Clinical Blood Gases : Assessment and Intervention

by Malley

• ISBN13: 9780721684222
• ISBN10: 072168422X
• Edition: 2nd
• Format: Hardcover
• Copyright: 2004-08-04
• Publisher: W B Saunders Co

Summary

This text provides a thorough resource on arterial blood gases, covering the full scope of applications. This book is the first of its kind to focus on the needs of educators, students, and practitioners alike. The new edition has been completely updated, providing the latest information from the field, including facts on technical issues, basic physiology, clinical oxygenation, clinical acid base, non-invasive techniques, just to name a few. Instructor resources are available; please contact your Elsevier sales representative for details. An Evolve Course Management System is available, allowing instructors to customize their own course content, conduct interactive exercises with students, and much more. This books amazing content coverage offers a wealth of useful material, including illustrations, tables, examples, and case studies. This new edition is up-to-date with the latest in technology and information, ensuring the most current information is available. New figures and tables enhance the understanding of chapter material. The addition of an NBRC (National Board of Respiratory Care) Challenge at end of each chapter helps readers learn, understand, and put the information together to master the subject. The incorporation of two new On Call Cases per chapter provides further opportunity to practice clinical application of content learned, as well as helping readers utilize their critical thinking skills. Reorganized and improved table of contents presents the material in a more logical, efficient manner.

Author Biography

William J. Malley, MS, RRT, CPFT: Administrative Director, Respiratory Services, The Western Pennsylvania Hospital; Program Director, School of Respiratory Care, Indiana University of Pennsylvania/The Western Pennsylvania Hospital, Pittsburgh

