Acid-Base Balance

cointosser13

cointosser13

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I'm a medic student and I'm trying so hard to understand this Acid-Base Balance. People tell me just to use the ROME algorithm:

Respirations=Opposite
Metabolic=Equal

But I want to understand all this, rather than it just being a "formula".
 
http://medictests.com/acid-base-balance/

there are several resources (like this one ^^^)you can utilize. I googled acid base balance paramedic and got several results similar. When I get home from my rotation next week (am currently halfway through a 2 week shift) I can post some notes and handouts that helped me.
 
cointosser13 said:
I'm a medic student and I'm trying so hard to understand this Acid-Base Balance. People tell me just to use the ROME algorithm:

Respirations=Opposite
Metabolic=Equal

But I want to understand all this, rather than it just being a "formula".
Click to expand...

That's STUNNINGLY oversimplified but sadly will probably work for NREMT.

There's a book called "ABGs Made Simple" or something similar, it's a good resource.
 
I actually think you save time and aggravation in the long run by acquiring at least a reasonable level of understanding of these types of topics rather than attempting to go by "tricks, rules" whatever. In the end you won't really understand what is going on and certainly would have a difficult time using the information for anything, especially if your aim is to work in Critical Care/Flight.

That being said there is nothing wrong with starting with the basics and then adding depth to your understanding as you progress. You may never become an expert on acid base balance but it is very reasonable to become proficient and provide good care if you put the time in.

I understand things when I can connect the whole picture. Learn why the body operates within the ph range it does. Learn how that balance is maintained. Learn what happens when the balance is off, and what the body may do in an attempt to restore that balance. That way you won't just see numbers but will begin to anticipate / understand acid base balance based off of the pt's presentation/other findings. Believe me it really does make blood gas or other lab results accessible. It's like when you are learning EKGs. You can try and memorize rhythms by the way they look to you, and surely be misled eventually. You could also choose to learn your basics, build on them with more advanced knowledge and soon enough a bunch of lines and bumps tell you a lot of information.
 
cointosser13 said:
I'm a medic student and I'm trying so hard to understand this Acid-Base Balance. People tell me just to use the ROME algorithm:

Respirations=Opposite
Metabolic=Equal

But I want to understand all this, rather than it just being a "formula".
Click to expand...

The answer to your question is time and research. And lots of both. Start with ROME. That will get you through NR. But when you fully understand ABG's, then you'll realize that there's more to acid-balance than pH, PaCO2, and HCO3. You'll discover about Anion Gap (Delta Gap) acidosis, Diabetic Ketoacidosis, Charles' Law, how oxygenation and ventilation are not related whatsoever, how PaCO2 and EtCO2 are not necessarily equal (margin of error +/- 5-6 points), how nothing will sork in an acid medium or an alkali medium, and the list goes on.

In the mean time get the basics down pat first. Then read up. Oh, and spend as much time in an ICU as you can asking question after question after question.
 
MSDeltaFlt said:
The answer to your question is time and research. And lots of both. Start with ROME. That will get you through NR. But when you fully understand ABG's, then you'll realize that there's more to acid-balance than pH, PaCO2, and HCO3. You'll discover about Anion Gap (Delta Gap) acidosis, Diabetic Ketoacidosis, Charles' Law, how oxygenation and ventilation are not related whatsoever, how PaCO2 and EtCO2 are not necessarily equal (margin of error +/- 5-6 points), how nothing will sork in an acid medium or an alkali medium, and the list goes on.
.
Click to expand...

Or, if you're a real sicko, you'll dicover...dun dun dun...the Stewart Approach!:ph34r:



Anyways, agree that this is not an easily learned topic. A pretty good grounding in renal physiology will help - gotta learn about all the transporters to really understand hypochlormic vs hyperchloremic acidosis etc.


when you get ready for a bit more advanced learning, here's an easy-ish approach to double and triple acid/base disorders, mostly without using a pencil and paper:

http://freeemergencytalks.net/2010/04/corey-slovis-kicking-the-acidosis/
slides that sorta match here: http://www.vanderbiltem.com/pdfs_unsorted/Highland-GR-Acid-Base.pdf


For me a great source for understanding rather than just "having an approach" (very advanced, probably too much unless you've boned up on basic physiology) listen to the emcrit 4 parter on acid/base: http://emcrit.org/podcasts/acid-base-i/

I wouldn't bother trying to understand the stewart approach used in the podcast, but if you just sort of let the information wash over you it gives you some insight into how to approach acid base traditionally also...he goes over where "anion gap" came from, why NS is an acidosis inducing fluid, why LR works etc.
 
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