Conversations with Keith and Courtney: Acid-Base Balance
Stay with us! In the final episode of this series, Keith and Courtney introduce Acid-Base Balance and Disturbances. It has taken years for both of them to get to grips on some of the basics of this topic, and they spend the next hour breaking down what is going on and how to interpret the values in front of you. During the second half of this episode, they discuss some case-based scenarios.
Even if you are not utilising blood gas analysis in practice, it doesn’t mean something acute is not happening to our patients under anaesthesia just because we can’t see it, so it is still useful to understand.
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1:01:12
Conversations with Keith and Courtney: Carbon Dioxide, Part 2
Last episode, we talked about how carbon dioxide is formed in the body, and how it gets from the cells to the lungs. Now that it has arrived there – what next?! In this episode, Keith and Courtney talk about what happens when carbon dioxide diffuses from the pulmonary capillary into the alveoli to be exhaled.
They break down the Alveolar Ventilation Equation and the Alveolar Gas Equation into a more user-friendly concept you can apply to your everyday patient and how it is actually useful after the anaesthesia itself. Keith discusses the loss of one of his patients during the recovery period and Courtney shares ways you can continue to support and monitor those patients in this critical time of anaesthesia – after all, your pulse oximeter and capnograph can still be used after they are extubated!
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1:01:50
Conversations with Keith and Courtney: Carbon Dioxide
In the first episode on carbon dioxide, Keith and Courtney will undoubtedly make you rethink the role of carbon dioxide in the blood – it isn’t the “bad guy” we perhaps thought it was.
They start their conversation right down at the cellular level again and discuss how it gets from there to the lungs. How is carbon dioxide carried? At what point does it hitch a right on the haemoglobin (Hb) to return to the lungs to be breathed out? If only 25% of the carbon dioxide is carried in the blood – where is the rest? Why do we talk about bicarbonate when talking about carbon dioxide? There are so many questions!
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57:36
Conversations with Keith and Courtney: Oxygen, Part 3: Patient Monitoring During Oxygen Delivery
In the last of the 3 episodes on oxygen, Keith and Courtney discuss how we can monitor the concentration of oxygen our patient is receiving and also how to monitor our patient’s oxygenation levels – both manually and with a machine.
We can “flip the lip” (but human eyesight can’t detect cyanosis for quite some time), use our pulse oximeter or run a blood gas analysis. Assuming the patient has normal haemoglobin levels. Anaemia, carbon monoxide poisoning from a house fire and even an overdose of certain everyday drugs can affect functional haemoglobin availability!
They finish this episode highlighting the importance of using an oxygen concentrator in a circle breathing system, and why we initially have high fresh gas flows to remove the nitrogen sitting in the tubing and carbon dioxide absorbing canister.
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59:00
Conversations with Keith and Courtney: Oxygen, Part 2: From the Lungs to the Mitochondria
In this second episode, Keith and Courtney discuss how oxygen gets from the lungs and down to the cellular level. This episode won’t Bohr you! Listen out for Keith’s fantastic explanation of how oxygen is carried in the blood to the tissues by using a “football fans and the London Underground network” analogy.
Also, after breaking down the Oxygen Dissociation Curve, you may want to get your pulse oximeter out and use it in the recovery phase of your patient’s anaesthesia experience! They also throw in a few case base discussion points on tick-bite paralysis, geriatric pets and those animals who have perhaps been exposed to carbon monoxide in a house fire. This episode is relevant for all disciplines in veterinary medicine – not just anaesthesia!
Über Clinical Anaesthesia Podcasts: Conversations with Keith and Courtney
“Conversations With” is a podcast by the Clinical Team at Burtons Academy. Both Keith and Courtney are experienced and knowledgeable in their field of veterinary anaesthesia, ventilation and monitoring and could talk all day about breaking down different concepts in anaesthesia so people felt like they understood the foundations of what they were doing in practice every day – so they simply hit the record button to capture these moments!
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