Monitoring of arterial blood gases

Exposure to dinoseb requires symptomatic treatment. Blood glucose, liver function, and renal function tests should be monitored in symptomatic patients. Adequate ventilation and oxygenation should be provided with close monitoring of arterial blood gases. The fluid and electrolyte balances should be maintained. The body temperature should be kept within tolerable limits. Antipyretic drugs are, however, not effective because dinoseb poisoning involves peripheral metabolism, not central nervous system control of temperature. Diazepam is administered to... 

Regular monitoring of arterial blood gases and serum electrolytes are necessary to determine the effectiveness of therapy. A gradual correction is appropriate to avoid overcorrection and subsequent complications such as alkalosis and other electrolyte abnormalities (see Chap. 51). Laboratory measurement of serum bicarbonate is associated with several technical problems. Blood collection techniques, transportation, and assay methodology can affect the measured concentrations. Blood samples should not have contact with air process delays should be avoided and consistent analytical methods should be used with serial measurements to improve accuracy. ... 

Royston BD (1993) Continuous monitoring of arterial blood gases. Int Anesthesiol Clin 31 1-22... 

Besides common direct measurements, indirect methods for blood gas determination are as follows capnometry (only PCO2), transcutaneous blood gas measurement [1, 4], and the pCOa [5] and p02 [6] determination at the gas outlet of a membrane oxygenator during extracorporeal membrane oxygenation (ECMO). However, these methods cannot replace the invasive blood gas analysis because of a number of limitations and the risk of artifacts. Typical problems are the patients disease pattern, age, the entire health condition, etc [4,7,8]. Nevertheless, these noninvasive alternatives for the monitoring of arterial blood gases have been applied, e.g., during cardiopulmonary bypass [5]. 

The determination of arterial blood gases is very important to monitor the gas exchange in critically ill patients. It provides valuable information about the patient s metabolism, gas exchange, ventilation, and acid-base homeostasis [2]. A reliable way for blood gas determination is the direct analysis of an arterial blood sample by point-of-care blood gas analyzers with implemented Clark and Severinghaus sensors to measure p02 and PCO2, respectively [3]. 

To characterize the responses to PbTx-2, five dose rates (0, 12.5, 25, 50, and 100 ig/kg/hr in 2 ml saline) were infused into the jugular catheters of rats (four per group). Heart rates, systolic and diastolic arterial blood pressures, pulse pressures, respiratory rates, core and peripheral body temperatures, lead VI0 ECCjs, and arterial blood gases were monitored. Clinical signs and behaviors were recorded by video camera. After infusion, animals were monitored for 6 hr, by which time most had either died or recovered to near baseline physiological levels. 

Monitor serum electrolytes and arterial blood gases regularly. Correct metabolic acidosis slowly to prevent the development of metabolic alkalosis or other electrolyte abnormalities. 

Arterial blood gases are the primary tools for evaluation of therapeutic outcome. They should be monitored closely to ensure resolution of simple acid-base disorders without deterioration to mixed disorders due to compensatory mechanisms. For example, arterial blood gases should be obtained every 2 to 4 hours during the acute phase of respiratory acidosis and then every 12 to 24 hours as acidosis improves. 

In acute exacerbations of COPD, white blood cell count, vital signs, chest x-ray, and changes in frequency of dyspnea, sputum volume, and sputum purulence should be assessed at the onset and throughout the exacerbation. In more severe exacerbations, arterial blood gases and oxygen saturation should also be monitored. 

First, the airway should be cleared of vomitus or any other obstruction and an oral airway or endotracheal tube inserted if needed. For many patients, simple positioning in the lateral decubitus position is sufficient to move the flaccid tongue out of the airway. Breathing should be assessed by observation and oximetry and, if in doubt, by measuring arterial blood gases. Patients with respiratory insufficiency should be intubated and mechanically ventilated. The circulation should be assessed by continuous monitoring of pulse rate, blood pressure, urinary output, and evaluation of peripheral perfusion. 

In cases of respiratory overexposure, the victim should be moved to fresh air immediately and treated according to severity of irritation. The presence and severity of respiratory irritation, bronchitis, and pneumonitis should be evaluated. If respiratory tract irritation or respiratory depression is evident, arterial blood gases, chest X-ray, and pulmonary function tests should be monitored. For acute lung injury, ventilation and oxygenation should be maintained and evaluation should be done with frequent arterial blood gas or pulse oximetry monitoring. 

Monitoring complete blood count, urinalysis, and liver and kidney functions test is suggested for patients with significant exposure. Assisted ventilation (100% humidified supplemental oxygen) should be provided as required, arterial blood gases should be monitored, and institution of basic life-support systems as necessary. 

Once a poisoning has occurred, acid-base balance (anion gap and arterial blood gases), fluid and electrolyte balance, and perfusion should be monitored. Other indicators of organ toxicity such as ALT, AST, bilirubin, prothrombin time, serum glucose and creatinine concentrations, as well as markers of physiologic stress or infection such as leukocytosis, also should be monitored. 

Arterial blood gases, along with serum electrolytes, physical findings, medical and medication history, and the clinical condition of the patient, are the primary tools to determine the cause of an acid-base disorder and to design and monitor a course of therapy. 

In addition to periodic recording of physical signs and serial measurements of blood chemistry and arterial blood gases, there should be continual monitoring of blood pressure, electrocardiograms and pulse oximetry. However, pulse oximetry may... 

B. Other useful laboratory studies include electrolytes, glucose, BUN, creatinine, liver transaminases, arterial blood gases or oximetry, ECG monitoring, and chest x-ray (if pulmonary edema or aspiration of hydrocarbon solvent is suspected). 

Treatment for the respiratory damage involves oxygen supplements, intubation, and artificial ventilation when indicated, as well as the use of a hyperbaric chamber to remove carbon monoxide, if needed. Any restriction to the chest owing to burned skin is removed surgically. The nurse must monitor arterial blood gases and oxygen saturation levels to determine the effectiveness of treatment. In addition, the nurse should monitor for signs of acidosis and related acid-base imbalances. <3 ... 

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