What are the definitions of:
|
|
|
- Giles Foster
- 6 years ago
- Views:
Transcription
1
2 What are the definitions of: Acidemia Alkalemia
3 Acidemia The condition of increased [H+] in blood Low blood ph Alkalemia The condition of decreased [H+] in blood High blood ph
4 What are the definitions of: Acidosis Alkalosis
5 Acidosis The disease process which increases [H+] Alkalosis The disease process which decreases [H+]
6 Can these 4 conditions coexist? Acidemia Alkalemia Acidosis Alkalosis
7 Acidemia and alkalemia Generally does not coexist. Acidosis and alkalosis More than one etiology may be simultaneously present.
8 Severe acidemia ph < 7.0 What are 5 effects of severe acidemia?
9 Impairs enzyme function Interferes with electrophysiology Disturbs electrolyte balance Blocks calcium influx into cells Inhibits catecholamine action
10 Aerobic cellular metabolism Produces energy Carbohydrate + Fat ==> ATP + CO2 CO2+H2O <==> H2CO3 <==> H+HCO3
11 Acid-base disorders Alterations in hydrogen ion activity ph = - log [H+] In extracellular fluid, what is the normal ph and [H+]?
12 In extracellular fluid: Normal ph = 7.40 Normal [H+] = 40 neq/l
13 What is the Henderson-Hasselbalch equation?
14 Henderson-Hasselbalch equation Under equilibrium conditions ph is related to the molar concentrations of bicarbonate and carbonic acid
15 ph = pk + log (HCO3- / H2CO3) ph = pk + log (HCO3-/[PCO2 x 0.03]) pk = 6.1 = - log of dissociation constant for H2CO3 What is total CO2?
16 tco2 = [HCO3-] + dissolved CO2 tco2 = [HCO3-] + [H2CO3] tco2 = [HCO3-] x PCO2 What are normal values for : ph, PCO2, PO2, [HCO3-]?
17 ph PCO mmhg PO mmhg [HCO3-] mmol/l
18 Respiratory Net gain or loss of CO2 Metabolic Net gain or loss of HCO3-
19 Primary Disorder / Compensation Respiratory acidosis Respiratory alkalosis Metabolic acidosis (respiratory) Metabolic alkalosis (respiratory) HCO3- retention (renal) HCO3- elimination (renal) CO2 elimination CO2 retention
20 How do kidneys compensate?
21 Kidneys adjust HCO3- reabsorption in the proximal tubules. The effect appears in 6 to 12 hours and slowly increases to a steady-state response over days. What is the relationship between ph and pco2 in acute renal compensation?
22 In acute respiratory derangement: If pco2 changes 10 mmhg, what is the acute change in ph? If pco2 changes 10 mmhg, what is the compensatory change in [HCO3]?
23 Acute renal compensation Change in ph = x change in pco2 Partial compensation change in ph < x change in pco2 Superimposed acid-base disorder change in ph > x change in pco2
24 Acute hypercapnia: PCO2 = 50 mmhg Alteration: ph decreases 0.08 Compensation: HCO3 increases 2 mm Acute hypocapnia: PCO2 = 30 mmhg Alteration: ph increases 0.08 Compensation: HCO3 decreases 2 mm
25 Chronic hypercapnia: PCO2 = 50 mmhg Alteration: ph decreased 0.03 Compensation: HCO3 increases 4 mm Chronic hypocapnia: PCO2 = 30 mmhg Alteration: ph increased 0.02 Compensation: HCO3 decreases 5 mm
26 ph < 7.35 and PCO2 > 45 Causes Decreased alveolar ventilation Increased CO2 production
27 Decreased alveolar ventilation Neuromuscular etiologies? CNS etiologies? Pulmonary etiologies? Mechanical ventilator
28 Neuromuscular etiologies Disorders of nerve, muscle, or neuromuscular junction Drugs / toxins Hypokalemia
29 CNS etiologies CNS injury, ischemia, hemorrhage, tumor CNS depression Narcotics, sedatives, anesthetics
30 Pulmonary etiologies Restrictive disease (fibrosis) Obstructive disease Pulmonary edema Severe pneumonia Impaired diaphragmatic excursion Hemothorax, pneumothorax, flail chest Obesity hypoventilation Mechanical Ventilator Increased CO2 Production?
31 Increased CO2 production High carbohydrate diet Hypermetabolism Fever Shivering
32 What is treatment?
33 Correct underlying cause Bronchospasm Pulmonary edema Reverse depressed ventilatory drive Sedation Narcotics Mechanical ventilation
34 What are some effects of severe alkalemia?
35 Cerebral vasoconstriction Seizures Confusion Coma Hypoventilation Arrhythmias Electrolyte disorder
36 ph > 7.45 and PCO2 < 35 Caused by increased alveolar ventilation
37 Causes CNS etiologies? Pulmonary etiologies? Pregnancy Thyrotoxicosis Hypoxemia Salicylates Sepsis Mechanical ventilation Burns Hepatic failure Severe anemia Carbon monoxide poisoning
38 CNS etiologies Hyperventilation syndromes Anxiety Pain Tumor Trauma Infection Encephalopathy
39 Pulmonary etiologies Pulmonary edema Pneumonia ARDS Pulmonary embolism Asthma Secretions
40 What is treatment?
41 Correct underlying cause Anxiety Infection Fever Pain Hypovolemia
42 How can we estimate the quantity of metabolic acids?
43 What is anion gap? What is normal anion gap?
44 Anion gap = Na (Cl + HCO3) Principle of electroneutrality Total serum cations = total serum anions Na + UC = (Cl + HCO3) + UA UC = K + Ca + Mg UA = PO4 + SO4 + protein + organic acids Normal AG 12 meq/l
45 What is the relationship between hypoalbuminemia and anion gap?
46 Plasma proteins are the major source of UA. Decrease in plasma proteins decreases UA, Results in realative increase in measured anions. Results in decreased AG. The AG decreases 2.5 meq/l for every 1 g/dl decrease in albumin. Is the AG a sensitive marker of lactic acidosis?
