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VBG or ABG

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by

Shaneen Doctor

on 12 December 2012

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Transcript of VBG or ABG

ABG vs VBG To understand differences between ABG's and VBG's.
Briefly review how to interpret results.
Review literature Objectives - Your friendly internal medicine colleague "Can you please obtain an ABG and call me back?" - ABG
* Painful
* New Stick
* Risk of thrombosis
* Allows for calculation of the A-a gradient

- VBG
* easier
* tells you almost the same information
* less complications The Basics Can we use venous blood gas values as clinical equivalents to arterial values? Conclusions Understanding Blood Gases and More

Shaneen Doctor, MD ABG
- PaO2 80 - 100
- PCO2 40
- pH 7.35-7.45 VBG
- PaO2 40
- PCO2 46
- pH 7.32 - 7.42 ABG #1
- pH:7.55
- CO2: 37
- HCO3: 31 Basic Steps to Understanding the ABG 1. Acidotic? or Alkalotic?
2. PC02?
> 45 mm Hg?
< 35 mm Hg?
3. HCO3?
< 22 mm Hg?
> 26 mm Hg?
4. Match PCO2/HCO3 with ph
5. PCO2 or HCO3 in opposite direction of
pH change? Basic Steps to Understanding the ABG

1. Acidotic? or Alkalotic?
2. PC02? > 45 mm Hg? < 35 mm Hg?
3. HCO3? < 22 mm Hg? > 26 mm Hg?
4. Match PCO2/HCO3 with ph
5. PCO2 or HCO3 in opposite direction of pH change? ABG #2
- pH:7.29
- CO2:58.9
- HCO3:25 Basic Steps to Understanding the ABG1. Acidotic? or Alkalotic?
2. PC02? > 45 mm Hg? < 35 mm Hg?
3. HCO3? < 22 mm Hg? > 26 mm Hg?
4. Match PCO2/HCO3 with ph
5. PCO2 or HCO3 in opposite direction of pH change? ABG #3
- pH:7.30
- CO2: 30
- HCO3:14 Blood gases Establish acid - base status
Measure electrolytes
Measure respiratory function DKA Sepsis COPD/Asthma AMS Case#1: 26 y/o type I diabetic in ED with "high" finger stick at home.
VBG: pH 7.24, HCO3 12, pCO2 35, Lactate 3.2, K+ 5.8 Case #2: 64 y/o male with COPD in ED with acute respiratory distress.
Vitals: BP 140/90, HR 115, O2 Sat 85% on RA
VBG: pH 7.34 pCO2 45, HCO3 25, CO 8.1 pH- ?
HCO3 - ?
pCO2 - ?
CO - ?
Lactate - ? Comparison of arterial and venous pH, bicarbonate, PCO2 and PO2 in initial ED assessment

- 95 patients
- pH, PCO2, PO2 show narrow limits of agreement
- PO2 not as much - 206 critically ill patients
- VBG good enough for pH, HCO3, K+ Venous vs arterial blood gases in the assessment of patients presenting with exacerbation of COPD

- 94 patients
- CO2 in ABG vs VBG
- 100% sensitivity for hypercarbia at PCO2 of 45 mm hg
- Insufficient evidence for vbg to replace abg And finally...the Lactate

- Normal venous lactate rules out arterial lactic acidosis

- Elevated does venous not equal elevated arterial

- Tourniquets have no effect

- Venous Lactate ~ Arterial Lactate Lavery RF, Livingston DH, Tortella BJ, Sambol JT, Slomovitz BM, Siegel JH. The utility of venous lactate to triage injured patients in the trauma center. J Am Coll Surg. 2000;190(6):656-664.

Acad Emerg Med 2007;14:587 Touger M. Relationship between venous and arterial carboxyhaemoglobin levels in patients with suspected carbon monoxide poisoning. Annals of Emergency Medicine 1995; 25: 481-483 - 61 patients
- carboxyhaemoglobin levels
- mean (SD):
arterial sample- 7.2% (8.5%)
venous sample- 6.9% (8.2%)
mean difference - 0.30% (95% CI -2.7% to3.3%)
correlation coefficient between arterial and venous CO Hb: 0.99 (95% CI: 0.99 to 0.99) CO 48 y/o male with hx of COPD in the ED. He's hypoxic to 83% on room air, looks like he's having a COPD exacerbation. I've done x,y,z and I think he needs to come in.
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