Master how to read and solve an ABG (arterial blood gas) in 60 minutes | RegularCrisis

#regularcrisis
This is video is recording of the regular ICU classes taken by Dr. Ankur Gupta (Intensivist) in the hospital.
The session is titled "Master how to read and solve an ABG (arterial blood gas) in 60 minutes" and explains reading and solving an ABG (arterial blood gas).
The session explains in details:
0:00 Introduction
2:45 Oxygenation Status (including Alveolar-Arterial gradient and P/F ratio)
18:58 Ventilation Status
21:59 Acid Base Status
28:05 Metabolic Acidosis (High anion gap metabolic acidosis [HAGMA], normal anion gap metabolic acidosis [NAGMA], low anion gap metabolic acidosis, negative anion gap metabolic acidosis)
50:38 Metabolic alkalosis (chloride dependent/ fluid responsive , chloride resistant/fluid unresponsive)
52:36 Respiratory Acid base status (respiratory acidosis and alkalosis)
We hope that this session will make ABG very simple and easy for you now . Hope ABG interpretation will now be a fun and fascinating thing. Keep practicing and if you have any doubts in ABG solving, you can post and ask your queries on esbicm.org/forums
Subscribe to regularcrisis channel at / regularcrisis
#readanABG #solveanABG #interpretanABG #ABGmadeeasy #ABGmadesimple #masterABG
regularcrisis.com is dedicated to doctors and nurses who regularly manage crisis like situations in ICU & ER.
Intensive care unit and emergency department are the backbones of any hospital where all critical situations are managed. Everyday is a crisis like situation there and with time the team working there get used to it with. With time, their skill gets more sharpen with which they manage these situations more and more efficiently each time.
But most importantly, the experience which they accumulate is invaluable; their experiences teach them things which at times are not mentioned in the regular textbooks. What if this experience is shared with the doctors and nurses who are newly joined in ICU and ER!
Regularcrisis.com serves this purpose only. We share educational material (mainly videos and forums discussion) which is a blend of latest guidelines and rich experience of ICU and ER teams.
We hope that his small effort of ours will be of some help to those working in ICU and ER.
Update: regularcrisis.com is now affiliated with ESBICM* for creating educational videos for health care working in ICU and ER.
*Educational Society of Bedside Intensive Care Medicine
regularcrisis is founded by Dr. Ankur Gupta, an Intensivist.
#drankurgupta
@regularcrisis

[@AmitSrivastava-rl8go]

Sir i m dr Amit Srivastava, doing pdcc critical care from eras lucknow medical College, u explained topics in very simple manner, hatts off sir, plz continue to upload videos like these

[@TheICUChannel]

Thanks dr amit for ur comments . We are working on uploading vidoes more frequently.

[@pradeekshadoor4012]

How is eras medical college? Are you satisfied with the exposure?

[@rudratripathi2787]

Yes sir ka video acha h bhot. Amit bhai pdcc course ka kitna fee lag rha.. Plz tell...

[@mangomanaliasaamadmi7891]

Guru Dronacharya 🙏

[@nathgoody5905]

Thanks a lot Sir, nobody explained so nicely ever,Cant thank you enough

[@kalp280]

You clear the concepts before the doubt comes. Your teaching is awesome sir. More respect to you.

[@TheICUChannel]

Thanks for your words,,, glad it helped.

[@drastishgore]

Such a difficult topic u explained in very simple manner. You are a great teacher,👏👏

[@amolpailwar848]

Hello Sir, myself Dr.Amol Anaesthesiologist, i have seen many of videos, you have explained everything in very easy way, you cover almost every aspect, your videos are very helpful, Thanx Sir

[@SurjeetSingh-vp8rh]

You are in great service of humanity….only few will understand…..may god give you more and more energy sir

[@bryandhanaraj2955]

Thank you sir for your time and supporting the medical faculty Learnt a lot from this .

[@drshalender5406]

So nice of you Dr Ankur sir. So comprehensive and illustrative presentation is very important to understand ABG explanation in a simple way to every learner in intensive care and emergency medical school. Thanks a lot. So nice of you.