47 What is the Delta AG?
48 Delta AG = Measured AG Normal AG
49 What is the pre-acidosis HCO3?
50 Pre-acidosis HCO3 = Delta AG + Measured HCO3
51 Hypoalbuminemia Renal anion excretion Paraproteinemia Hyponatremia Hyperosmolar states Hypercalcemia Hypermagnesemia Halide poisoning (Br, I; false elevation in Cl) Lithium intoxication (cation) Polymyxin B (cation)
52 Carbenicillin (anion) Exposure of sample to air
53 ph < 7.35 and normal PCO2 Causes Increased acids AG acidosis Decreased HCO3 normal AG acidosis Increased Cl normal AG acidosis
54 Increased acids - AG acidosis Lactic acidosis Renal failure (impaired excretion) Ketoacidosis Diabetic, alcoholic Rhabdomyolysis Toxins Salicylates, methanol, paraldehyde, ethylene glycol, propylene glycol, toluene
55 Decreased HCO3 normal AG acidosis Renal tubular acidosis Tubulointerstitial disease Acetazolamide therapy Hyperchloremic acidosis NaCl, NH4Cl, HCl, arginine Cl Renal failure Dilutional acidosis GI HCO3 loss Biliary or pancreatic drainage, diarrhea, fistula Ureteral diversions Adrenal insufficiency
56 Kidneys unable to account for normal acid production 4 Types
57 I. Proximal H+ secretion, normal GFR TX: NaHco3 II. Classical distal, normal GFR TX: NaHCO3 III. Buffer deficiency distal, Low GFR TX: NaHCO3 IV. Generalized distal, Low GFR TX: NaHCO3, K restriction, furosemide, fludrocortisone
58 What causes respiratory compensation? Rule of sevens?
59 H+ sensitive chemoreceptors located in the carotid body and in the brainstem modulates respiratory drive. Rule of sevens With ph decrease of 0.1 PCO2 decreases 7 mmhg
60 What is the expected PCO2 in respiratory compensation of metabolic acidosis?
61 Expected PCO2 = 1.5 x HCO3 + 8 ± 2
62 What is treatment?
63 Correct underlying cause Shock, DKA, toxin Administer NaHCO3 HCO3 deficit = Weight x 0.2 x (24 mm actual HCO3) 0.2 = 20% extracellular fluid
64 Adverse effects?
65 Neurologic Depressed consciousness Seizures Carpopedal spasms Hypoventilation Tissue oxygenation? Increases calcium binding to albumin - decreased ionized (free) calcium impairs myocardial contractility. Shifts oxyhemoglobin dissociation curve to the left, decreasing oxygen release in tissues.
66 Excessive use of NaHCO3 Increased Na load Shifts oxyhemoglobin distribution curve to the left compromising O2 delivery
67 ph > 7.45 and HCO3 > 26 Causes Cl-responsive? Cl-resistant?
68 Cl-responsive Urine Cl < 10 mm Reduced ECF volume (contraction) Vomiting Nasogastric suction Diuretics Diarrhea Posthypercapnia Carbenicillin Penicillin Villous adenoma
69 Cl-resistant Urine Cl > 20 mm Normal ECF volume Hyperaldosteronism Cushing s disease Glucocorticoids Refeeding alkalosis K depletion Excess alkali (HCO3, citrate, lactate) Mg depletion
70 What is treatment?
71 Correct underlying cause NG suction, diarrhea, diuretics Life-threatening alkalosis 0.1 N HCl infusion Restoration of intravascular volume 0.9 NaCl Correction of electrolyte abnormalities K and Mg Carbonic anhydrase inhibitor Acetazolamide (carbonic anhydrase inhibitor) Blocks HCO3- reabsorpiton in the proximal tubules.
72 In primary acid-base disorders: the process that caused the ph shift is the primary disorder compensation cannot overcorrect the ph derangement A mixed disorder is present when: Unexpected ph for a given PCO2 change Unexpected ph for a given HCO3- change
73 The bicarbonate-carbonic acid system is the primary intracellular buffering system.
74 False Important intracellular buffers include proteins and phosphates.
75 The ratio of the base bicarbonate to carbonic acid determines the extracellular fluid ph.
76 True
77 The functions of the extracellular buffering system are expressed in the Henderson- Hasselbalch equation: ph = pk + log ([H2CO3] / [HCO3-])
78 False ph = pk + log ([HCO3-] / [H2CO3])
79 A bicarbonate-carbonic acid ratio of 10:1 is associated with a normal ph (7.4).
80 False 20:1
81 Hyperkalemia is a frequent complication of respiratory alkalosis.
82 False In alkalosis, preferential excretion of potassium, rather than hydrogen ion, in exchange for sodium occurs at the level of the distal convoluted tubule.
83 Potassium restriction is an important adjunct in the treatment of respiratory alkalosis.
84 False Hypokalemia contributes to alkalosis because hydrogen ion rather than potassium is excreted for sodium resorption.
85 The most common cause of acid excess in the critical care patient is prolonged NG suction.
86 False Shock and lactic acidosis.
87 Restoration of blood pressure with vasopressors corrects the metabolic acidosis with circulatory failure.
88 False Volume replacement results in the restoration of circulation.
89 1. Does the patient have an acidemia or alkalemia? 2. Is the primary disturbance respiratory or metabolic? 3. Is the compensation appropriate? 4. Is the anion gap elevated? 5. Determine whether an additional disorder is present.
