Hypercarbia and Hypoxemia
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Hypercarbia and Hypoxemia11.7.11
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What happens to our cells if we don’t get enough O2?
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What happens to our cells if we don’t remove CO2?
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tissue
CIRCULATION
CO2 O2
PIO2 = 150 mmHgPICO2 = 0.3 mmHg (0)
P aO
2 = 9
8 m
mH
gP a
CO
2 = 4
0 m
mH
g
CO2 O2
P vO
2 = 4
0 m
mH
gP v
CO
2 = 4
5 m
mH
g
PAO2 = 100 mmHgPACO2 = 40 mmHg
Subscripts:I = inhaledA = alveolara = arterialv = venous
Why is PIO2 150 mmHg if atmospheric PO2 is 160 mmHg?
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Causes of Hypoxemia
1.
2.
3.
4.
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Diffusion impairment
PAO2
PcapO2
T
A
.VO2 = K x A x (PAO2 – PaO2)/T
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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?
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V/Q Abnormalities
0Upper parts of the lung receive more/less blood supply than the lower parts (gravity).
0Upper parts of the lung also receive more/ less of the tidal volume.
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V/Q Abnormalities
0The 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.
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Shunt
Definition:
Let’s take a short cut! But is it a good short cut?
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ShuntWhich causes blood to go from the right to left heart without going through the lungs?
A. Foreign object (ie. Peanut)B. Bronchial circulationC. Pneumonia or abundant pusD. Foramen Ovale
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ShuntBronchial 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
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Shunt
What happens with these two?
Foreign object (ie. Peanut)Pneumonia or abundant pus
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Does hypoventilation cause hypoxemia or hypercarbia?
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Hypoventilation
What things can cause hypoventilations?1.
2.
3.
4.
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Hypercarbia
In addition to hypoventilation,
Think ALVEOLAR VENTILATIONThink DEAD SPACE
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How to calculate alveolar ventilation?
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What happens when you increase dead space?
VA = (VT V‑ D) x f
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Dead Space
Name 3 things that cause changes in dead space.
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Equipment
-Snorkel-Gas Mask-Ventilator
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Deep Vein Thrombosis
How does DVT cause dead space?
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Air can get in but gas exchange surface is destroyed.