BLOOD GAS
A patient is trapped in a panic room during a malfunction. They hyperventilate for 20 minutes straight, blowing off huge amounts of CO₂. Their ABG shows a very high pH and a PaCO₂ far below normal.
What acid–base disorder is this?
What is acute respiratory alkalosis?
A Demogorgon arrives needing NIV, but its head opens into five separate petal-like mouths, each capable of inhaling and exhaling independently.
To even attempt creating a functional mask seal, you need to choose one airway to interface with. Which one do you choose?
What is the most central mouth?
You time-travel to a medieval healer who believes a patient with widespread wheezing is “possessed by wind demons.”
Using actual pathophysiology, what modern condition would you actually suspect based on diffuse bronchoconstriction and airway inflammation?
What is Asthma?
Your patient on volume control suddenly has a PIP that shoots up, but the plateau pressure stays the same. This tells you the problem is most likely due to what?
What is Increased Airway resistance?
The event that caused the ventilator to be invented.
What is Polio?
A vampire is found unconscious just before sunrise after being trapped outdoors for several minutes.
On scene, he is pale (even for him), tachypneic, and clutching his chest.
His ABG comes back as:
pH: 7.18
PaCO₂: 28 mmHg
HCO₃⁻: 12 mEq/L
PaO₂: 89 mmHg
SaO₂: Normal despite his grayish skin tone
Vampires rely almost entirely on anaerobic metabolism when distressed — sunlight burns their skin and triggers extreme lactic acid production.
Based on the ABG, what is the PRIMARY acid–base disorder?
What is acute metabolic acidosis with respiratory compensation
A giant tortoise-like creature is brought in for research. Its heart beats only 3–4 times per minute naturally, and its conduction system depolarizes extremely slowly.
You attach a human ECG and notice the intervals are massively stretched out — especially the PR interval.
Based on real ECG physiology, which common human rhythm diagnosis would be IMPOSSIBLE to make accurately on this creature because its baseline conduction is naturally slow?
What is first-degree AV block?
A vampire feeds on a patient and removes just enough blood to cause weak pulses, cold skin, and a dropping MAP — but the patient still has intact volume in their interstitial space.
What type of shock is this patient developing?
What is hypovolemic shock?
A mermaid washes ashore in respiratory failure. Her lung density is adapted for underwater pressure, meaning on land she has poor oxygenation due to alveolar collapse. Which vent adjustment is going to be the MOST helpful for a creature with massive atelectasis?
What is PEEP?
The answer julia confidently yelled out in ARS in response to the question, "what event caused the invention of the mechanical ventilator"
You’re called to interpret an ABG, but the machine is down, so three different nurses give you the values they “wrote down earlier”:
Nurse A says the pH is 7.60
Nurse B says the PaCO₂ is 60 mmHg
Nurse C says the HCO₃⁻ is 22 mEq/L
You immediately notice these numbers cannot all be from the same blood gas, because they don’t physiologically match any acid–base disorder.
Whose numbers do you trust?
What is you can’t trust any of them — repeat the ABG?
A deep-sea “octotherm” creature is brought to your lab after surfacing too quickly and developing severe bronchospasm-like airway tightening.
Genetic sequencing reveals it lacks muscarinic (M₃) receptors on its airway smooth muscle — it uses an entirely different evolutionary pathway for parasympathetic control.
According to respiratory pharmacology principles, which commonly used bronchodilator class would be completely ineffective for this creature?
What are anticholinergic bronchodilators?
A diver descends so deep that ambient pressure increases dramatically. Nitrogen dissolves into tissues like CO₂ into a soda can under pressure. When he ascends too fast, the nitrogen forms bubbles in blood and joints.
What condition does this represent?
What is decompression sickness (the bends)?
You’re tasked with mechanically ventilating a dolphin, but every time it “breathes,” The ventilator keeps screaming “LOW Vt” even though pressures look fine. What is the reason for this alarm?
What is a blowhole?
Because the Moon has no atmosphere, no ambient pressure, and definitely no oxygen (rude), a standard mechanical ventilator absolutely would not work outside a spacesuit — even if it had power. What specific reason makes normal ventilation impossible in a vacuum?
What is the absence of external pressure to generate a pressure gradient?
I sit in a tiny chamber,
guarded by a thin membrane.
I do not taste the blood,
but I sense the gas that slips through.
When oxygen touches my silver heart,
an electric current wakes inside me—
the stronger the current,
the more oxygen you’ve brought.
I do not measure acid,
I do not measure breath,
but I whisper your oxygen’s truth
in microamps.
What electrode am I?
What is the PO₂ Clark electrode?
A serpent-like creature arrives with two possible airway channels in its throat, and under stress the anatomy shifts unpredictably — sometimes the left opening leads to the trachea, sometimes the right, and sometimes both collapse halfway down.
You need an airway device that will still allow ventilation even if you accidentally place it in the wrong lumen.
Which airway device gives you the best chance of ventilating this creature regardless of which channel the tube enters?
What is the Combitube (dual-lumen esophageal–tracheal airway)?
A freak electrical storm zaps a patient and briefly turns their myocardium into a twitchy bag of popcorn kernels. Their ventricles start quivering instead of pumping.
Which deadly rhythm has essentially taken over?
What is ventricular fibrillation?
A research experiment accidentally gives a patient lungs with two different compliances — the right lung is stiff like cardboard, the left lung is as floppy as a bicycle inner tube. In volume control, which lung receives more volume and why?