90 22M w/ DM develops a severe URI. Na = 128 K = 5.9 Cl = 94 HCO3 = 6 PCO2 = 15 PO2 = 102 ph = 7.19 Glucose = 324 A. What is the acid-base disorder?
91 22M w/ DM develops a severe URI. Na = 128 K = 5.9 Cl = 94 HCO3 = 6 PCO2 = 15 PO2 = 102 ph = 7.19 Glucose = 324 A. Is the patient acidemic or alkalemic? Acidemic, ph < 7.4
92 22M w/ DM develops a severe URI. Na = 128 K = 5.9 Cl = 94 HCO3 = 6 PCO2 = 15 PO2 = 102 ph = 7.19 Glucose = 324 B. Is the primary disorder respiratory or metabolic?
93 22M w/ DM develops a severe URI. Na = 128 K = 5.9 Cl = 94 HCO3 = 6 PCO2 = 15 PO2 = 102 ph = 7.19 Glucose = 324 B. Is the primary disorder respiratory or metabolic? Metabolic, PCO2 < 40
94 22M w/ DM develops a severe URI. Na = 128 K = 5.9 Cl = 94 HCO3 = 6 PCO2 = 15 PO2 = 102 ph = 7.19 Glucose = 324 C. What is this patient s anion gap?
95 22M w/ DM develops a severe URI. Na = 128 K = 5.9 Cl = 94 HCO3 = 6 PCO2 = 15 PO2 = 102 ph = 7.19 Glucose = 324 C. What is this patient s anion gap? AG = 128 (94 + 6) = 28 High AG metabolic acidosis
96 22M w/ DM develops a severe URI. Na = 128 K = 5.9 Cl = 94 HCO3 = 6 PCO2 = 15 PO2 = 102 ph = 7.19 Glucose = 324 D. Is there a mixed metabolic acidosis and alkalosis? Delta AG = = 16
97 22M w/ DM develops a severe URI. Na = 128 K = 5.9 Cl = 94 HCO3 = 6 PCO2 = 15 PO2 = 102 ph = 7.19 Glucose = 324 D. Is there a mixed metabolic acidosis and alkalosis? Pre-acidosis HCO3 = = 22 No underlying metabolic alkalosis
98 22M w/ DM develops a severe URI. Na = 128 K = 5.9 Cl = 94 HCO3 = 6 PCO2 = 15 PO2 = 102 ph = 7.19 Glucose = 324 E. Is the compensation for metabolic acidosis appropriate?
99 22M w/ DM develops a severe URI. Na = 128 K = 5.9 Cl = 94 HCO3 = 6 PCO2 = 15 PO2 = 102 ph = 7.19 Glucose = 324 E. Is the compensation for metabolic acidosis appropriate? Expected PCO2 = 1.5 x ± 2 Expected PCO2 = 17 ± 2 Simple compensated metabolic acidosis
100 What is the cause of this patient s increase in anion gap?
101 Diabetic ketoacidosis
102 47F w/ CRF & severe alcohol intoxication. Na = 134 K = 6.1 Cl = 112 HCO3 = 10 PCO2 = 30 PO2 = 52 ph = 7.10 Creatinine = 3.7 A. What is the acid-base disorder?
103 47F w/ CRF & severe alcohol intoxication. Na = 134 K = 6.1 Cl = 112 HCO3 = 10 PCO2 = 30 PO2 = 52 ph = 7.10 Creatinine = 3.7 A. Is the patient acidemic or alkalemic? Acidemic, ph < 7.4
104 47F w/ CRF & severe alcohol intoxication. Na = 134 K = 6.1 Cl = 112 HCO3 = 10 PCO2 = 30 PO2 = 52 ph = 7.10 Creatinine = 3.7 B. Is the primary disorder respiratory or metabolic?
105 47F w/ CRF & severe alcohol intoxication. Na = 134 K = 6.1 Cl = 112 HCO3 = 10 PCO2 = 30 PO2 = 52 ph = 7.10 Creatinine = 3.7 B. Is the primary disorder respiratory or metabolic? Metabolic, pco2 < 40
106 47F w/ CRF & severe alcohol intoxication. RR = 10. Na = 134 K = 6.1 Cl = 112 HCO3 = 10 PCO2 = 30 PO2 = 52 ph = 7.10 Creatinine = 3.7 C. What is the AG?
107 47F w/ CRF & severe alcohol intoxication. RR = 10. Na = 134 K = 6.1 Cl = 112 HCO3 = 10 PCO2 = 30 PO2 = 52 ph = 7.10 Creatinine = 3.7 C. What is the AG? AG = 134 ( ) = 12 Normal AG metabolic acidosis
108 47F w/ CRF & severe alcohol intoxication. RR = 10. Na = 134 K = 6.1 Cl = 112 HCO3 = 10 PCO2 = 30 PO2 = 52 ph = 7.10 Creatinine = 3.7 D. Is the compensation for the metabolic acidosis appropriate?
109 47F w/ CRF & severe alcohol intoxication. RR = 10. Na = 134 K = 6.1 Cl = 112 HCO3 = 10 PCO2 = 30 PO2 = 52 ph = 7.10 Creatinine = 3.7 D. Is the compensation for the metabolic acidosis appropriate? Expected PCO2 = 1.5 x ± 2 Expected PCO2 = 23 ± 2 Mixed metabolic and respiratory acidosis.
110 What could cause this patient s mixed metabolic and respiratory acidosis?
111 Metabolic acidosis may be related to CRF. Respiratory acidosis may be related to alcohol intoxication with reduced respiratory drive.
112 47F w/ binge drinking, N/V, fever. Na = 140 K = 2.9 Cl = 96 HCO3 = 18 PCO2 = 49 PO2 = 45 ph = 7.15 Glucose = 96 UA: 4+ ketones CXR: infiltrates A. What is the acid-base disorder?
