hey everyone it's sarah thread sterner sorry and calm and in this video we're going to review the ROE method to help you solve those abd problems for your exams and as always whenever you get done watching this YouTube video you can access the free quiz which will give you some more ABG practice so let's get started when you're solving arterial blood gas problems for your lecture exams there are different methods you can use to help you do that in a previous review we covered the tic-tac-toe method however in this video we're going to concentrate on the roam method personally I like them both because they're very easy to use but it's really whatever your personal preference is so what are we looking for whenever we're solving these ABG problems well we're looking for a potential acid-base imbalance and for exams they're gonna give you three things and you're gonna have to look at the value of those things and determine what is going on with the patient so they're gonna give you the blood pH level along with the carbon dioxide level which is represented as co2 and the BI card level which is represented as hco3 and you want to remember that co2 carbon dioxide represents the respiratory system and bicarb hco3 represents the metabolic system and what's really cool about our body is when this blood pH decreases too much where we have acidosis or it increases too much where we have alkalosis these two systems the rest for your metabolic system will try to balance that blood pH to get it back to normal so whenever you were solving these arterial blood gas problems there are three things that you want to ask yourself along with applying the method that you are using to help you solve these problems so the first question you want to ask yourself is this a respiratory or metabolic problem second you want to ask yourself do we have acidosis or do we have alkalosis and then third you want to ask yourself do we have compensation you're either going to have no compensation where would be uncompensated or you're going to have partial compensation or you're gonna have full compensation and I'm show you how to solve those problems with all three different scenarios so before you even try to solve an arterial blood gas problem you have to have this table committed to memory because you're going to pull from your memory bank these values and apply it to whatever method you're using to solve the ABG problem so let's quickly go over this table pH a normal blood pH is 7.35 to 7.45 anything less than seven point three five is considered acidotic anything greater than seven point four five is considered alkalotic then carbon dioxide co2 a normal level is thirty five to forty five anything greater than 45 is acidotic and anything less than 35 is alcoholic then we have hco3 a normal level a bicarb is 22 to 26 and anything less than 22 is acidotic and anything greater than 26 is alkalotic now let's look at the acronym roam our stands for respiratory oh four opposite m for metabolic and E for equal and I like to keep the are in the Oh together and the M and the e together to help me keep my information separated so one the world does respiratory opposite mean well what value represented respiratory that was our carbon dioxide level or a co2 so whenever your carbon dioxide level is high and your blood pH is low hence their opposite its respiratory acidosis when your co2 level is low but your blood pH is high and can their opposite its respiratory alkalosis now what does metabolic an equal mean well metabolic was represented with bicarb hco3 so whenever your hco3 is low and your blood pH is low hence they're equal because they're both low its metabolic acidosis when your bicarb is high and your blood pH is high they're equal because they're both high its metabolic alkalosis so now let's take this method and work some problems so her problem tells us that we have a blood pH of seven point two eight a carbon dioxide level of 50 and a bicarb level of twenty four and I've went ahead and set up a problem and I've wrote out Rome ro in II remember that's respiratory opposite metabolic equal and then I have our blood pH over there so our blood pH a normal level is 7.35 to 7.45 we're at seven point two eight so we're on the low side and it's abnormal and it's considered acidotic so I'm gonna put a down arrow over here blood pH and just write acid to let myself remember that then we're gonna look at the respiratory system which is represented with co2 or carbon dioxide level and it's 50 a normal carbon dioxide level is about 35 to 45 and we're on the high side of this so we're gonna put it's elevated and anything greater than 45 is considered acidotic so we're gonna write a sit over there then we're gonna later by carb level and that's represented with the M of our acronym metabolic and it's 24 a normal level is 22 to 26 so we're actually normal with our metabolic level now let's apply Rome we have opposite going on our respiratory systems high pH is low so according to row we have respiratory acidosis so we're gonna write that out that's the story acidosis so we've answered our first two questions we figured out that we have a respiratory problem and we figured out that we have acidosis going on but our third thing we need to figure out is do we have compensation and this is where you have to look further at your problem I mean you know whatever method you're using you have to dive a little bit deeper with it so first of all ask yourself do we have compensation going on at all well whenever you have compensation going on full compensation that means the body has fully compensated its corrected itself our blood pH should be normal is not normal so whatever you're solving these problems and you see a normal blood pH level you should be thinking full compensation but we don't have that so we can rule that out now do we have partial compensation going on maybe or are we completely uncompensated for so partial compensation would be another system that is trying to balance it out for instance we have a respiratory problem we've determined that well if we had partial compensation our metabolic system should be abnormal because it should be trying to throw itself until I can alkalotic state so we can bring this will actually increase this blood pH back because remember they're trying to balance each other out like how I talked about at the beginning we don't even have that our metabolic system is still normal it's just hanging out it's like hey what's going on nothing's really going