everyone this is Sarah with registered nurse Orion comm and today we're going to solve arterial blood gas problems using the tic-tac-toe method I'm in my previous video I showed you how to solve a BG problems using the tic-tac-toe method I talked about how to set it up what it looks like normal lab values and water abnormal values so if you don't know how to use the tic-tac-toe method I really recommend you check out that video previously it's called AVG tic-tac-toe method and before you watch this video because you may be a little lost also when you're done watching this video test your knowledge on how well you know your ABG's by going to our website register sauron comm and click the slider that says quizzes and you can go there and test your knowledge on how well you know your ABG's so first what we're going to do is we're going to set up these problems and we're going to solve them I'm going to be working five problems I want to be covering metabolic disorders registry disorders and if they're compensated or uncompensated so um if you're ready let's start our first problem in nursing school normally what you're given are just basic little and lab values you're given the pH level you're giving the metabolic level and the respiratory level right here I have written the normal level so if you want to go ahead and just write that down I'm your normal pH levels I'm going to go over this real fast is 7.35 to 7.45 anything less than seven point three five is an acid anything over seven point four five is a base which is alkalotic your PC OPA co2 represents respiratory levels and it's the opposite of pH anything over 45 is an acid anything under 35 is base alkalotic so instead of your first number being an acid your last number being a base its flipped metabolic which is represented with hco3 22 to 26 is normal and it's the same as pH anything less than 22 is an acid and anything over than 26 is alkyl adding so those are your normal values okay so for a problem we have a pH of 7.5 three a respiratory paco2 of 23 and an hco3 of 18 so we set up our tic-tac-toe grid we have written acid normal and base and that is our little baseline and anytime we get it straight up and down of three we know that we're done okay for our pH we ask yourself is this an acid or a base and we know because it's over seven point four five it is a base so it's alkalotic so we are going to put pH under base and we're going to look at our paco2 levels and it's 23 and remember it's the opposite so your normal was 35 to 45 it's 23 so we know that that is basic so we're going to put paco2 under base and notice that they are lining up but we still need to look at our hco3 levels to tell us are we compensating or not in it's 18 and but the normal value is 22 to 26 and since it's 18 we know it's an acid it's a Sadaat 'ok so we're going to put this under acid okay and we have our tick-tack-toe so let's interpret we're ready to interpret since this is under here and we got the three across we are seeing we gotta ask yourself is this a respiratory issue or a metabolic issue we know that this is a respiratory issue because it's the piece a co2 so it's respiratory next we have to ask yourself is this alkalotic or acidotic and we're under the base category so we know it's alkyl otic and we have to ask herself is the patient compensating or not compensating and the other value of the metabolic will tell us this see the hco3 is abnormal the body is trying to regulate itself so it's thrown off the metabolic rate so we know that the body is trying to partially compensate so this would be respiratory alkalosis partially compensated now if your hco3 was still normal the body who isn't really trying to compensate so it would be uncompensated so it's respiratory alkalosis and partially compensated okay let's celebrate our net all oblem we have a pH of seven point two zero a paco2 of thirty a and an hco3 of seventeen we've set up set up our tic tac toe with acid normal and bathe as our baseline and our goal is to get as in tic-tac-toe a line of three together so we're going to look at the pH at 7.20 we know that that's an acid so we're going to put under acid pH we're going to look at the paco2 and it's 38 and the normal paco2 is 35 to 45 so it's normal so we're going to put this under the normal next we're going to look at the hco3 and it is 17 the normal is 22 to 26 so we know that this value is acidotic so it's going to go under acid just like pH now we've like in tech tic-tac-toe we have our cross so we're ready to interpret it and we know that hco3 represents metabolic so we know with that we have a metabolic problem and it's under acid so we have metabolic acidosis next we're going to see if it's uncompensated or partially compensated and our paco2 the body is doing nothing about it so the respiratory system is still normal so it's