ABG’s, what do they mean?

Arterial blood gases… Chances are if you work in a progressive care or intensive care unit you have seen ABG results or you will.

If you’re like me in the beginning, you have no idea how to interpret the results. For the longest time I had no idea what I was looking at. I knew the pH was indicative of acidosis or alkalosis, and that was the end of it. Once I started working in an ICU I wanted to really understand what the results meant. I made one of our respiratory therapist teach me how to understand the results (he was awesome and was happy to help). It turns out ABG results are not too terribly difficult to interpret. You are trying to obtain three key pieces of information:

  • Is the patient acidotic or alkalotic?
  • Is this a respiratory or a metabolic issue?
  • Is the body fully compensating, partially compensating?

While there is plenty of information on the ABG slip (or in the chart if your unit doesn’t have an ABG machine available) you can come up with the answer by looking at three key results: pH, paCO2, HCO3.

One of the ECCO learning modules I did had this handy little chart that made it easier to interpret the results. I thought I would share it with you all in case there is someone out there confused like I was, but may not have a quick resource available.

That’s it. This little handy chart has helped me a lot. It took what was, for me, a larger amount of overwhelming information and broke it down into something I could use. Here’s how to use it:

Look at the pH, is it <7.35 (you’re acidotic) or >7.45 (you’re alkalotic) or is it normal? Circle which side of the chart your value falls in. Then look at the PaCO2. We are looking at carbon dioxide in the blood here. Repeat the previous steps and circle where your value falls. Then look at your bicarb, HCO3. Circle where that value falls.

Remember pH tells you if they are acidotic or alkalotic. Now that you’ve figured that part out, it’s time to figure out if this is respiratory or metabolic. Look at your chart, is the CO2 circled on the same side as the pH? If yes, it’s respiratory. Is the bicarb circled on the same side as the pH? If yes, then it’s metabolic. Now, are we compensating? If you are partially compensating then you will have one value on the other side of the grid. If you are fully compensating then your pH will actually be normal.

I’m a person that needs to see something in action so let’s do a couple of examples:

Note let’s break out the chart:

pH is low so we know the patient is acidotic. The CO2 is on the same side as the pH. The bicarb is on the opposite side of the grid so the body is trying to compensate. We have respiratory acidosis, partially compensated.

Let’s do one more:

Bust out the handy dandy chart!

The pH is high so we know it’s alkalosis. The bicarb is on the same side of the chart as the pH but the CO2 is on the opposite side. Here we have metabolic alkalosis, the respiratory system is partially compensating, that’s why the CO2 is high.

I would like to mention one thing, if all your values are on the same side of the chart then it most likely means the one of the systems of the body aren’t compensating.

Hopefully this post is able to help someone out. If you have any other hints, tips, tricks let me know!

Resident-splaining

One thing that absolutely drives me nuts is having a new resident come to the trauma unit, that I have worked on for almost three years, and “resident-splain” something obvious to me!

What is resident-splaining? It’s when a resident condescendingly “explains” something to you that they assume you know nothing about because you’re just a nurse…

I’ve had a resident (not a very good one at that) start to “explain” calcium in the blood to me. Why? Well, we had given quite a lot of blood products and I asked about giving some calcium as the ABG showed the ionized calcium was low. This is common. Massive infusions almost always drop the serum calcium due to the citrate used in the unit of blood (if this is new to you, here is an article that explains it rather well). Like I said, I know this. Trauma nurses are typically very aware of this because, you know, we give a lot of blood. Trauma… Bleeding… But hey, I’m just a nurse.

Now, she’s not giving me the calcium I need. She starts explaining calcium in the blood and why I should go by the ionized calcium instead of the calcium level on his BMP. Remember, I told her the ionized calcium on the ABG was low… Ionized. Calcium. The level she is currently explaining to me. That level. That’s not enough, she’s not even looking at me while she is talking and it’s in a very condescending tone.

Bruh.

I finally stop her with this statement: “I’m well aware of the purpose of an ionized calcium which is why I told you what it was on the ABG that I just ran (can you hear the attitude in my voice?). I don’t need an explanation, I need calcium. Can you order that or did you need me to throw that order in real quick?” Her:

*blank stare* “Oh, yeah I can put that in for you…” *quickly and quietly begins ordering what I need*

I had no more issues with her for the duration of her rotation on our unit.

It’s irritating. So so irritating. I’m far too outspoken to have someone resident-splain things to me. Don’t try me buddy…

Story time no.1

I’m at work because it’s a Saturday and why the fuck not 😒.

We have a patient that has been screaming ALL NIGHT LONG. They were recently extubated, recently as in dayshift. For some reason NO ONE thought to get a follow up ABG. The RT decided to get an ABG tonight for shits and giggles. Values as follows:

pH 7.546

PCO2 37.4

PO2 44.3

Bicarb 31.7

O2 sats 86.5


Oh. *Maybe* we should do something about that! 

Guess who ended up reintubated…