Table of Contents

Unit I Introduction to Blood Gases	1	(58)
Arterial Blood Gases	3	(32)
Introduction	3	(1)
Normal Blood Gas Values	4	(3)
Arterial versus Venous Blood	7	(1)
Technique	8	(17)
Arterial Cannulation	25	(3)
Arterial Line/Blood Gas Controversy	28	(1)
Capillary Sampling	29	(1)
AARC Clinical Practice Guidelines	30	(1)
Exercises	31	(4)
Blood Gas Classification	35	(24)
Introduction	35	(1)
Systematic Approach	36	(1)
Acid-Base Status	36	(2)
Basic (Primary) Acid-Base Disturbance(s)	38	(4)
Compensation Assessment	42	(4)
Acid-Base Classification versus Interpretation	46	(1)
Oxygenation Status	46	(2)
Complete Blood Gas Classification	48	(1)
Alternative Terminology	48	(2)
Exercises	50	(9)
Unit II Technical Issues in Blood Gas Analysis	59	(74)
Blood Gas Sampling Errors	61	(21)
Introduction	61	(1)
Basic Physics of Gases	61	(5)
Potential Sampling Errors	66	(9)
Measurement of Blood Gases and Electrolytes from a Single Sample	75	(1)
Exercises	76	(6)
Blood Gas Electrodes and Quality Assurance	82	(32)
Blood Gas Electrodes	82	(8)
Total Quality Management	90	(1)
Quality Assurance	91	(1)
Quality Control	92	(11)
Continuous Monitoring of Blood Gases	103	(3)
Point-of-Care Testing	106	(1)
Regulations and Laboratory Accreditation	107	(1)
Exercises	107	(7)
Accuracy Check and Metabolic Acid-Base Indices	114	(19)
Accuracy Check	114	(6)
Metabolic Acid-Base Indices	120	(6)
Exercises	126	(7)
Unit III Basic Physiology	133	(92)
Oxygenation and External Respiration	135	(30)
Introduction	135	(3)
External Respiration	138	(21)
Exercises	159	(6)
Oxygen Transport and Internal Respiration	165	(31)
Introduction	165	(1)
Blood Oxygen Compartments	165	(14)
Quantitative Oxygen Transport	179	(2)
Hemoglobin Abnormalities	181	(5)
Internal Respiration	186	(4)
Exercises	190	(6)
Acid-Base Homeostasis	196	(29)
Hydrogen Ions and pH	196	(2)
The Lungs and Regulation of Volatile Acid	198	(7)
The Kidneys and Acid-Base Balance	205	(1)
Buffer Systems	206	(4)
Henderson-Hasselbalch Equation	210	(8)
Exercises	218	(7)
Unit IV Clinical Oxygenation	225	(80)
Assessment of Hypoxemia and Shunting	227	(19)
Overview	227	(1)
Assessment of Hypoxemia	228	(1)
Effects of Cardiac Output on PaO2	228	(4)
Assessment of Physiologic Shunting	232	(4)
Differential Diagnosis of Hypoxemia	236	(3)
Clinical Appearance of the Patient with Hypoxemia/Hypercapnia	239	(1)
Hyperoxemia	239	(1)
Exercises	240	(6)
Treatment of Hypoxemia and Shunting	246	(26)
Treatment	246	(1)
Oxygen Therapy	247	(9)
Mechanical Ventilation	256	(2)
Positive End-Expiratory Pressure	258	(6)
Body Positioning	264	(2)
Nitric Oxide	266	(1)
Long-term Oxygen Therapy	267	(1)
Exercises	267	(5)
Hypoxia: Assessment and Intervention	272	(33)
Overview	272	(1)
Oxygen Supply Variables	273	(17)
Key Indicators of Hypoxia	290	(8)
Exercises	298	(7)
Unit V Clinical Acid Base	305	(80)
Regulation of Acids, Base, and Electrolytes	307	(25)
Overview	307	(1)
Regulation of Ventilation	308	(5)
Renal Function	313	(1)
Body Fluids and Electrolytes	314	(3)
Sodium Regulation in the Kidney	317	(5)
Urinary Buffers and H+ Excretion	322	(1)
Plasma pH and [K+]	323	(1)
Law of Electroneutrality	324	(2)
Stewart's Strong Ion Difference	326	(1)
Exercises	327	(5)
Differential Diagnosis of Acid-Base Disturbances	332	(29)
Introduction	333	(1)
Respiratory Acidosis	334	(6)
Respiratory Alkalosis	340	(3)
Metabolic Acidosis	343	(7)
Metabolic Alkalosis	350	(6)
Exercises	356	(5)
Mixed Acid-Base Disturbances and Treatment	361	(24)
Overview	361	(1)
Factors That May Complicate Clinical Acid-Base Data	362	(2)
Mixed Acid-Base Disturbances	364	(5)
Acid-Base Treatment	369	(10)
Exercises	379	(6)
Unit VI Noninvasive Techniques and Case Studies	385	(56)
Noninvasive Blood Gas Monitoring	387	(32)
Introduction	388	(1)
Oximetry	388	(5)
Pulse Oximetry	393	(10)
Transcutaneous PO2/PCO2 Monitoring	403	(3)
Capnometry	406	(9)
Exercises	415	(4)
Arterial Blood Gas Case Studies	419	(22)
Narcotic Overdose	419	(1)
Unexplained Acidemia	420	(1)
Gastrointestinal Disturbance	420	(1)
Status Asthmaticus	421	(1)
Acute Respiratory Acidemia	422	(1)
Nasogastric Suction	422	(1)
Unexplained Alkalemia	423	(1)
Oxygenation Disturbance	423	(1)
Diabetic Patient	424	(1)
Acute Exacerbation of Chronic Obstructive Pulmonary Disease	425	(1)
Mitral Valve Replacement	426	(1)
Patient with Burns	427	(2)
Chronic Obstructive Pulmonary Disease and Congestive Heart Failure	429	(1)
Pulmonary Edema	430	(2)
Answers to Arterial Blood Gas Case Studies	432	(9)
References	441	(19)
Answers	460	(37)
Illustration Credits	497	(4)
Index	501