[@TheICUChannel]

thanks doctor

[@NeMcHa]

Very interesting teaching... Loved the way you explain... Hats off 😍🥰😘

[@DoctorSap]

Beautifully explained doctor👏👏 cnt thank you enough!

[@vishwast6248]

Most comprehensive, good overview, for someone starting to read ABGs, though eager to learn, all videos I came across were in bits and pieces, Thank you so much sir 🙏🏾

[@TheICUChannel]

Glad it was helpful!

[@nagendraprad]

Super sir ..impressed with your simple explanation .

[@awesomevideo9291]

Thank you so much for really wonderful series..sir..🙏🙏🙏

[@aroor1785]

I think in 60 mnts u made shining star out standing physician hahahahaah thank u soooooo much, i pray for u that u will be granted all the good things and happiness doctor

[@poojagupta6333]

Very well explained and made many points clear in a very simple and easy way. Thanks a lot and wish you all the best!

[@TheICUChannel]

Thanks , glad it helped

[@drabaidrehman2833]

Wonderful 👍. I m a consultant anesthetist and pain physician from Pakistan. You are amazing. Keep up the good work. Love from 🇵🇰

[@anushjain9385]

Sir, After watching ur videos, i would like to work under ur guidance. Very effective learning.I m also working in ICU since 5 yrs and ur teaching helps me a lot. THANK U SIR

[@muhammadsaeed7941]

Wow appreciated you ... cleared the Brain of everybody

[@kashifazizsiddiqui9543]

This is one of best presentation .

[@hanzalaqazi8376]

Respect and love from the General Surgeon from Pakistan

[@dr.rahulbharat8210]

Outstanding! Academic excellence 💐👏🎊

[@TheICUChannel]

Thanks dr Rahul

[@manishavyas6736]

Very well explained, thank you sir

[@AhmedKhaled-sj1zx]

Your Videos + The ICU book = best intro to Critical care

[@TheICUChannel]

many thanks and welcome

[@faragahmed6560]

Icu book names?

[@harishakshu]

excellent explanation ......

[@WahidKhan-iw3nr]

Awesome sir, hats off u. Your way of teaching is very simple...... Plz continue to upload the more videos...

[@TheICUChannel]

Thanks Wahid

[@dhaneshkumarsharma8190]

Sir such a great initiative for future medical students .and this initiative is more helpful for patients. This is our last goal for all medical students Ki patient ki care aache se ho sake

[@TheICUChannel]

Thanks Dhanesh , nice to hear it’s useful

[@sanjeevkumar-or4lz]

Too good sir,very informative in simple way,thanks a lot

[@TheICUChannel]

Glad to know u liked sanjeev

[@drvishalparmar]

Very well explained❤❤❤

[@mdnadeemkhanindia9236]

Sir really you are giving great knowledge... thanks a lot sir

[@TheICUChannel]

Thanks for your words

[@drraviverma6319]

You are ultimate sir, I think you should start your own app recording these wonderful lectures

[@TheICUChannel]

Already on it

[@kishornellikonda6062]

True sir. Let us know once started

[@ananyasaxena4027]

Well explained sir

[@sagarawachar]

First time i understood topic so nicely,great teaching

[@TheICUChannel]

Glad to hear that, thanks and welcome

[@prasenjitsarkar6668]

Thank you very very much sir . I wish I could got it earlier.

[@saibalsahoo8597]

Thanks Sir!🙏🌹❤

[@kuhukiwifamily]

Very helpful....

[@sadshitpoorpoop]

Thank you so much. God bless you.

[@TheICUChannel]

Thanks

[@anjujaswal7512]

Thank you so much sir

[@vireshkannure6981]

Thanks a lot sir ❤many thanks

[@harishgautam3878]

G8 ...u r doing very very good job....this should be way things must be taught in college Thanks & regards

[@TheICUChannel]

So nice of you

[@sarangjaiswal3789]

Highly informational video @ 22.34 "that smile" is for those who directly jump on pH levels judgmental being acidosis/alkalosis before seeing pO2 and pCO2 levels in ABG.

