Handbook of Blood Gas/Acid-Base Interpretation

344 Pages·2013·4.48 MB·English

Handbook of Blood Gas/Acid-Base Interpretation

Ashfaq Hasan
Handbook of Blood Gas/
Acid-Base Interpretation
Second Edition
Ashfaq Hasan, M.D
Department of Pulonary Medicine,
Deccan College of Medical Sciences
Care Institute of Medical Sciences (Banjara)
Hyderabad, Andhra Pradesh
India
ISBN 978-1-4471-4314-7 ISBN 978-1-4471-4315-4 (eBook)
DOI 10.1007/978-1-4471-4315-4
Springer London Heidelberg New York Dordrecht
Library of Congress Control Number: 2013934836
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To my wife

Preface to the Second Edition
One of the primary objectives of the fi rst edition of this book was to facilitate under-
standing and retention of a complex subject in the least possible time—by breaking
the subject matter down into small, easily comprehensible sections: these were pre-
sented in a logical sequence as fl ow charts, introducing concepts fi rst, and then
gradually building upon them.
The aim of the second edition is no different. However, keeping pace with the
requirements of busy modern health providers, several changes have been made.
Many sections have been completely rewritten and new ones added. The format is
now more conventional. For better readability, the size of the print has been enlarged
and made uniform throughout the book. In spite of this, the volume has been kept
down to a manageable size.
My thanks are due to Liz Pope, Senior Editorial Assistant; to Grant Weston,
Senior Editor, who was involved with my other books as well; to my colleague MA
Aleem, for his valuable advice; and to my readers who found the time to provide
valuable feedback—much of which is re fl ected in this second edition.
Hyderabad Ashfaq Hasan, M.D
India

Preface to the First Edition
[Blood gas analysis is] the…single most helpful laboratory test
in managing respiratory and metabolic disorders. [It is]…
imperative to consider an ABG for virtually any symptom…,
sign…, or scenario… that occurs in a clinical setting, whether
it be the clinic, hospital, or ICU.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 modi fi cation 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 approach of Peter Stewart.
In the modern medical practice, the multi-tasking health provider’s time has
become precious—and his attention span short. It is therefore important to retain
focus on those aspects of clinical medicine that truly matter. In the handling of those
subjects rooted in clinical physiology (and therefore predictably diffi c ult to under-
stand), 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 at least a
hundred—not to say, much precious time—and make for clarity of thinking. I have
personally found this method relatively painless—and easy to assimilate. The book
is set out in the form of fl ow charts in logical sequence, introducing and gradually
building upon the underlying concepts.
The goal of this book is to enable medical students, residents, nurses and respira-
tory care practitioners to quickly grasp the principles underlying respiratory and
acid-base physiology, and to apply the concepts effectively in clinical decision mak-
ing. Each of these sections, barring a few exceptions, has been designed to fi t into a
single powerpoint slide: this should facilitate teaching.
1 Canham EM, Beuther DA. Interpreting Arterial Blood Gases, PCCU on line, Chest.
x Preface to the First Edition
Over the years, many excellent books and articles have appeared on the subject.
I have found the manuals by Lawrence Martin2 and Kerry Brandis3 thoroughly
enjoyable as also the online tutorials of Alan Grogono 4 and Bhavani Shankar
Kodali 5 : I have tried to incorporate into my own book, some of their energy and
content.
No matter how small, a project such as this can never be accomplished without
the support of well wishers and friends. I would like to acknowledge the unwavering
support of my colleagues Dr. TLN Swamy and Dr. Syed Mahmood Ahmed; my
assistants A. Shoba and P. Sudheer; and above all, my family who had to endure the
painstaking writing of yet another manuscript.
Hyderabad Ashfaq Hasan, M.D
India
2 Martin L. All you really need to know to interpret blood gases. Philadelphia: Lippincott Williams
and Wilkins; 1999.
3 B randis K. Acid-base pHysiology; w ww.anaesthesiaMCQ.com
4 G rogono AW. w ww.acid-base.com
5 K odali BS. 2007. Welcome to C apnography.com