113 47F w/ binge drinking, N/V, fever. Na = 140 K = 2.9 Cl = 96 HCO3 = 18 PCO2 = 49 PO2 = 45 ph = 7.15 Glucose = 96 UA: 4+ ketones CXR: infiltrates A. Is the patient acidemic or alkalemic? Acidemic, ph < 7.4
114 47F w/ binge drinking, N/V, fever. Na = 140 K = 2.9 Cl = 96 HCO3 = 18 PCO2 = 49 PO2 = 45 ph = 7.15 Glucose = 96 UA: 4+ ketones CXR: infiltrates B. Is the primary disorder respiratory or metabolic?
115 47F w/ binge drinking, N/V, fever. Na = 140 K = 2.9 Cl = 96 HCO3 = 18 PCO2 = 49 PO2 = 45 ph = 7.15 Glucose = 96 UA: 4+ ketones CXR: infiltrates B. Is the primary disorder respiratory or metabolic? Respiratory, PCO2 > 40
116 What is the expected HCO3 in metabolic compensation for acute respiratory acidosis?
117 Expected HCO3 = 24 + (PCO2-40) / 10
118 47F w/ binge drinking, N/V, fever. Na = 140 K = 2.9 Cl = 96 HCO3 = 18 PCO2 = 49 PO2 = 45 ph = 7.15 Glucose = 96 UA: 4+ ketones CXR: infiltrates C. Is the compensation for the respiratory acidosis appropriate?
119 47F w/ binge drinking, N/V, fever. Na = 140 K = 2.9 Cl = 96 HCO3 = 18 PCO2 = 49 PO2 = 45 ph = 7.15 Glucose = 96 UA: 4+ ketones CXR: infiltrates C. Is the compensation for the respiratory acidosis appropriate? Expected HCO3 = 24 + (49 40) / 10 Expected HCO3 = 25 Mixed respiratory and metabolic acidosis
120 47F w/ binge drinking, N/V, fever. Na = 140 K = 2.9 Cl = 96 HCO3 = 18 PCO2 = 49 PO2 = 45 ph = 7.15 Glucose = 96 UA: 4+ ketones CXR: infiltrates D. What is the AG?
121 47F w/ binge drinking, N/V, fever. Na = 140 K = 2.9 Cl = 96 HCO3 = 18 PCO2 = 49 PO2 = 45 ph = 7.15 Glucose = 96 UA: 4+ ketones CXR: infiltrates D. What is the AG? AG = 140 ( ) = 26 High AG metabolic acidosis
122 47F w/ binge drinking, N/V, fever. Na = 140 K = 2.9 Cl = 96 HCO3 = 18 PCO2 = 49 PO2 = 45 ph = 7.15 Glucose = 96 UA: 4+ ketones CXR: infiltrates E. Is there a mixed metabolic acidosis and alkalosis?
123 47F w/ binge drinking, N/V, fever. Na = 140 K = 2.9 Cl = 96 HCO3 = 18 PCO2 = 49 PO2 = 45 ph = 7.15 Glucose = 96 UA: 4+ ketones CXR: infiltrates E. Is there a mixed metabolic acidosis and alkalosis? Delta AG = = 14 Pre-acidosis HCO3 = = 32 Mixed respiratory acidosis, metabolic acidosis, and metabolic alkalosis.
124 What is the explanation for this patient s triple acid-base disturbance?
125 Chronic alcoholic Metabolic acidosis Alcaholic ketoacidosis UA w/ 4+ ketones Respiratory acidosis Pneumonia CXR w/ infiltrates Metabolic alkalosis Nausea / vomiting
PHTY 300 Wk 1 Lectures
PHTY 300 Wk 1 Lectures Arterial Blood Gas Components The test provides information on - Acid base balance - Oxygenation - Hemoglobin levels - Electrolyte blood glucose, lactate, renal function When initially
Essential Skills Course Acute Care Module. Respiratory Day 2 (Arterial Blood Gases) Pre course Workbook
Essential Skills Course Acute Care Module Respiratory Day 2 (Arterial Blood Gases) Pre course Workbook Acknowledgements This pre course workbook has been complied and updated with reference to the original
Ch 16: Respiratory System
Ch 16: Respiratory System SLOs: Explain how intrapulmonary pressures change during breathing Explain surface tension and the role of surfactant in respiratory physiology. Compare and contrast compliance
Chapter 17 The Respiratory System: Gas Exchange and Regulation of Breathing
Chapter 17 The Respiratory System: Gas Exchange and Regulation of Breathing Overview of Pulmonary Circulation o Diffusion of Gases o Exchange of Oxygen and Carbon Dioxide o Transport of Gases in the Blood
HCO - 3 H 2 CO 3 CO 2 + H H H + Breathing rate is regulated by blood ph and C02. CO2 and Bicarbonate act as a ph Buffer in the blood
Breathing rate is regulated by blood ph and C02 breathing reduces plasma [CO2]; plasma [CO2] increases breathing. When C02 levels are high, breating rate increases to blow off C02 In low C02 conditions,
- How do the carotid bodies sense arterial blood gases? o The carotid bodies weigh 25mg, yet they have their own artery. This means that they have
- How do the carotid bodies sense arterial blood gases? o The carotid bodies weigh 25mg, yet they have their own artery. This means that they have the highest blood flow of all organs, which makes them
Some major points on the Effects of Hypoxia
Some major points on the Effects of Hypoxia Source: Kings College London http://www.kcl.ac.uk/teares/gktvc/vc/dental/year1/lectures/rbmsmajorpoints/effectsofhypoxia.htm Cells obtain their energy from oxygen.
