Tag: Tricks of the trade

Tricks of the trade – what your patient’s urine collection bag is telling you.

Posted on by PulmaKu

 

urcn02

yellow =  normal

uryll

darker yellow = concentrated urine (patient may be dehydrated)

urtrm

red (non-translucent) = traumatic catheter insertion / traumatized genitourinary (GU) system.

urmhbur

red (translucent) = hemoglobinurea (free hemoglobin in urine) >> may cause acute renal failure > keep patient mildly alkalemic to avoid free hemoglobin-distal convoluted tubule complexes from forming.

urmtlynbl

green / light blue – patient may be receiving MethleneBlue intravenously as “nitric oxide scavenger” therapy (MORE TO FOLLOW).  or after abdominal surgery (if JP drains drain from the abdomen, there is a vascular leak in the abdomen (MORE TO FOLLOW).

urlsx

near clear = likely a “forced” diuresis (ex. Lasix)

urbldirgn

red (from dark red > to light red > to clear) – likely, ongoing bladder irrigation as a washout of bladder.

urbldirgnii

2 bottles hanging  are infusing into the bladder – to be followed by release of bladder irrigant into urine collection bag.

Tricks of the trade : PaO2 vs. SpO2

Posted on by PulmaKu

Always keep SpO2 < 100% (with rare exception).

An SpO2 between 92% to 99% says something about your patient’s condition.

SpO2                           PaO2                            FiO2                                      P/F ratio

100 %                            600                              100%                                      600

100%                             500                               100%                                     500

100%                             400                                100%                                     400

100%                             300                                100%                                     300

100%                             200                                100%                                     200

100%                              100                                100%                                    100

99%                                   90                                 100%                                       90

98%                                   87                                  100%                                      87

97%                                   85                                  100%                                      85

96%                                   82                                   100%                                     82

95%                                   80                                   100%                                     80

90%                                   60                                    100%                                    60

 

Tricks of the trade : the P/F ratio

Posted on by PulmaKu

 

Normal P/F ratio=600.

As a generalization :

everybody breathing room air (21%) will have an PaO2=100.  P/F ratio=100/0.2 = 500.

everybody breathing 100% oxygen via NRB will have an PaO2=500.  P/F ratio=500/1=500.

so now, you can figure out the max PaO2 on any FiO2.

FiO2                           P/F ratio                        PaO2

100%                          600                                 600

90%                              540                                600

80%                              480                                600

70%                             420                                600

60%                              360                               600

50%                             300                                600

40%                             240                                600

30%                            180                                 600

21%                            120                                 600

 

 

 

Tricks of the trade : P/F ratio without knowing an ABG.

Posted on by PulmaKu

Look at your patient’s SpO2 > this will allow you to approximate both your patient’s  PaO2 and P/F ratio.

If your patient’s spo2 = 90%, your patient’s PaO2=60mmHg.

If your patient’s spo2=99%,  your patient’s PaO2=90mmHg.

So if your patient’s SpO2 = 97% and the FiO2=40%, you can estimate the P/F ratio as ~80/0.4=200.

If your patient’s SpO2=100%, your PaO2 can be anywhere from 90 to 600 > this is no help because you cannot approximate, let alone pinpoint, the pao2.

So, your patient with an SpO2=100% is not very telling of the patient condition.

If your patient’s spo2=100% and the pao2=100, on an fio2=40%, the p/f ratio=100/0.4=250 (=ALI = acute lung injury).

if your patient’s spo2=100% and the pao2=240, on an fio2=40%, the p/f ratio=240/0.4=600 (= normal).