TAILIEUCHUNG - Critical Care Obstetrics part 8

Critical Care Obstetrics part 8 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Maternal-Fetal Blood Gas Physiology methods of acid-base interpretation have been devised including graphic nomograms and step-by- step analysis. Each method is detailed in this section to aid in rapid and correct diagnosis of disturbances in acid-base balance. Blood gas results are not a substitute for clinical evaluation of a patient and laboratory values do not necessarily correlate with the degree of clinical compromise. A typical example is the patient with an acute exacerbation of asthma who experiences severe dyspnea and respiratory compromise before developing hyper-capnea and hypoxemia. Thus a blood gas is an adjunct to clinical judgment and decision-making should not be based on a single test. Graphic nomogram Nomograms are a graphic display of an equation and have been designed to facilitate identification of simple acid-base disturbances 49-52 . Figure is an example of a nomogram with arterial blood pH represented on the v-axis HCO- concentration on the y-axis and arterial PCO2 on the regression lines. Nomograms are accurate for simple acid-base disturbances and a single disorder can be identified by plotting measured blood gas values. When blood gas values fall between labelled areas a mixed disorder is present and the nomogram does not apply. These complex disorders must then be characterized by quantitative assessment of the expected compensatory changes Table . A systematic approach to an acid-base abnormality Several different approaches for blood gas interpretation have been devised 53-55 . A six-step approach modified from Narins and Emmitt provides a simple and reliable method to analyze a blood gas particularly when a complicated mixed disorder is present 33 56 57 . This method adjusted for pregnancy is as follows Figure . 1 Is the patient acidemic or alkalemic If the arterial blood pH is the patient is acidemic while a pH defines alkalemia. 2 Is the primary disturbance respiratory or metabolic The primary alteration .

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