Mark Klimek Review updated[2021-2022]
MARK KLIMEK DAY 1
ACID BASE INTERPRETATION
• ABG Values
o pH 7.35 – 7.45
o HCO3 22 – 26 (bicarb)
o CO2 35 – 45
o PO2 80 – 100%
• If the pH and the HCO3 are in the same direction metabolic (bicarb, both, -bolic)
• If the pH and the HCO3 are in the opposite direction respiratory
• As the pH goes up/down, the patient goes the same direction; except for potassium (it goes the opposite
direction of the pH)
o pH goes up (alkalosis) everything goes up (hyper, tachy, increased, elevated) wild & crazy
▪ irritability, hyperreflexia 3+ and 4+
▪ tachypnea, tachycardia, borborygmic (hyperactive bowel sounds)
▪ seizure, spasms, tremors, hypertension
▪ hyperventilation, diarrhea, tetany (hyper contractility)
o pH goes down (acidosis) everything goes down (hypo, brady, decreased, suppressed)
▪ hyporeflexia, lethargy, decreased, suppressed
▪ bradycardia, constipation, decreased bowel sounds
▪ paralytic ileus, coma, flaccidity
▪ cardiac arrest (HR is 0)
• Respiratory and Metabolic Acidosis
o You see that and it needs an ambu bag at bedside
• Respiratory and Metabolic Alkalosis
o You need suctioning by the bedside
• Kussmal Respirations (compensatory mechanism, not a s/s)
o “MAC” Kussmal Metabolic ACidosis
o Kussmal respirations are deep and labored breathing pattern
• Question: Respiratory acidosis. Select all that apply.
o +1 reflexes
o Diarrhea
o Adynamic ileus
o Spasms
o Urinary retention
o Paroxysmal atrial tachycardia
o Second degree Mobitz type 2 heart block
o Hypokalemia
• Question: Metabolic acidosis. What are the s/s? Select all that apply.
o Heart block – it is being stopped, so it is going down
,Mark Klimek Review updated[2021-2022]
• Alkalosis:
o Palpitations
o Tremors
,Mark Klimek Review updated[2021-2022]
o Cardiac arrest
o Daytime sleepiness
o Anxiety
o Tetany
• Causation of Acid Base Imbalances
o Ask: is it lung? Respiratory
o Are they over/under ventilating?
▪ Over Respiratory alkalosis
▪ Under Respiratory acidosis (near drowning, emphysema, PCA pump)
• SaO2 not good and RR is increased (RR has nothing to do with ventilation)
▪ Pay attention to the SaO2 not the RR since RR is often compensating
o If it’s not lungs Metabolic
▪ Prolonged gastric vomiting/suctioning Metabolic alkalosis (losing stomach acids)
▪ If you don’t know what to pick choose metabolic acidosis (dehydration, ARF, infantile
diarrhea, burns, etc.)
• For everything that is not lung – choose metabolic acidosis
o SO, ASK: IS IT LUNG? IS IT VOMITING?
