficult to understand), it makes perfect sense, in my opinion, to adopt an ‘algorithmic’ approach. A picture can say a thousand words; a well constructed algorithm can save atleastahundred—nottosay,muchprecioustime—andmake for clarity of thinking. I have personally found this method 1Canham,EM,Beuther,DA,InterpretingArterialBloodGases,PCCU online,Chest vii viii Preface relativelypainless—andeasytoassimilate.Thebookissetout intheformofflowchartsinlogicalsequence,introducingand graduallybuildingupontheunderlyingconcepts. The goal of this book is to enable medical students, resi- dents, nurses and respiratory care practitioners to quickly grasptheprinciplesunderlyingrespiratoryandacid-basephy- siology,andtoapplytheconceptseffectivelyinclinicaldecision making. Each of these sections, barring a few exceptions, has beendesignedtofitintoasinglepowerpointslide:thisshould facilitateteaching. Over the years, many excellent books and articles have appearedonthesubject.IhavefoundthemanualsbyLawrence Martin2 and Kerry Brandis3 thoroughly enjoyable as also the online tutorials of Alan Grogono4 and Bhavani Shankar Kodali5: I have tried to incorporate into my own book, some oftheirenergyandcontent. No matter how small, a project such as this can never be accomplishedwithoutthesupportofwellwishersandfriends. I would like to acknowledge the unwavering support of my colleagues Dr TLN Swamy and Dr Syed Mahmood Ahmed; myassistantsAShobaandPSudheer;andaboveall,myfamily who had to endure the painstaking writing of yet another manuscript. AshfaqHasan 2Martin,L.Allyoureallyneedtoknowtointerpretbloodgases.1999, LippincottWilliamsandWilkins. 3KerryBrandis.Acid-BasePhysiology;www.anaesthesiaMCQ.com 4Grogono,AW.www.acid-base.com 5BhavaniShankarKodali.2007.WelcometoCapnography.com Contents 1 TheBloodGases ........................... 1 2 GasExchange ............................. 5 3 TheNoninvasiveMonitoringof BloodGases............................... 63 4 AcidsandBases ............................ 117 5 BufferSystems............................. 143 6 ThepH................................... 165 7 AcidosisandAlkalosis ....................... 189 8 RespiratoryAcidosis ........................ 195 9 RespiratoryAlkalosis........................ 207 10 MetabolicAcidosis.......................... 213 11 MetabolicAlkalosis......................... 263 ix x Contents 12 TheAnalysisofBloodGases&FactorsModifying theAccuracyofABGResults.................. 279 13 CaseExamples............................. 297 Index........................................ 347
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