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CardioPulmonary
Cardiopulmonary Physiology - Unit 4 - SPC
| Question | Answer |
|---|---|
| Normal V/Q ratios | Normal = (4/5) = 0.8, ABG values are norm, 7.40, CO2 = 40, O2 = 100 |
| High V/Q ratios = Deadspace = Responsive Hypoxemia | High = (5/5) = 1.0, ABG pH = 7.45, CO2 = 30, O2 = 110(hypocapnic) because venous blood not in the mix so CO2 is not in ABG as much |
| Low V/Q ratio = Shunt = Refractory Hypoxemia | Low = (3/5) = 0.6, ABG - pH=7.35, CO2 50(hypercapnic), O2 = 80 |
| Deadspace disorders | Pumlonary Emboli, Circulatory Shock = High V/Q |
| Shunt disorders | Atelectasis, Pneumonia, Pumlonary Edema = Low V/Q |
| Fick's Law | Diffusion over alveolar Cap. Membrane, directoly proportional to SA, Pressure Gradient, and Diffusion coefficent, inversly proportional to thickness |
| Normal DLCO | Diffusion capacity for CO(carbon monoxide), 25ml/min/mmHg |
| How to increase diffusion factors | Recumbent position - Increases SA, exercise - increases ventilation, perfusion, and hemoglobin, Body size = height not wt. |
| How to decrease diffusion factors | decrease SA - most dramatic in emphysema, Increase membrane thickness - in interstitial lung diseases like IIPF and pneumoconosis diseases |
| How is Oxygen transported in the blood | Plasma, and hemoglobin |
| Hemoglobin A | made p of 2 alpha and 2 beta polypeptide chains, with 4 HEME groups |
| p50 | point of reference for loading or unloading of O2 onto hemoglobin, partial pressure required to saturate the Hb to 50% level |
| Normal p50 | 27mmHg |
| Decreased p50 | less than 27 = left shift(LOAD), increased affinity between O2 and Hb, O2 loading easier in LUNGS, but harder in Tissues |
| Increased p50 | greater than 27 = Right shift(RELEASE), dreased affinity between O2 and Hb, O2 loading harder in Lung, unloading easier in tissues |
| LEFT Shift Factors | increased pH(ALKALEMIA), decreased CO2, Hypothermia, Decreased 2,3,DPG, promotes O@ loading |
| RIGHT Shift Factors | Decreased pH(ACIDEMIA), increase CO2, hyperthermia(Fever), increase 2,3 DPG, promotes O2 unloading |
| BOHR effect | CO2 and pH effect oxyHb disassociation curve, LEFT/LUNG/LOW CO2/ALKALEMIA...favors LOADING...RIGHT/TISSUES/HIGH CO2/ACIDEMIA...favors unloading |
| Methemoglobin (MHb)- Bad hemoglobin | congential or chemically induced(Nitrates, NO, Caine drugs)alters HEME portion of Hb, cause DECREASED p50- O2 loads on Hb but will not unload in tissues, PulseOx reads 85% |
| Carboxyhemoglobin (HbCO) | caused by CO poisoning or smoking, DECREASED p50- O2 loads on Hb but will not unload in tissues |
| Fetal Hemoglobin (HbF) | in the fetus and neosaltered 2,3,DPG binding causes DECREASED p50, O2 load on Hb but not unload in tissues |
| Total Oxygen Delivery (DO2) - how much O2 going out | DO2 = C.O. x (CaO2x10), normal is 5 x (20x10)= 1000ml/min, if given dl, multiply by 10 |
| O2 consumption/uptake | O2 consuption = C.O. x [C(a-v)O2x10], normal is 250ml/min |
| Factors that increase O2 consumption | Exercise, Fever, Seizures, Shivering, all >250ml.min |
| Factors that decrease O2 consumption | Peripheral shunting - bl not reaching tissues in limbs, Cyanide poison - block mitochondria from processing O2 properly, Hypothermia, metabolic rate goes down |
| C(a-v)O2 - (a-v) is diff between arterial and venous | normal is 20-15 or 5ml/min |
| Factors that increase (a-v) gap | Decreased CO, Increased O2 consumption, exercise, shivering, seizure, fever, tissues asking for more O2 |
| Factors that decrease (a-v) gap | Peripheral shunting, cyanide poisoning, hypothermia |
| Extraction Ratio O2ER | O2ER = (CaO2-CvO2)/CaO2, normal = 25%, (20-15)/20 |
| Increased ER | Same as (a-v) gap, Decreased CO, Increase O2 consumption, failing heart, exercise, seizure, fever, shivering |
| Decreased ER | Same as (a-v) gap, Increased CO, Decreased O2 consumption, peripheral shunting, cyanide poisoning, hypothermia |
| SVO2 = Venous saturation | Normal 75%, PVO2 - 40-45, critical at 60% |
| Factors that increase SVO2 | Ex. 80%, incresaed CO, decreased O2 consumption at tissues, Peripheral shunting, Cyanide poisoning, hypothermia |
| Factors that decrease SVO2 | Ex. 60%, decreased CO, increased O2 consumption at tissues, exercise, seizures, shivering, fever |
| Calculate shunt (QS=shunted blood, QT=total blood flow)(CCO2=content O2 in pulm. Cap. Bed) | QS/QT= (CCO2-CaO2)/(CCO2-CvO2) |
| Clinical significance of shunting | <10=NORMAL, 10-20%=MILD, 20-30%=MODERATE, >30%=SEVERE |
| CO2 Transport | 10% dissolved in Plasma, 20% in Carbamino on the protein portion, and 70% on Bicarbonate in the hemoglobin |
| Haldane Effect | As SaO2 decreases, CO2 loading on Hb is enhanced(TISSUE LEVEL)...As SaO2 increases, CO2 unloading is enhanced (LUNG LEVEL) |
| Chloride Shift at TISSUE LEVEL | Chloride IN, Bicarb OUT, CO2 LOADED, O2 UNLOADED(H+ increase) |
Created by:
mac6672
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