ABG interpretation

Wow! It sounds like there's a story behind that ABG & now I wanna know.

Editing to add that I know it's a respiratory acidosis and attempting, but failing, to compensate metabolically. (If the pt was successfully compensating, the pH would be closer to normal & not still so far below normal, right?)

(I'm going to surmise that she probably didn't make it, but I still wanna know what happened to her.)

*Disclosure* I don't often work with ABGs. If they're that sick, they get shipped out to the local children's hospital. They don't stay with us.

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She was a 70-year-old chronic lunger (hence the high bicarbs) who was admitted just after midnight by a new attending who wrote her to have "3/4 LPM" by nasal prongs. The new grad read that as "3 to 4 LPM" and when she didn't look so hot on 3 LPM pushed it up to 4.

When the experienced nurse came in at 0700 and saw this old bird barely moving her chest at all she yanked off the O2 and grabbed the Ambu and started bagging her for all she was worth. This ABG was actually taken a few minutes into that, so it was worse before that.

What happened to the old bird? Well, not having seen that much arterial oxygen since the Eisenhower administration, her carotid bodies had decided that everything was just fine and dandy, and stopped telling her resp center to breathe anymore. So her CO2 rose to just ::this close:: to lethal levels before the experienced nurse found her. They bagged the heck out of her and got some of the CO2 off, getting her down to her normal 50-60ish, and let her PaO2 slide down to her normal 50-60ish, making things more compatible with her normally high bicarb (also like that since the Eisenhower administration) and she woke up.

Remember that metabolic compensation takes at least 24 hours, so this was pretty much her baseline bicarb.

She was still acidotic-- compensation never gets you quite into the normal range, by definition, but not so much so that she was bleaching the sheets, more like her normal 7.30.

Download the app ABGStat. You will not be able to use it on tests, but it should help you learn patterns that eventually will make sense. You can even test yourself by changing a value then guessing which way the patient will lean. Good luck

Remember too, to investigate systems as well as the blood gases. If the bicarb is out of whack -what condition are the kidneys in? If it is CO2, what condition are the lungs in? Any brain injury? Try to relate conditions to numbers for better understanding.