on so I'm not going to be doing anything it doesn't really know to compensate yet so we have no compensation going on so this is respiratory acidosis uncompensated our next problem says that our blood pH is 7.30 our carbon dioxide level is 40 and our bicarb level is 18 so let's analyze blood pH normal again what was at 7.35 to 7.45 we're at 7.30 so we're on the low side specifically acid side our respiratory system which is represented with carbon dioxide so we're gonna put it up here is 40 normal level is 35 to 45 so we're actually normal here and our bicarb is 18 again in normal is 22 to 26 so we're on the low side for our by carbon that was representing the metabolic system so we're low for that and we're on the acidotic side so with using Rome we see we have an equal metabolic is low pH is low so we have metabolic acidosis so we've answered our first two questions now the third question do we have any compensation going on is there blood pH normal no so we're not fully compensated but are we partially compensated so our system that should be helping balance this out because we already have a metabolic problem should be a respiratory system an arrest or a system right now is normal so it's not trying to make itself out normal to help balance this acidotic blood pH out so we don't have any compensation going on so we have metabolic acidosis and compensate it our next problem says that our blood pH is 7.4 to our co2 or carbon dioxide levels 26 and our bicarb is 18 so let's look at our blood pH normal levels 7.35 to 7.45 we're at 7.4 to so we're normal so right now if you're thinking about compensation you should be thinking oh I bet we have full compensation I bet you're right but we've got it this Herman is this arrest for a problem or metabolic problem so whatever we're looking at this blood pH we're normal but what side of normal are we on our wheel in the acid oxide normal or the alcoholic side normal and to help you do that remember that the absolute normal blood pH is 7 point 4 0 so anything greater than that would be on the alcoholic side of normal and anything less than that would be on the Asus acidotic side so we're at 7 point 4 2 so we're on the alkalotic side so we're just gonna put its elevated and just fit alkalotic to help us remember that now let's look at respiratory those represented in carbon dioxide and we are at 26 a normal level is 35 to 45 so we are on the low side so we're gonna put low and it's alkalotic so and then our metabolic is 18 normal is bicarb is 22 to 26 so we are on the low side so we're going lo and we are on the acidotic side because it's less than 22 so using the RO method we look at our blood pH which is elevated we're looking at a rest or a metabolic system we have opposites going on because metabolic isn't what isn't low and the pH isn't low so they're not equal so we definitely have a respiratory problem going on specifically we have respiratory alkalosis and we already know our third answer to our third question we have full compensation going on because our blood pH is normal our body has thrown the metabolic system out of normal levels to help balance that blood pH and help get it back to normal so we have respiratory alkalosis fully compensated the next problem says our blood pH is seven point three seven our carbon dioxide level is thirty two and our bicarb is 17 so let's look at our blood pH normal level is 7.35 to 7.45 we're at seven point three seven so we're normal and again if you're thinking about compensation that's the herd question oh we have full compensation going on but we got to figure out the other two questions is this metabolic or respiratory is it's alkalosis or acidosis so with our blood pH it's normal but what side of normal is it on absolute normal is seven point four zero so it's seven point three seven so it's lower than that so we're on the Asus acidotic side of normal so we're low and we're just going to put acid to help us remember okay respiratory normal carbon dioxide is thirty five to forty five we're at thirty two so we are low and we're on the alkalotic asad so we're going to put alcoholic here our bicarb is seventeen normals 22 to 26 we are low so we are going to put low on the metabolic part of our acronym and what side of low are we on we're on acidotic side so we're just going to write a sit here now using the row method when we look at our pH which is on the low side and we look at our metabolic it's also low so they're equal so this is where we're at we have metabolic acidosis and we are fully compensated our blood pH is back to normal but our respiratory system because remember these two systems balance each other up also when I'm normal on the alcoholic side to help balance those acidotic conditions we are having so we are now fully compensated our next problem says that the blood pH is 7.5 one carbon dioxide is 47 and our bicarb is 32 so let's analyze the blood pH normal blood pH is 7.35 to 7.45 so we are elevated because we're at 7 point 5 1 so it's increased and it's alcoholic hey our respiratory system which is represented with carbon dioxide is 47 normal carbon dioxide level is about 35 to 45 so we are on the high end so we are elevated and it's acidotic and our bicarb which represents the metabolic is at 32 normal bicarb is 22 to 26 so we are elevated and we are elevated on the side of alkalosis okay and using the row method we see that we have something that's equal we have metabolics elevated pH is elevated according to a row method that would make it metabolic alkalosis so we're gonna write that now we have to answer that third question do we have compensation and if so are we uncompensated or we partially compensate our fully well let's look at the blood pH it is abnormal so we know we don't have full compensation so we can write that off now do we have partial compensated cassation or are we uncompensated well let's look pH is I'm normal but we have a metabolic problem so is a respiratory system trying to help out did it go abnormal to try to correct our blood pH and it did but it hasn't achieved the results that we need yet because our blood pH isn't normal yet so it's trying to compensate so we have partial compensation now it would be uncompensated if this respiratory system its value the carbon dioxide is still normal because it's not really trying to compensate to help us correct this metabolic alkalosis okay so that wraps up this review over the roam method and don't forget to access the free quizzes which will give you more ABG practice