uncompensated so your answer would be metabolic acid is uncompensated if the paco2 was under bass the body would be trying to do something about it so it would be partially compensated but in this case it's uncompensated hey let's do our next problem okay for our next problem we have a pH of seven point four eight a paco2 of 42 and hco3 of thirty-five so we've set up our problem for the tic tac toe you have acid normal and base and we're going to determine where each value goes in the Tic Tac Toe pH is seven point four eight and anything over seven point four five is a base alkalotic so pH is going to go under base our paco2 is 42 we know that paco2 normal ranges are 35 to 45 so since it's 42 our paco2 is normal so that's going to go under the normal category hco3 is 35 our normal range for hco3 is 22 to 26 so we know that our metabolic is a basic so we're going to put hco3 under basic and we have our tic tac toe this will help us interpret we know that we have a metabolic problem it's under base so it's metabolic alkalosis next we have to ask yourself is as compensated or uncompensated and remember if the body is trying to do something it would throw off the other value it's not or paco2 is normal so we know that it's uncompensated so the answer to this problem is metabolic alkalosis uncompensated and again just to remind you if this paco2 was an acid it would be trying to compensate the bodies trying to do something to get that homeostasis back but in this case it's not so that's how you solve that problem let's do our next problem ok for our next problem we have the following lab values we have a pH of seven point two one a paco2 of 50 and hco3 of 28 we've set up a problem using the tic-tac-toe we have asked the normal and base and now we want to plug in these values to get the tic-tac-toe and see what we have so first we're going to ask yourself with the pH we have seven point two one is this an acid or a base and we know anything less than seven point three five for an ph is acid so it's acidotic so under acid we're going to be H for paco2 we know that the normal range is thirty five to forty five and we have a range of 50 so we know that this is going to be an acid so your paco2 is acidotic so we're going to put that under acid and we already have our tic-tac-toe but we still need to plug in the third value the hco3 normal hco3 is 22 to 26 it's 28 so we know that it is basic so we're going to put hco3 under base so now we are ready to determine what we have our problem is respiratory we have respiratory acidosis because that is where our tic-tac-toe is and so respiratory acidosis and we have to ask yourself next last question are we compensating or we own compensating uncompensated so our hco3 is thrown off it's an acid it's not in the normal range so our body is trying to compensate so we would have respiratory acidosis partially compensated so that's the answer to that okay let's do our next question for this question we have the following lab values we have a pH of seven point five zero a paco2 level of forty seven and an hco3 level of twenty seven we've set our problem up for the tic-tac-toe grid we have acid normal and base and now we're going to plug in these values to see where we get a tic-tac-toe so first we'll start with pH it's seven point five zero we know that a normal pH is 7.35 to 7.45 so we know that our pH is basic its alkalotic so we're going to put pH under base next we are going to look at our paco2 levels it's 47 a normal paco2 level is 35 to 45 so our paco2 level is acidotic so under acid we're going to put paco2 lastly we are going to look at our hco3 level and it is 27 a normal hco3 level is 22 to 26 so we know that that is basic its alkalotic so we're going to put hco3 under base and we have a tic-tac-toe so do a line and we're going to interpret we know that this is a metabolic problem because hco3 represents metabolic and we know it's basic so we have metabolic alkalosis so we have to determine are we trying to compensate our body compensating or not and the body is trying to compensate because the paco2 level is abnormal it's acid so the body is trying to do some homeostasis and get the body corrected so we have our answer is metabolic alkalosis partially compensated remember if this paco2 level was under normal it would be uncompensated because the body's not doing anything about it so that is how you solve these AVG problems and go to our website register nurse Orion comm and click the banner that says quizzes it's actually a slider and it will take you to quizzes we have a lot of in clicks quizzes ABG quizzes drug and dosage calculation quizzes and you can test your knowledge on how well you grasp this using the tic-tac-toe method and thank you so much for watching I hope you found this helpful and please give it a thumbs up and I hope you have a great day