Acid Base Lecture Quiz

Passive Airway Management

• High fowler's position is used for effective airway management.
• Conditions that require aggressive airway treatment include COPD, asthma, overdose, and respiratory diseases.
• Intubation is indicated for severe airway obstruction or respiratory failure.
• CPAP is utilized typically for conditions like ARDS and PE.
• High flow oxygen is crucial for patients experiencing hypoventilation or respiratory arrest.

Acid-Base Balance Overview

• pH is regulated by the body’s buffer system; normal range is 7.35 - 7.45.
• Higher hydrogen concentration results in lower pH, indicating acidity.
• Conditions affecting acid-base balance include diseases, dehydration, shock, and trauma.

Respiratory Alkalosis

• Causes include hypoxia, hyperventilation, anemia, anxiety, and sepsis.
• Symptoms encompass dyspnea, dizziness, and carpal pedal spasms.
• Treatment focuses on managing respiration rates, improving CO2 uptake, and addressing underlying causes.

Metabolic Acidosis

• Common causes include severe trauma, sepsis, DKA, and ASA overdose.
• Patients exhibit symptoms related to respiratory distress and carbon monoxide exposure.
• Treatment may involve high flow oxygen, aggressive airway management, and, in some cases, controversial sodium bicarbonate infusion.

Metabolic Alkalosis

• Typically caused by vomiting, antacid overdose, and Cushing's syndrome.
• Treatment emphasizes fluid and electrolyte replacement, along with identifying causes.

Mixed Acid-Base Disorders

• Acid-base imbalances often coexist in critically ill patients.
• Emergency treatment plans may involve rapid evaluation and intervention based on base excess or deficit measurements.

Hydrogen and Potassium Dynamics

• Potassium shifts in and out of cells can influence acid-base status.
• Notable interactions occur in gastrointestinal systems, highlighting the relationship between potassium imbalances and acid-base disturbances.

Concept of Acidosis in Patients

• Illness and injury often lead to measurable acidosis, primarily from lactic acid produced during cellular metabolism.
• Understanding metabolic causes, such as hemorrhagic shock or sepsis, is essential for effective management.

Base Excess and Base Deficit

• The base excess/deficit calculation refers to how much strong acid must be added to normalize pH.
• A negative value indicates acidosis; a positive value suggests alkalosis.

PaO2 and Oxygen Consumption

• Normal PaO2 ranges from 90-100 mmHg; deviations may indicate tissue hypoxia or organ dysfunction.
• Effective oxygen consumption is critical for overall tissue health and metabolic functions.

Respiratory Acidosis

• Characterized by hypoxia, altered level of consciousness, and decreased ventilation.
• Treatment includes strategies to increase ventilation and correct underlying diseases.

Renal Buffering

• Renal buffering involves the exchange of bicarbonate (HCO3-) at the kidneys and takes hours to days to be effective.
• Bicarbonate is crucial for carbon dioxide (CO2) transport in blood, accounting for 65%.
• Maintains acid-base balance by regulating H+ and HCO3- levels at the nephron tubules.
• Bicarbonate is eliminated via urine.

Carbonic Acid-Bicarbonate Buffering

• This buffering system primarily occurs in the lungs.
• Functions as a compensatory mechanism in acid-base balance.
• Closely linked with renal and protein buffering mechanisms.
• CO2 levels, monitored through PaCO2 or ETCO2 readings, indicate the effectiveness of this buffering.

CO2 Elimination

• H+ and CO2 diffuse to the alveoli in lung capillaries for elimination.
• Carbonic acid (H2CO3) quickly dissociates into water (H2O) and carbon dioxide (CO2), which is then exhaled.

Waveform Capnography

• End-tidal capnography represents the graphical measurement of CO2 partial pressure during expiration.
• Essential for monitoring CO2 elimination in paramedic settings.

Protein Buffering

• Requires hemoglobin and circulating blood to eliminate H+ and CO2.
• Hemoglobin binding is the primary method for acid elimination.
• Reduced effectiveness of protein buffering is often seen in conditions like hemorrhaging.

Acid-Base Disorders

• Respiratory and metabolic acidosis or alkalosis can be identified by evaluating bicarbonate (HCO3-) and CO2 (PaCO2) levels.

Respiratory Alkalosis

• Characterized by hyperventilation, hypoxia, anxiety, or conditions like sepsis.
• Treatment focuses on decreasing respiratory rates and managing underlying causes.

Metabolic Acidosis

• Causes include severe trauma, sepsis, diabetic ketoacidosis (DKA), and carbon monoxide exposure.
• Management may involve fluid replacement and sodium bicarbonate administration, though the latter is controversial.

Metabolic Alkalosis

• Results from vomiting, antacid overdose, or hormonal imbalances like Cushing's syndrome.
• Treatment emphasizes fluid and electrolyte replacement.

Complete Acidosis

• A state where pH falls below 7.35, indicating severe acidemia, potentially leading to death.

Base Excess / Base Deficit

• Measurement of the strong acid needed to achieve a normal pH (7.40) at specified conditions.
• Key indicator for metabolic adjustments and related to conditions such as trauma and hemorrhaging.

Acid-Base Balance

• Controlled by kidneys (metabolic component - HCO3-) and lungs (respiratory component - PaCO2).
• Arterial blood gas (ABG) analysis is used to determine acid-base status.

Respiratory Acidosis

• Causes include hypoxia, altered loss of consciousness (ALOC), and cardiac arrest.
• Treatment strategies involve improving ventilation and addressing the underlying issues.