P215 Respiratory System, Part 2
P15 Respiratory System, Part Gas Exchange Oxygen and Carbon Dioxide constant need for oxygen constant production of carbon dioxide exchange (and movement) lung alveoli pulmonary arteries pulmonary capillaries
Rodney Shandukani 14/03/2012
Rodney Shandukani 14/03/2012 OXYGEN THERAPY Aerobic metabolism accounts for 90% of Oxygen consumption by tissues. generates ATP by oxidative phosphorylation. Oxygen cascade: Oxygen exerts a partial pressure,
GASP! OXYGENATION, VENTILATION, AND BLOOD GAS MANAGEMENT IN ANESTHETIZED PATIENTS Kim Spelts, BS, CVT, VTS
GASP! OXYGENATION, VENTILATION, AND BLOOD GAS MANAGEMENT IN ANESTHETIZED PATIENTS Kim Spelts, BS, CVT, VTS ANESTHESIA Providing adequate oxygen delivery and maintaining tissue perfusion is key in maintaining
Respiratory System Study Guide, Chapter 16
Part I. Clinical Applications Name: Respiratory System Study Guide, Chapter 16 Lab Day/Time: 1. A person with ketoacidosis may hyperventilate. Explain why this occurs, and explain why this hyperventilation
CHAPTER 6. Oxygen Transport. Copyright 2008 Thomson Delmar Learning
CHAPTER 6 Oxygen Transport Normal Blood Gas Value Ranges Table 6-1 OXYGEN TRANSPORT Oxygen Dissolved in the Blood Plasma Dissolve means that the gas maintains its precise molecular structure About.003
Exam Key. NROSCI/BIOSC 1070 and MSNBIO 2070 Exam # 2 October 28, 2016 Total POINTS: % of grade in class
NROSCI/BIOSC 1070 and MSNBIO 2070 Exam # 2 October 28, 2016 Total POINTS: 100 20% of grade in class 1) An arterial blood sample for a patient at sea level is obtained, and the following physiological values
Physiology Unit 4 RESPIRATORY PHYSIOLOGY
Physiology Unit 4 RESPIRATORY PHYSIOLOGY In Physiology Today Respiration External respiration ventilation gas exchange Internal respiration cellular respiration gas exchange Respiratory Cycle Inspiration
Section Three Gas transport
Section Three Gas transport Lecture 6: Oxygen transport in blood. Carbon dioxide in blood. Objectives: i. To describe the carriage of O2 in blood. ii. iii. iv. To explain the oxyhemoglobin dissociation
Respiration (revised 2006) Pulmonary Mechanics
Respiration (revised 2006) Pulmonary Mechanics PUL 1. Diagram how pleural pressure, alveolar pressure, airflow, and lung volume change during a normal quiet breathing cycle. Identify on the figure the
NROSCI/BIOSC 1070 and MSNBIO 2070 Exam # 2 October 28, 2016 Total POINTS: % of grade in class
NROSCI/BIOSC 1070 and MSNBIO 2070 Exam # 2 October 28, 2016 Total POINTS: 100 20% of grade in class 1) An arterial blood sample for a patient at sea level is obtained, and the following physiological values
CARBON DIOXIDE METABOLISM AND CAPNOGRAPHY
CARBON DIOXIDE METABOLISM AND CAPNOGRAPHY CARBON DIOXIDE METABOLISM Production Transportation Elimination Carbon Dioxide production CO 2 is the metabolite produced by the utilization by cells of oxygen
Respiratory Medicine. A-A Gradient & Alveolar Gas Equation Laboratory Diagnostics. Alveolar Gas Equation. See online here
Respiratory Medicine A-A Gradient & Alveolar Gas Equation Laboratory Diagnostics See online here Alveolar gas equation helps to calculate the partial pressure of oxygen in alveoli and A-a gradient is the
Chapter 23. Gas Exchange and Transportation
Chapter 23 Gas Exchange and Transportation What is air? Mixture of gasses 78.6 % nitrogen 20.9% oxygen 0.04% carbon dioxide 0 4% water vapor depending on temperature and humidity and minor gases argon,
Alveolus and Respiratory Membrane
Alveolus and Respiratory Membrane thin membrane where gas exchange occurs in the lungs, simple squamous epithelium (Squamous cells have the appearance of thin, flat plates. They fit closely together in
Chapter 23. Gas Exchange and Transportation
Chapter 23 Gas Exchange and Transportation What is air? Mixture of gasses 78.6 % nitrogen 20.9% oxygen 0.04% carbon dioxide 0 4% water vapor depending on temperature and humidity other minor gases argon,
Gas exchange. Tissue cells CO2 CO 2 O 2. Pulmonary capillary. Tissue capillaries
Gas exchange Pulmonary gas exchange Tissue gas exchange CO 2 O 2 O 2 Tissue cells CO2 CO 2 Pulmonary capillary O 2 O 2 CO 2 Tissue capillaries Physical principles of gas exchange Diffusion: continuous
Respiratory Signs: Tachypnea (RR>30/min), Desaturation, Shallow breathing, Use of accessory muscles Breathing sound: Wheezing, Rhonchi, Crepitation.
Respiratory Signs: Tachypnea (RR>30/min), Desaturation, Shallow breathing, Use of accessory muscles Breathing sound: Wheezing, Rhonchi, Crepitation. Paradoxical breathing Hyper-resonance on percussion:
Respiratory physiology II.
