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Scenario five – next steps

The attending nurse hands you the results of an arterial blood sample from the patient. You know that you need to use the 5-step approach to analyse the patient’s ABG results. What is your next step? Roll over the image to enlarge it.

Step 1: You should review how the patient is.

  • We would not expect any significant impairment of oxygenation in an 18-year-old
  • Given he is a known insulin-dependent diabetic, potentially severely dehydrated and has taken no insulin, a degree of ketoacidosis is likely causing him to be acidaemic
  • Given the acuteness of the situation the kidneys will not have had time to compensate
  • He may have consumed large amounts of bicarbonate to buffer the acidosis and his kidneys will not have had time to compensate

You need to continue with the 5-step approach to ensure that you correctly analyse the ABG results of this patient. Roll over the ABG results to enlarge them. You can find the 5-step approach in the Essentials tab if you need a reminder.

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References

References

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See chapter 15 of the ALS manual for further reading about arterial blood gas analysis.

5-step approach to ABG interpretation

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Step 1 – how is the patient?

Step 2 – is the patient hypoxaemic?

Step 3 – is the patient acidaemic or alkalaemic?

Step 4 – what happened to the PaCO2?

Step 5 – what has happened to the base excess or bicarbonate?

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