What is the higher-compliance lung receives more volume, because volume distributes to the path of least resistance?
The first test subject of the Iron Lung
In a vast and crowded kingdom,
there are countless travelers… yet none may speak.
One among them is different.
He carries no sword, yet all battles fail without him.
He is hollow, yet never empty.
He bears no wealth of his own,
but binds to treasure that is not his.
When the air in the mountain temple grows thin,
his burden grows lighter than it should,
and the kingdom begins to fade.
Who is this silent traveler?
What is hemoglobin?
A patient collapses inside a warehouse after exposure to a dense chemical fog that instantly stiffened all exposed mucous membranes. Their tongue and soft palate move normally, but the tissue inside the oropharynx is rigid and non-compressible, preventing a proper laryngoscope view.
Bag-mask ventilation is ineffective and oral intubation is impossible.
According to difficult-airway algorithms, what should be your next airway step?
What is a surgical airway (cricothyrotomy)?
A dragon accidentally exhales on someone (as they do), causing deep partial-thickness burns over their chest. Hours later, their lung compliance tanks and oxygenation plummets due to increased capillary permeability.
Which pathophysiologic syndrome has developed?
What is ARDS?
You are asked to ventilate The Hulk. During sedation break he suddenly wakes up, doubles in size, and his lung volumes increase by like… a lot. All your tidal volumes are now wildly too low. According to normal vent physics, which two vent parameters would need immediate adjustment to accommodate his sudden increase in lung surface area?
What is Oxygen Technicians
Three patients are brought into your RT unit after a bizarre event at a mountain lodge.
Each has a VERY different story — but only one of them is alkalotic.
Suspect A — The Climber
He was stuck at high altitude for hours.
He is breathing fast, light-headed, tingling in the fingers, and complaining that “the world looks too bright.”
His ABG shows:
CO₂ lower than his fear of heights
pH high
Suspect B — The Vomiter
She reports 12 hours of nonstop vomiting from food poisoning.
She is dehydrated, weak, and says she feels “too tired to breathe deeply.”
Her ABG shows:
HCO₃⁻ elevated
CO₂ slightly elevated from slow, shallow breaths
Suspect C — The Fire Survivor
He inhaled smoke and now has shallow, rapid breathing.
His ABG shows:
pH low
CO₂ high
HCO₃⁻ normal
Whose blood is most likely ALKALOTIC?
Who is Suspect A — The Climber?
A patient arrives from a warehouse accident reporting that “something” fell into their shirt and may have punctured the skin near their upper chest. On the AP chest X-ray, you see a small round metallic density… but you can’t tell whether it’s on the skin, under the skin, or actually inside the thorax.
To determine the true location and depth of the object, which X-ray projection should you order next?
What is the lateral view?
You time-travel and try to take the blood pressure of a brachiosaurus. The cuff doesn’t fit , but you notice its heart must generate MASSIVE pressure just to perfuse its brain several meters above the chest.
What human cardiac condition mirrors the pathophysiology of needing extremely high pressure to perfuse the upper body?
What is left ventricular hypertrophy from chronic afterload increase? (Hypertension)
A cryogenically frozen patient is thawed too quickly, causing all the gas in their lungs to warm and expand faster than the chest wall can keep up — like a biology-based hot air balloon mishap. On the ventilator, this would appear as unexpectedly high tidal volumes in pressure control. Which core physical principle explains this vent behaviour?
What is Charles' Law?
The Reason X rays are called X rays
X is used as an "unknown" symbol in science and math. When physicist Wilhelm Conrad Röntgen recorded about the new rays he was researching, he labelled them as "X'" rays
Two trauma patients arrive at the same time.
Their ABGs get accidentally switched, and you’re handed both values with no names attached:
pH: 7.52
PaCO₂: 18 mmHg
HCO₃⁻: 15 mEq/L
pH: 7.28
PaCO₂: 18 mmHg
HCO₃⁻: 8 mEq/L
You are told:
One patient has been vomiting for 24 hours.
The other is in severe shock with poor perfusion and rising lactate.
Which ABG belongs to the vomiting patient?
What is ABG A (the partially compensated metabolic alkalosis)?
How much FIO2 is given with 5L/min NP
You have 7 seconds to answer
What is 0.40%
A Yeti wanders down from its usual high-altitude mountain range and suddenly finds itself at sea level, where barometric pressure is much higher than what it’s used to.
The abrupt increase in ambient pressure massively boosts PaO₂, causing intense cerebral vasoconstriction followed by rebound vasodilation as the brain tries to autoregulate.
Moments later, the Yeti becomes disoriented, irritable, and staggers like it just did three back-to-back 12-hour shifts.
Which high-altitude–related condition is this rapid pressure transition mimicking?
What is high-altitude cerebral edema (HACE)
You travel back to ancient Greece and try to explain a mechanical ventilator to a philosopher who thinks the lungs are just “bellows filled with spirit-air.”
When you say, “It’s a machine that takes over breathing by controlling pressure, flow, and volume,” he confidently tells you machines can’t breathe because they don’t have souls.
Which basic ventilator concept is he fundamentally unable to understand because the entire idea relies on a future discovery about how gas actually enters the lungs?
What is negative and positive pressure mechanics?
This famous 17th-century experiment involved sticking one end of a goose trachea into a hog trachea to prove that air was needed for life. Name the early scientist who performed it. Its always him.