CO2 content, however, I measured and that’s the CO2 as it comes. It doesn’t matter what. Now the vast majority of CO2 is present in bicarbonate, like 95%. So most people use those terms interchangeably. CO2, CO2 content, bicarb. For practical purposes that’s okay. Unless somebody is trying to find out it you have deep scientific knowledge, it is okay to use them interchangeably because clinically we do use them. But CO2 content has a little bit more than bicarbonate, and you should know that. Finally, as far as oxygen is concerned, it won’t transfer it in any meaningful way unless it’s attached to hemoglobin. So two things: one, it’s the oxyhemoglobin that carries the overwhelming - 99.9% or some huge amount - of all the oxygen that goes from the alveoli to the tissues. So that means then that every time you are doing blood gases you have to ask, number one: what’s the hemoglobin, number two: is it normal? Is it some kind of abnormal hemoglobin? Has the patient been in a fire, this or that. Drinking bad well water, so does the patient have the right amount of hemoglobin? Is it abnormal? Something that would prevent the oxygen from jumping aboard? As you know, most smokers have enough carboxyhemoglobin to make a difference in marginal cases. People with arteriosclerotic heart disease can have enough carboxyhemoglobin to actually make a difference.
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The third thing is blood pressure, pulse and cardiac output. Again, most all of those things can be clinically estimated, but you can have all the hemoglobin you want, you can have all the oxygen you want, and if the pump isn’t working, you aren’t getting it where you want. It’s amazing when people sometimes look at the numbers that we provide, they sometimes leave the patient mentally and go back and look at the numbers only. And you can’t. You have to go back and forth and back and forth and each time ask all the other questions about hemoglobin. Pretty simple but if you don’t remember to do it you can make big errors.
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Now, the Henderson-Hasselbalch equation here - I just showed it to remind you that you saw it one time and you’ll probably never see it again - but it will show you what it really says. What it really says is the pH is directly related to the bicarbonate. In other words, as the bicarbonate goes up pH goes up and the pH is inversely related to the PCO2. So as the pH goes up, PCO2 goes down, and vice-versa. So if you want to remember Henderson-Hasselbalch, as a which way does it happen? This is the one to remember. The pH is directly related to the bicarbonate; pH is inversely related to PCO2. Once you start working with these numbers, which many of you do, you will find out that you are already accommodating to that. You’re just not thinking about it when you do it.
Jan 25
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