• Compensation
o pH is normal
▪ either you have a normal ABG or a compensated imbalance
▪ look at HCO3
▪ if HCO3 and pH is normal pt. is okay
o you will never compensate beyond the midpoint of the range (7.40); this is mixed base disorder
o if everything is abnormal – partially compensated
VENTILATOR ALARMS
• High Pressure Alarm: Obstructions
o Triggered by increased resistance to airflow
o Three causes of obstruction
▪ Kinks – tubing is compressed
▪ Water collecting in the tube (then empty it)
▪ Mucus – turn, cough, deep breathe (do not choose suction)
• Best way to clear secretion – cough mechanism
• If that does not work, then you suction
o Drag & Drop Question:
▪ Check for kinks in the tubing (unkink it)
▪ Empty water collection
▪ Turn, cough, deep breath
▪ Suction
• Low Pressure Alarm: Disconnections
o Triggered by decreased resistance to airflow (machine is saying “that is too easy”)
,Mark Klimek Review updated[2021-2022]
o Caused by disconnections of:
▪ Tubing
▪ Oxygen sensors
MARK KLIMEK DAY 1
ACID BASE INTERPRETATION
• ABG Values
o pH 7.35 – 7.45
o HCO3 22 – 26 (bicarb)
o CO2 35 – 45
o PO2 80 – 100%
• If the pH and the HCO3 are in the same direction metabolic (bicarb, both, -bolic)
• If the pH and the HCO3 are in the opposite direction respiratory
• As the pH goes up/down, the patient goes the same direction; except for potassium (it goes the opposite
direction of the pH)
o pH goes up (alkalosis) everything goes up (hyper, tachy, increased, elevated) wild & crazy
▪ irritability, hyperreflexia 3+ and 4+
▪ tachypnea, tachycardia, borborygmic (hyperactive bowel sounds)
▪ seizure, spasms, tremors, hypertension
▪ hyperventilation, diarrhea, tetany (hyper contractility)
o pH goes down (acidosis) everything goes down (hypo, brady, decreased, suppressed)
▪ hyporeflexia, lethargy, decreased, suppressed
▪ bradycardia, constipation, decreased bowel sounds
▪ paralytic ileus, coma, flaccidity
▪ cardiac arrest (HR is 0)
• Respiratory and Metabolic Acidosis
o You see that and it needs an ambu bag at bedside
• Respiratory and Metabolic Alkalosis
o You need suctioning by the bedside
• Kussmal Respirations (compensatory mechanism, not a s/s)
o “MAC” Kussmal Metabolic ACidosis
o Kussmal respirations are deep and labored breathing pattern
• Question: Respiratory acidosis. Select all that apply.
o +1 reflexes
o Diarrhea
o Adynamic ileus
o Spasms
o Urinary retention
o Paroxysmal atrial tachycardia
o Second degree Mobitz type 2 heart block
o Hypokalemia
• Question: Metabolic acidosis. What are the s/s? Select all that apply.
o Heart block – it is being stopped, so it is going down
,Mark Klimek Review updated[2021-2022]
• Alkalosis:
o Palpitations
o Tremors
,Mark Klimek Review updated[2021-2022]
o Cardiac arrest
o Daytime sleepiness
o Anxiety
o Tetany
• Causation of Acid Base Imbalances
o Ask: is it lung? Respiratory
o Are they over/under ventilating?
▪ Over Respiratory alkalosis
▪ Under Respiratory acidosis (near drowning, emphysema, PCA pump)
• SaO2 not good and RR is increased (RR has nothing to do with ventilation)
▪ Pay attention to the SaO2 not the RR since RR is often compensating
o If it’s not lungs Metabolic
▪ Prolonged gastric vomiting/suctioning Metabolic alkalosis (losing stomach acids)
▪ If you don’t know what to pick choose metabolic acidosis (dehydration, ARF, infantile
diarrhea, burns, etc.)
• For everything that is not lung – choose metabolic acidosis
o SO, ASK: IS IT LUNG? IS IT VOMITING?
• Compensation
o pH is normal
▪ either you have a normal ABG or a compensated imbalance
▪ look at HCO3
▪ if HCO3 and pH is normal pt. is okay
o you will never compensate beyond the midpoint of the range (7.40); this is mixed base disorder
o if everything is abnormal – partially compensated
VENTILATOR ALARMS
• High Pressure Alarm: Obstructions
o Triggered by increased resistance to airflow
o Three causes of obstruction
▪ Kinks – tubing is compressed
▪ Water collecting in the tube (then empty it)
▪ Mucus – turn, cough, deep breathe (do not choose suction)
• Best way to clear secretion – cough mechanism
• If that does not work, then you suction
o Drag & Drop Question:
▪ Check for kinks in the tubing (unkink it)
▪ Empty water collection
▪ Turn, cough, deep breath
▪ Suction
• Low Pressure Alarm: Disconnections
o Triggered by decreased resistance to airflow (machine is saying “that is too easy”)
,Mark Klimek Review updated[2021-2022]
o Caused by disconnections of:
▪ Tubing
▪ Oxygen sensors