Respiratory physiology II. Learning objectives: 29. Pulmonary gas exchange. 30. Oxygen transport in the blood. 31. Carbon-dioxide transport in the blood. 1 Pulmonary gas exchange The transport mechanism
Unit II Problem 4 Physiology: Diffusion of Gases and Pulmonary Circulation
Unit II Problem 4 Physiology: Diffusion of Gases and Pulmonary Circulation - Physical principles of gases: Pressure of a gas is caused by the movement of its molecules against a surface (more concentration
RESPIRATION III SEMESTER BOTANY MODULE II
III SEMESTER BOTANY MODULE II RESPIRATION Lung Capacities and Volumes Tidal volume (TV) air that moves into and out of the lungs with each breath (approximately 500 ml) Inspiratory reserve volume (IRV)
Oxygen and Carbon dioxide Transport. Dr. Laila Al-Dokhi
Oxygen and Carbon dioxide Transport Dr. Laila Al-Dokhi Objectives 1. Understand the forms of oxygen transport in the blood, the importance of each. 2. Differentiate between O2 capacity, O2 content and
Respiratory Lecture Test Questions Set 3
Respiratory Lecture Test Questions Set 3 1. The pressure of a gas: a. is inversely proportional to its volume b. is unaffected by temperature changes c. is directly proportional to its volume d. does not
RESPIRATORY REGULATION DURING EXERCISE
RESPIRATORY REGULATION DURING EXERCISE Respiration Respiration delivery of oxygen to and removal of carbon dioxide from the tissue External respiration ventilation and exchange of gases in the lung Internal
Chapter 13 The Respiratory System
Chapter 13 The Respiratory System by Dr. Jay M. Templin Brooks/Cole - Thomson Learning Atmosphere Tissue cell External respiration Alveoli of lungs 1 Ventilation or gas exchange between the atmosphere
Hyperbaric Oxygen Therapy
Hyperbaric Oxygen Therapy WWW.RN.ORG Reviewed September 2017, Expires September 2019 Provider Information and Specifics available on our Website Unauthorized Distribution Prohibited 2017 RN.ORG, S.A.,
Some Clinical Aspects on the Blood Gas Physiology
Special Article* Some Clinical Aspects on the Blood Gas Physiology Hiroshi Sasamoto Professor and Chairman, Department of Medicine, School of Medicine Keio University, Shinjuku, Tokyo Recent trends on
AIIMS, New Delhi. Dr. K. K. Deepak, Prof. & HOD, Physiology AIIMS, New Delhi Dr. Geetanjali Bade, Asst. Professor AIIMS, New Delhi
Course : PG Pathshala-Biophysics Paper 13 : Physiological Biophysics Module 17 : Gas transport and pulmonary circulation Principal Investigator: Co-Principal Investigator: Paper Coordinator: Content Writer:
Gases and Respiration. Respiration Overview I
Respiration Overview I Respiration Overview II Gas Laws Equation of State: PV = nrt Same volumes of different gases have same # of molecules BTPS: body temp, atmospheric pressure, saturated ATPS: ambient
Question 1: Define vital capacity. What is its significance? Vital capacity is the maximum volume of air that can be exhaled after a maximum inspiration. It is about 3.5 4.5 litres in the human body. It
Lung Volumes and Capacities
Lung Volumes and Capacities Normally the volume of air entering the lungs during a single inspiration is approximately equal to the volume leaving on the subsequent expiration and is called the tidal volume.
49 Arterial Blood Gases
49 Arterial Blood Gases E. P. TRULOCK, III Definition Arterial blood gases (ABGs) is a collective term applied to three separate measurements-ph, Pco 2, and Poe -generally made together to evaluate acid-base
Blood gas adventures at various altitudes. Friedrich Luft Experimental and Clinical Research Center, Berlin-Buch
Blood gas adventures at various altitudes Friedrich Luft Experimental and Clinical Research Center, Berlin-Buch Mount Everest 8848 M Any point in bird watching here? Respiration is gas exchange: the process
Recitation question # 05
Recitation and Lab # 05 The goal of this recitations / labs is to review material related to the CV and respiratory lectures for the second test of this course. Info required to answer this recitation
EMS INTER-FACILITY TRANSPORT WITH MECHANICAL VENTILATOR COURSE OBJECTIVES
GENERAL PROVISIONS: EMS INTER-FACILITY TRANSPORT WITH MECHANICAL VENTILATOR COURSE OBJECTIVES Individuals providing Inter-facility transport with Mechanical Ventilator must have successfully completed
Office. Hypoxia. Or this. Or even this. Hypoxia E-1. COL Brian W. Smalley DO, MSPH, CPE
Hypoxia Office COL Brian W. Smalley DO, MSPH, CPE Or this Or even this Hypoxia State of oxygen deficiency in the blood cells and tissues sufficient to cause impairment of function 4 Types Hypoxic Hypemic
VENTILATION AND PERFUSION IN HEALTH AND DISEASE. Dr.HARIPRASAD VS
VENTILATION AND PERFUSION IN HEALTH AND DISEASE Dr.HARIPRASAD VS Ventilation Total ventilation - total rate of air flow in and out of the lung during normal tidal breathing. Alveolar ventilation -represents
Chapter 13 The Respiratory System
VI edit Pag 451-499 Chapter 13 The Respiratory System V edit. Pag 459-509 Tissue cell Alveoli of lungs Atmosphere 1 External respiration Ventilation or gas exchange between the atmosphere and air sacs
Respiratory Physiology. Adeyomoye O.I
Respiratory Physiology By Adeyomoye O.I Outline Introduction Hypoxia Dyspnea Control of breathing Ventilation/perfusion ratios Respiratory/barometric changes in exercise Intra-pulmonary & intra-pleural
Section 01: The Pulmonary System
Section 01: The Pulmonary System Chapter 12 Pulmonary Structure and Function Chapter 13 Gas Exchange and Transport Chapter 14 Dynamics of Pulmonary Ventilation HPHE 6710 Exercise Physiology II Dr. Cheatham
Chapter 22 The Respiratory System
Chapter 22 The Respiratory System 1 Respiration Pulmonary ventilation (breathing): movement of air into and out of the lungs External respiration: O 2 and CO 2 exchange between the lungs and the blood
Ch. 12: Respiratory Physiology
Ch. 12: Respiratory Physiology Objectives: 1. Review respiratory anatomy. 2. Understand mechanics of breathing. 3. Learn lung volumes & respiratory vocabulary 4. Learn gas exchange at lungs & at body tissues
Respiratory System Physiology. Dr. Vedat Evren
Respiratory System Physiology Dr. Vedat Evren Respiration Processes involved in oxygen transport from the atmosphere to the body tissues and the release and transportation of carbon dioxide produced in
Hyperbaric Oxygen Therapy
1 RSPT 1410 Medical Gas Therapy Part 2: Wilkins: Chapter 38; p. 891-894 Cairo: Chapter 3, p. 78-81 2 Definitions Hyperbaric oxygen (HBO) therapy is the therapeutic use of oxygen at pressures greater than
system. and then into the tissues. Diffusion of wastes such as Carbon Dioxide from tissues into blood and out of blood into the lungs.
