A 90-second shift of arterial blood gases. Read the result, tap the interpretation chain, beat your best. Every gas is generated fresh, so no two shifts match.
How to play
Each card is an arterial blood gas with a short clinical stem. H and L tags mark values above or below normal.
Tap the chain in order: pH status, then primary disorder, then compensation. ICU adds the anion gap. Night Shift Charge adds a hunt for a second disorder.
Every correct tap scores. A full correct chain earns a bonus, a speed bonus, and builds your streak multiplier (up to x2).
One wrong tap ends that gas and opens the worked solution with this patient's numbers. The shift clock pauses while you read.
Keyboard: number keys 1 to 5 pick options, Enter goes to the next gas.
Pocket card
Normals
pH 7.35 to 7.45, PaCO2 35 to 45, HCO3 22 to 26, PaO2 80 to 100, AG 8 to 12
ROME
Respiratory Opposite (pH and PaCO2 move opposite), Metabolic Equal (pH and HCO3 move together)
Compensation
Uncompensated: the other value is still normal. Partial: it moved, pH still abnormal. Full: pH back in range (side of 7.40 shows the primary).
Winter's
Metabolic acidosis: expected PaCO2 = 1.5 x HCO3 + 8 (plus or minus 2)
Met alkalosis
PaCO2 rises about 0.7 per 1 mEq/L rise in HCO3 (plus or minus 2)
Resp acidosis
HCO3 rises 1 per 10 mmHg PaCO2 (acute), 3.5 to 4 per 10 (chronic)
Resp alkalosis
HCO3 falls 2 per 10 mmHg PaCO2 (acute), 4 to 5 per 10 (chronic)
Anion gap
Na minus (Cl + HCO3). With low albumin: AG + 2.5 x (4.0 minus albumin)
Delta ratio
(AG minus 12) / (24 minus HCO3). Under 1: added non-gap acidosis. Over 2: added metabolic alkalosis.