[@AstrologerSahuJi]

Good👍

[@AmirChaudhry.]

sir more i listen to u , my love toward you is getting more and more

[@TheICUChannel]

So nice of you

[@shardendu06]

Most detailed and practical ABG concepts explained in such a lucid manner here... Thanks sir.

[@TheICUChannel]

Thanks a lot , glad it helped

[@sunilsolar616]

Best💯

[@hemalathas7387]

Excellent explanation sir 👍

[@TheICUChannel]

Thanks

[@cms2168]

Sir pls make videos on cardiology in micus , valvular heart diseases, insults , etc. Thanking you

[@adisingh110]

Thank you sir

[@eshagupta5453]

Excellent lecture 👍👍

[@TheICUChannel]

Many thanks, glad it was helpful

[@ranitabhattacharya441]

Sir you are the best teacher.Thanks will be less for your efforts.Sir please take classes on acid base disorders and electrolytes in details..

[@TheICUChannel]

Thank u , your suggestions noted

[@RohitKumar-oo1sl]

Thanks u sir🙏

[@sashwattarenia258]

very nice explanation

[@TheICUChannel]

Thanks , glad u liked.

[@drkounsar]

hi, excellent lectures

[@TheICUChannel]

Glad you like them!

[@sivasankarnallapati]

Nice

[@dushyantsaini4888]

Sir plz make a video on how to give insulin acording to sliding scale or algorithm .

[@jigdalbhutia8112]

Hello Sir, what is the role of Lactate and Base excess in interpretation of ABG , Thanking you in advance🙏🙏🙏

[@nitinjain2089]

*You tried to cover extremely vast topic in short time good efforts. PO2, which is dissolved oxygen in blood, is responsible for HB saturation(Spo2) & not the other way round. Again Hypoxemia is relavant, we should analyse low PO2 clinically, E.g in Acute Exa of COPD there is acute rise in PC02, & P02 may be Less than 50 in v/o low PA02 & Spo2 which may be less than 60, but is easily correctable with a litre of Oxygen. If we consider this severe hypoxemia & give high concentration of Oxygen patient will go into CO2 narcosis (coma) within minutes, whereas P02 of 60 in patient with Acute Pancreatitis may be detrimental & may herald ventilatory support. Whether it's Hypoventilation, V/Q mismach or shunt which matters more.* *Secondly when PH is low doesn't mean low HC03 but possible high HCO3 (compensatory) & High PCO2. Regarding AG we should simplify it, just calculated AG by formula & correct it, when Albumin is Low, add 2.5 X Albumin (4.5 - present alb) that would be corrected AG & now see the Delta HC03 & Delta AG,they should be equal in simple acid base disorder (Normally change in bicarbonate should be equals to change in AG), if not then mixed disorder likely.OR calculate Delta ratio which is more correct. Uremia/ Renal failure is one of the major cause of HAGMA in ICU. Regarding compensation in Acute & Chronic Respiratory acidosis it's usually 1 & 4 rise in Bicarbonate respectively & In Acute & chronic Respiratory alkalosis it's 2 & 5 decrease in Bicarbonate respectively. It's easy to use Winters formula while calculating expected PCO2 in Metabolic acidosis.Unless patient is gasping, obtain ABG @ room air...keep it up.👍🏼*

[@TheICUChannel]

Well said nitin. But didn’t get what you meant by dissolved o2 and bound by Hb… we have said that only in the video above. Anything different?

[@abhijitchatterjee7408]

Sir , should the K+, Na+ , Cl-, given in the ABG Report can also be taken as true and surmise the effect of Acidemia/Alkalemia . Or a separate Serum electrolyte Test should be done instantly. Are the amount of the NA, K, Cl dependable as given in the ABG Report? Kindly answer. its a necessity.

[@ahmadgumman3390]

when do you supplement HCO3 in HAGMA and how? kindly guide me, thanks

[@paediatricspotcases5220]

Sir i m paediatrician and i learnt more frm u dn my picu posting in pg D advantqge is dat i m working in tribal area but i manage pt here only bczz of u

[@TheICUChannel]

such a nice compliment dear... we are planning to start the live classes also on youtube live which everyone can join... very nice to hear that our videos are of some help.

