{"id":19027,"date":"2020-07-02T04:54:40","date_gmt":"2020-07-01T20:54:40","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=19027"},"modified":"2020-07-14T16:25:30","modified_gmt":"2020-07-14T08:25:30","slug":"deranged-physiology%e6%96%87%e7%ab%a0%ef%bc%9a%e8%a1%80%e6%b0%94%e5%88%86%e6%9e%90%e4%bb%aa%e5%a6%82%e4%bd%95%e6%b5%8b%e5%ae%9a%e5%8a%a8%e8%84%89%e8%a1%80%e6%b0%94%e6%8c%87%e6%a0%87","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=19027","title":{"rendered":"[Deranged Physiology\u6587\u7ae0]\uff1a\u8840\u6c14\u5206\u6790\u4eea\u5982\u4f55\u6d4b\u5b9a\u52a8\u8109\u8840\u6c14\u6307\u6807"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\">How the blood gas analyser measures ABG variables<\/h1>\n\n\n\n<p><a href=\"http:\/\/www.derangedphysiology.com\/main\/cicm-fellowship-exam\/past-papers\/2008-paper-2-saqs\/question-91\">Question 9.1<\/a>&nbsp;from the second paper of 2008 asks of the bewildered candidates:<\/p>\n\n\n\n<blockquote class=\"wp-block-quote\"><p><em>\"Outline &nbsp;how pH, PCO2 and PO2 &nbsp;are measured in a blood gas analyser and briefly state the underlying principle behind &nbsp;each of those measurements.\"<\/em><\/p><\/blockquote>\n\n\n\n<p>The pass rate of 47% was pleasantly surprising, suggesting that many (if not all) of the candidates&nbsp;arose from an intellectually robust anaesthetic background. Judging by the college model answer, the bare minimum of expected knowledge resembles the contents of the following three paragraphs:<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">pH measurement<\/h2>\n\n\n\n<ul><li>pH is measured with a&nbsp;<em>glass electrode<\/em>&nbsp;suspended in the blood sample.<\/li><li>The blood sample acts a a conducting electrolyte.<\/li><li>The potential difference across the electrode is proportional to the pH difference, and this can be measured.<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">PaCO<sub>2<\/sub>&nbsp;measurement<\/h2>\n\n\n\n<ul><li>PaCO<sub>2<\/sub>&nbsp;is measured with a&nbsp;<em>modified glass electrode<\/em>.<\/li><li>The electrode is bathed in a solution which contains some sodium bicarbonate, and generates a known potential difference.<\/li><li>The CO<sub>2<\/sub>&nbsp;from the blood sample diffuses across a semipermeable membrane into the bicarbonate solution,<\/li><li>The reaction changes the pH in the electrode, which corresponds to a change in potential difference, and this is measured.<\/li><li>The CO<sub>2<\/sub>&nbsp;is then inferred from the change in pH.<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">PaO<sub>2<\/sub>&nbsp;measurement<\/h2>\n\n\n\n<ul><li>PaO<sub>2<\/sub>&nbsp;is measured with a&nbsp;<em>Clark electrode<\/em><\/li><li>The Clark electrode measures the change in current flowing through a reaction chamber where O<sub>2<\/sub>&nbsp;is reduced to OH<sup>-<\/sup>&nbsp;ions by a change in voltage.<\/li><li>O<sub>2<\/sub>&nbsp;from the blood sample diffuses through a semipermeable membrane into an aqueous buffer.<\/li><li>In the aqueous buffer it is reduced to OH<sup>-<\/sup>&nbsp;ions with the application of a potential difference (600-800mV); this causes a current to flow between two submerged electrodes. Increasing the voltage across this system also increases the current - up to a plateau. The plateau level depends upon, and is proportional to, the concentration of oxygen.<\/li><li>The rate of increase of current in proportion to increase in voltage becomes non-linear at a PaO2 above 150mmHg, and the ABG machine is usually clever enough to compensate for this known fact.<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Derived measurements<\/h2>\n\n\n\n<ul><li>HCO<sub>3<\/sub><sup>-<\/sup>&nbsp;is calculated from the Henderson-Hasselbalch equation.<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>How the blood gas analyser measures ABG variables Quest [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[13,14],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19027"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=19027"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19027\/revisions"}],"predecessor-version":[{"id":19028,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19027\/revisions\/19028"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=19027"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=19027"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=19027"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}