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Paper Chase 3 – All Hail the VBG

Sanjay Arora, MD and Mike Menchine, MD
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03:57
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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00:49

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EM:RAP 2016 December Written Summary 910 KB - PDF

VBG plus reading from O2 sat monitor had excellent correlation with ABG values in terms of measuring pH, oxygen saturation and pCO2.

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Rabbott -

If you look at the scatter plot of pCO2 in this article, the 95% CI ranges from arterial higher by 8 torr, to lower by 17 torr in comparison to the VBG value. And in 1 of every 20 comparisons, the discrepancy is more than about 20 torr. I'm not sure that we'd accept other laboratory studies that had that much chance of providing misleading information: a pCO2 VBG of 40 with an ABG pCO2 of 48 would still be within the 95% CI, as would a VBG value of 50 when the ABG value was 33 - but both discrepancies would lead to distinctly erroneous management decisions. And that doesn't address the 1 in 20 results that are even more discrepant. This article (as with similar prior articles) does not give me much confidence that VBG's are highly useful, except when they support my pretest clinical impression. If the pCO2 (or pH) on the VBG is even a little bit surprising, get the ABG.

David W., M.D. -

The case managers and hospitalists tell me that they won't get paid for a COPD admission on the results of a VBG, just an ABG. Any advice on how to address that issue?

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Pneumonia in the Hotseat Full episode audio for MD edition 227:49 min - 317 MB - M4AEM:RAP 2016 December Aussie Edition Australian 31:23 min - 43 MB - MP3EM:RAP 2016 December Spanish Edition Español 79:39 min - 109 MB - MP3EM:RAP 2016 December Canadian Edition Canadian 16:00 min - 18 MB - MP3EM:RAP 2016 December French Edition Français 30:18 min - 42 MB - MP3EM:RAP 2016 December German Edition Deutsche 94:18 min - 129 MB - MP3EM:RAP 2016 December Written Summary 910 KB - PDFEMRAP 2016 December MP3 Files 183 MB - ZIPEM:RAP 2016 December Board Review Answers 201 KB - PDFEM:RAP 2016 December Board Review Questions 193 KB - PDF

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