[@paediatricspotcases5220]

@@TheICUChannel waiting for classes 👏

[@ankuraryan8951]

👏👏

[@adisingh110]

sir it will be better for us if you give units of various variables while explaining.

[@loveablend10]

Thanku for elaborating ABG.

[@TheICUChannel]

thanks and welcome to ESBICM

[@matinqureshi2090]

👏👏👏🙏🏼🙏🏼🙏🏼🙏🏼

[@neerajakkarachittoor181]

Sir ,as this channel has grown tremendously from past 3 years ,hence is it possible to take this same class again . ?

[@TheICUChannel]

Noted , will do a livestream

[@9950240592]

What is normal alveolar arterial gradient sir . ?

[@anshumanrajawat5666]

sir kaafi kch clear hua abg ko lekr is video mai...thnq sir...par sir agr thoda simpal language m use kre to better hoga..ku ki muje icu join kiye kch months hi huye h🙏🙏🙏🙏🙏🙏

[@TheICUChannel]

we are planning for an updated version , but it will take time ... but we will make it in parts. keep practicing it will become simple.

[@drmanjitsingh85]

🙏👌

[@paramveerjaura2820]

Sir, why are we comparing the anion gap with expected anion gap instead of comparing it with Normal anion gap value I.e 21 +_2 while classifying type of metabolic acidosis???????

[@MohammadSayeed-ho9sc]

I was watching your weaning from vent How do checks cough while on vent

[@ahmadgumman3390]

@The ICU Channel by ESBICM, SIR have not understood the concept of corrected HCO3, having M.Alkalosis when the Main Disorder is acidotic and PH < 7.35, kindly elaborate more

[@TheICUChannel]

can you post on the telegram group where I can voice message as this is difficult to type in detail .

[@sudharshankola5534]

Sir what is the significance of expected AG in treating the patient

[@PoonamGupta-sq7jz]

I think you add up to actual anion gap with each 1gm/dl fall from 4. You said subtract

[@TheICUChannel]

Yes it should subtract … can you point out the video time where the confusion arised?

[@gabrujawan7575]

Sir do we need to add potassium along with sodium in calculation of anion gap or should we include only sodium ?

[@TheICUChannel]

if potassium is added normal anion gap is 16, if not then 12. that's the only difference

[@SJ-ki5je]

Is corrected and expected anion gap the same?

[@sudharshankola5534]

And sir why can’t we classify the metabolic acidosis on the basis of AG

[@ahanraj4163]

Sir 1 have a question.....🙋‍♀️ pH 7.20, pco2 74, hco3 14. It's acidosis but Respiratory or Metabolic? Plz answer it

[@kumkum.s.agrahari9782]

Sir why minus 2 and plus 4 in pH correction?

[@pravatsahoo102]

Sir 🙏, while calculating expected anion gap for albumin correction why 2 is subtracted for each decrease in albumin. With decrease in albumin, anion gap should increase or decrease? Adjusted anion gap = observed anion gap + 0.25 x ([normal albumin]- [observed albumin])

[@TheICUChannel]

albumin is the major unmeasured anion and contributes almost the whole of the value of the anion gap. So if albumin is low , expected anion gap also decrease ( means less unmeasured ions in the blood)

[@mrityunjoykoley3911]

Sir please share a video to how to a central line incertain

[@TheICUChannel]

Ok we will try , but many videos already available on this on net . What exactly the problem you are facing ?

[@NEETGUIDANCEMBBSBAMS]

Abg values in aspiration pneumonia

[@pravatsahoo102]

Sir, urine Ph more than 6.5 or 5.5 in type-1 RTA.

[@sujaysahu1998]

Sir My question is that if any abg drawn by a 5/10 ml syringe using a 22G needle ...is this process right if not then what are the reasons behind... Sir Plz clear this concept .

[@divyanshishukla3523]

How can I get the pdf?? . .that link given in description not working

[@TheICUChannel]

go to esbicm.com in downloads section

[@kamal7835]

In bipap, how fio2 is becoming 24 in 1litre, 28 in 2lit ? Can anyone explain 😢 20 lit is for oxygen that i hv understood but rest?