Respiratory System 1.Exchange Why do of we gases breathe? into the Think blood of all and the tissues. reasons Diffusion why we of Oxygen need a respiratory into blood from the lungs system. and then into
PICU Resident Self-Study Tutorial The Basic Physics of Oxygen Transport. I was told that there would be no math!
Physiology of Oxygen Transport PICU Resident Self-Study Tutorial I was told that there would be no math! INTRODUCTION Christopher Carroll, MD Although cells rely on oxygen for aerobic metabolism and viability,
GAS EXCHANGE & PHYSIOLOGY
GAS EXCHANGE & PHYSIOLOGY Atmospheric Pressure Intra-Alveolar Pressure Inspiration 760 mm HG at Sea Level (= 1 atm) Pressure due to gases (N2, O2, CO2, Misc.) Pressure inside the alveolus (air sac) Phrenic
Lung Volumes and Ventilation
Respiratory System ssrisuma@rics.bwh.harvard.edu Lung Volumes and Ventilation Minute ventilation Volume of an inspired or expired air per minute = tidal volume (V T ) x respiratory rate Dead space ventilation
Module Two. Objectives: Objectives cont. Objectives cont. Objectives cont.
Transition to the New National EMS Education Standards: EMT-B B to EMT Module Two Objectives: Upon completion, each participant will do the following to a degree of accuracy that meets the Ntl EMS Education
Physiology of Respiration
Physiology of Respiration External Respiration = pulmonary ventilation breathing involves 2 processes: inspiration expiration Inspiration an active process involves contraction of diaphragm innervated
Respiration - Human 1
Respiration - Human 1 At the end of the lectures on respiration you should be able to, 1. Describe events in the respiratory processes 2. Discuss the mechanism of lung ventilation in human 3. Discuss the
Respiration. The resspiratory system
Respiration The resspiratory system The Alveoli The lungs have about 300 million alveoli, with a total crosssec onal area of 50 70 m2.. Each alveolar sac is surrounded by blood capillaries. The walls of
Chapter 16 Respiration. Respiration. Steps in Respiration. Functions of the respiratory system
Chapter 16 Respiration Functions of the respiratory system Respiration The term respiration includes 3 separate functions: Ventilation: Breathing. Gas exchange: Occurs between air and blood in the lungs.
2. State the volume of air remaining in the lungs after a normal breathing.
CLASS XI BIOLOGY Breathing And Exchange of Gases 1. Define vital capacity. What is its significance? Answer: Vital Capacity (VC): The maximum volume of air a person can breathe in after a forced expiration.
RESPIRATORY PHYSIOLOGY. Anaesthesiology Block 18 (GNK 586) Prof Pierre Fourie
RESPIRATORY PHYSIOLOGY Anaesthesiology Block 18 (GNK 586) Prof Pierre Fourie Outline Ventilation Diffusion Perfusion Ventilation-Perfusion relationship Work of breathing Control of Ventilation 2 This image
82 Respiratory Tract NOTES
82 Respiratory Tract NOTES RESPIRATORY TRACT The respiratory tract conducts air to the lungs where gaseous exchange occurs. It is separated into air-conducting and respiratory (where gas exchange occurs)
Understanding Arterial Blood Gases (ABGs)
NYSNA Continuing Education The New York State Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. This
Smoke inhalation 2/1/2013. Disclosures. Smoke Inhalation. Case Study
Disclosures Smoke inhalation Craig Smollin MD Associate Medical Director, California Poison Control Center, SF Assistant Professor of Emergency Medicine University of California, San Francisco No financial
Lesson 9.1: The Importance of an Organ Delivery System
Lesson 9.1: The Importance of an Organ Delivery System Animals require a continuous supply of oxygen (O 2 ) for cellular respiration, and they must expel carbon dioxide (CO 2 ), the waste product of this
1 out of every 5,555 of drivers dies in car accidents 1 out of every 7692 pregnant women die from complications 1 out of every 116,666 skydives ended
1 out of every 5,555 of drivers dies in car accidents 1 out of every 7692 pregnant women die from complications 1 out of every 116,666 skydives ended in a fatality in 2000 1 out of every 126,626 marathon
Author: Thomas Sisson, MD, 2009
Author: Thomas Sisson, MD, 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Non-commercial Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/
Section Two Diffusion of gases
Section Two Diffusion of gases Lecture 5: Partial pressure and the composition of gasses in air. Factors affecting diffusion of gases. Ventilation perfusion ratio effect on alveolar gas concentration.
Pco2 *20times = 0.6, 2.4, so the co2 carried in the arterial blood in dissolved form is more than the o2 because of its solubility.
