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Hypercarbia and Hypoxemia. 11.7.11. What happens to our cells if we don’t get enough O 2 ?. What happens to our cells if we don’t get enough O 2 ?. Cannot make ATP. What happens to our cells if we don’t remove CO 2 ?. What happens to our cells if we don’t remove CO 2 ?.

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Hypercarbia and hypoxemia

Hypercarbiaand Hypoxemia

11.7.11





What happens to our cells if we don’t remove CO2?

CO2 is not bad by itself but can combine with H2O in the blood  makes carbonic acid  change in pH can cause structure changes in proteins  if 3D structure can lead to loss in function.


Why is PIO2 150 mmHg if atmospheric PO2 is 160 mmHg?


Why is PIO2 150 mmHg if atmospheric PO2 is 160 mmHg? Saturation with H2O in the lung space decreases the PO2


Causes of hypoxemia
Causes of Hypoxemia

1.

2.

3.

4.


Causes of hypoxemia1
Causes of Hypoxemia

1. Diffusion Impairment

2. V/Q Abnormalities

3. Shunt

4. Hypoventilation


Diffusion impairment
Diffusion impairment

.

VO2 = K x A x (PAO2 – PaO2)/T


Diffusion impairment1
Diffusion impairment

.

VO2 = K x A x (PAO2 – PcapO2)/T

How does the rate of transport change with:

-Increased thickness, ie. with fibrosis?

-Decreased surface area, ie pneumonia?

-Decreased PcapO2, less O2 in the capillary blood?


Diffusion impairment2
Diffusion impairment

.

VO2 = K x A x (PAO2 – PcapO2)/T

How does the rate of transport change with:

-Increased thickness, ie. with fibrosis?

Slow

-Decreased surface area, ie pneumonia?

Slow

-Decreased PcapO2, less O2 in the capillary blood?

fast, increased diffusion


V q abnormalities
V/Q Abnormalities

  • Upper parts of the lung receive more/less blood supply than the lower parts (gravity).

  • Upper parts of the lung also receive more/ less of the tidal volume.


V q abnormalities1
V/Q Abnormalities

  • Upper parts of the lung receive more/lessblood supply than the lower parts (gravity).

  • Upper parts of the lung also receive more/ less of the tidal volume.


V q abnormalities2
V/Q Abnormalities

  • The result is that the upper parts of the lung receive relatively more/less ventilation than they do blood flow, while the lower parts of the lung receive relatively more/less ventilation than they do blood flow.


V q abnormalities3
V/Q Abnormalities

  • The result is that the upper parts of the lung receive relatively more/less ventilation than they do blood flow, while the lower parts of the lung receive relatively more/lessventilation than they do blood flow.


Shunt
Shunt

Definition:

Let’s take a short cut! But is it a good short cut?


Shunt1
Shunt

Definition:

When blood passes from the right heart to the left heart without becoming oxygenated?


Shunt2
Shunt

Which causes blood to go from the right to left heart without going through the lungs?

  • Foreign object (ie. Peanut)

  • Bronchial circulation

  • Pneumonia or abundant pus

  • Foramen Ovale


Shunt3
Shunt

Which causes blood to go from the right to left heart without going through the lungs?

  • Foreign object (ie. Peanut)

  • Bronchial circulation

  • Pneumonia or abundant pus

  • Foramen Ovale


Shunt4
Shunt

Bronchial circulation- only goes through the larger airways and does not reach the alveolar region

Foramen Ovale- system established in utero that may not close when the baby is born


Shunt5
Shunt

What happens with these two?

Foreign object (ie. Peanut)

Pneumonia or abundant pus


Shunt6
Shunt

What happens with these two?

Foreign object (ie. Peanut)

Pneumonia or abundant pus

Blood goes through the lungs but does not come into contact with the gas exchange region.




H ypoventilation
Hypoventilation

What things can cause hypoventilations?

1.

2.

3.

4.


H ypoventilation1
Hypoventilation

What things can cause hypoventilations?

1. Problems with nerves

2. Problems with muscles

3. Drugs that suppress resp. drive (morphine)

4. Problems with central resp. drive (CCHS, Ondine’s)


Hypercarbia
Hypercarbia

In addition to hypoventilation,

Think ALVEOLAR VENTILATION

Think DEAD SPACE





What happens when you increase dead space1
What happens when you increase dead space?

VA = (VT ‑ VD) x f

Incr. dead space  decrease alveolar ventilation  increase PaCO2 = hypercarbia if above 40 mmHg


Dead space
Dead Space

Name 3 things that cause changes in dead space.


Equipment
Equipment

-Snorkel

-Gas Mask

-Ventilator


Deep vein thrombosis
Deep Vein Thrombosis

How does DVT cause dead space?


Deep vein thrombosis1
Deep Vein Thrombosis

How does DVT cause dead space?

Sedentary  blood clot travels to lung  embolus creates dead space  decreased gas exchange  air in and out is unchanged