[@Emtupo]

albumin corrected anion gap = anion gap +[2.5*(4-albumin)

[@TheICUChannel]

that's actually saying 2.5 drop of AG for 1 gm drop of albumin.

[@pravatsahoo102]

How to measure urine anion gap in NAGMA .

[@patrioticindian5194]

Sir one question you told in the lecture hco3 drop by one pco2 will drop by one to 1.5 But what about if hco3 increase then pco2 will increase by same proportion that is 1- 1.5 or any thing else Please guide

[@TheICUChannel]

The increase rate will be 0.5 to 1

[@singhjassi93]

sir as you told saturation is a binding of hb + O2. but in anaemic patient 4 gram. hb saturation is 97 plzzz tell how is this possible

[@TheICUChannel]

haemoglobin is saturated... there is no deficiency of o2 ... instead its total amount of oxygen carrying capacity of blood is reduced due to low hb... but the tissues demand remains the same, that's why patient gets fatigue.

[@SK-lj1ql]

Isn't albumin correction added to Anion Gap. Meaning low albumin will increase the anion gap right. You're showing that AG is decreasing instead of increasing with low albumin??

[@TheICUChannel]

It’s actually contributing to unmeasured ions and hence anion gap … but if you have measured and found low , the expected and corrected anion gap will be further low .

[@9950240592]

Alveolar gradient = (713×fio2 ) - (1.25×pco2)

[@9950240592]

So if a pt having fio2 70% , pco2=47 then is alveolar gradient is 376 is correct or m I doing some mistake

[@TheICUChannel]

Didn’t understand your question

[@chinmayeemohanty6608]

Sir ph of 7.41 Pco2 48 Hco3 30 Sir what will be its interpretation

[@ranitabhattacharya441]

Sir please tell how to check it is VBG or ABG

[@TheICUChannel]

kzbin.info/www/bejne/epqrcqqhZ9Fld6Msi=3EBn229aMDr_i1UN

[@sujaygowda5972]

Which hospital wroking sir

[@TheICUChannel]

Apollo

[@ahmadgumman3390]

why not mention BE , LA and hb levels

[@dr.chandan2881]

Sir apka telegram account jis pe pdf available ho plz tell me

[@TheICUChannel]

No … only ESBICM.com

[@mardmaratha4323]

Sir, I am not able to solve one ABG. Please help me in this regards. Ph 6.95 Pco2 155 Po2 35 Hco3 22.5. Though it looks like respiratory acidosis but as per your guidance, i calculated base line pco2 of 95 mm Hg, but is it Acute or chronic, I am unable to solve. Can you please help me??

[@TheICUChannel]

Post on esbicm forums

[@Beautifulhealthywealthy]

Is it important to know anion gap Any easy way to learn anion gap

[@TheICUChannel]

yes , I have tried to explain in the lecture. you can refer any good book for that.

[@Beautifulhealthywealthy]

This anion gap is very tough and I always get confused with this

[@TheICUChannel]

practice that after listening , you will pick up.

[@prof.-swapnil6377]

Fig heart fan💉🧠,❤️

[@TheICUChannel]

Thank u

[@user-hy4yz1co3t]

Dear sir. I am working in ICU in hyderabad. Our intensivist is not accepting your metabolic acidosis classification and calculation of HAGMA, NAGMA etc. They are following other formulas.

[@TheICUChannel]

It’s not my classification. It’s what books and texts mentioned . We have tried to simplified for practical purpose. Everyone has the choice to follow with which they are comfortable. U can always refer the text. All will come to same .

[@user-hy4yz1co3t]

@@TheICUChannel Sorry to say this sir but i searched Washington manual, Irwin's text book also, marinos text book also, but i could not get the matter you have explained in ABG. So our intensivist is asking that from which book you got this stuff. I was unanswerable.

[@TheICUChannel]

@user-hy4yz1co3t read dedicated ABGs book, there are many. Just giving for your reference Fluid, Electrolyte and Acid-Base Physiology: A Problem-Based Approach - 5E amzn.eu/d/dPq0GK6

[@user-hy4yz1co3t]

@@TheICUChannel Thank you for your valuable reply sir.