Physiology, sheet #9 Oxygen, is first dissolved in the plasma and the cytosol of the rbc, we have around blood constitutes 7% of our body weight, oxygen, in the capillaries is present in the rbc s and
Gas Exchange Respiratory Systems
alveoli gills Gas Exchange Respiratory Systems elephant seals 2008-2009 Why do we need a respiratory system? respiration for respiration Need O 2 in for aerobic cellular respiration make ATP Need CO 2
Author of: The Six-Pack Diet Plan: The Secrets to Getting Lean Abs and a Rock-Hard Body Permanently
Interview with Rehan Jalali, President, Supplement Research Foundation Author of: The Six-Pack Diet Plan: The Secrets to Getting Lean Abs and a Rock-Hard Body Permanently Background Information: According
Chapter 4: Ventilation Test Bank MULTIPLE CHOICE
Instant download and all chapters Test Bank Respiratory Care Anatomy and Physiology Foundations for Clinical Practice 3rd Edition Will Beachey https://testbanklab.com/download/test-bank-respiratory-care-anatomy-physiologyfoundations-clinical-practice-3rd-edition-will-beachey/
Breathing: The normal rate is about 14 to 20 times a minute. Taking in of air is called Inspiration and the forcing out of air is called Expiration.
Biology 12 Respiration Divisions of Respiration Breathing: entrance and exit of air into and out of the lungs External Respiration: exchange of gases(o2 and CO2) between air (in alveoli) and blood Internal
GOOD BREATHING, BAD BREATHING Breathing is behavior, a unique behavior that regulates body chemistry, ph. Peter M. Litchfield, Ph.D.
GOOD BREATHING, BAD BREATHING Breathing is behavior, a unique behavior that regulates body chemistry, ph. Peter M. Litchfield, Ph.D., May 2006 Breathing is behavior, a behavior that regulates acid-base
Smoke inhalation. Disclosures. Smoke Inhalation
Disclosures Smoke inhalation Craig Smollin MD Associate Medical Director, California Poison Control Center, SF Assistant Professor of Emergency Medicine University of California, San Francisco No financial
Point-of-Care Testing: A Cardiovascular Perfusionist s Perspective
Point-of-Care Testing: A Cardiovascular Perfusionist s Perspective Cory M. Alwardt, PhD, CCP Chief Perfusionist/ECMO Coordinator Assistant Professor of Surgery Mayo Clinic Hospital, Phoenix alwardt.cory@mayo.edu
IV. FROM AQUATIC TO ATMOSPHERIC BREATHING: THE TRACHEA & THE LUNG
GAS EXCHANGE AND TRANSPORT I. INTRODUCTION: Heterotrophs oxidize carbon cmpds using O 2 to generate CO 2 & H 2 O. This is cellular respiration II. HOW GAS ENTERS A CELL A. The composition of air: 79% N
Human Biology Respiratory System
Human Biology Respiratory System Respiratory System Responsible for process of breathing Works in cooperation with Circulatory system Three types: 1. Internal Respiration 2. External Respiration 3. Cellular
AP Biology. Gas Exchange Respiratory Systems. Gas exchange. Why do we need a respiratory system? Optimizing gas exchange. Gas exchange in many forms
alveoli Gas Exchange Respiratory Systems gills elephant seals 2008-2009 Why do we need a respiratory system? Need O 2 in food respiration for respiration for aerobic cellular respiration make ATP Need
Ch. 12: Respiratory Physiology
Ch. 12: Respiratory Physiology Objectives: 1. Review respiratory anatomy. 2. Understand mechanics of breathing, gas pressure vocabulary, and the principles of surface tension, compliance, and recoil. 3.
Respiratory system & exercise. Dr. Rehab F Gwada
Respiratory system & exercise Dr. Rehab F Gwada Objectives of lecture Outline the major anatomical components & important functions of the respiratory system. Describe the mechanics of ventilation. List
RESPIRATORY GAS EXCHANGE
RESPIRATORY GAS EXCHANGE Alveolar PO 2 = 105 mmhg; Pulmonary artery PO 2 = 40 mmhg PO 2 gradient across respiratory membrane 65 mmhg (105 mmhg 40 mmhg) Results in pulmonary vein PO 2 ~100 mmhg Partial
Respiratory System. Prepared by: Dorota Marczuk-Krynicka, MD, PhD
Respiratory System Prepared by: Dorota Marczuk-Krynicka, MD, PhD Lungs: Ventilation Perfusion Gas Exchange - Diffusion 1. Airways and Airway Resistance (AWR) 2. Mechanics of Breathing and Lung (Elastic)
ph is defined as the hydrogen ion concentration and its activity is measured by ion-selective electrode potentiometry.
Subject Blood Gas istat Index Number Lab-8648 Section Laboratory Subsection Regional/Affiliate Category Departmental Contact Rachel Blum Last Revised 9/13/2017 References Required document for accreditation
Accumulation of EEV Barotrauma Affect hemodynamic Hypoxemia Hypercapnia Increase WOB Unable to trigger MV
Complicated cases during mechanical ventilation Pongdhep Theerawit M.D. Pulmonary and Critical Care Division Ramathibodi Hospital Case I Presentation Male COPD 50 YO, respiratory failure, on mechanical
alveoli Chapter 42. Gas Exchange elephant seals gills AP Biology
alveoli Chapter 42. Gas Exchange gills elephant seals Gas exchange O 2 & CO 2 exchange exchange between environment & cells provides O 2 for aerobic cellular respiration need moist membrane need high
OXYGEN PHYSIOLOGY AND PULSE OXIMETRY
Louis Al-Saleem 5/4/13 OXYGEN PHYSIOLOGY AND PULSE OXIMETRY A very experienced senior resuscitation nurse approached me at work recently, and asked if there was any circulating academic evidence about
CUSTODIOL HTK Solution. Preserve and Protect Organs for Transplantation
CUSTODIOL HTK Solution Preserve and Protect Organs for Transplantation w w w. m e t h a p h a r m. c o m CUSTODIOL HTK Solution Composition 1000 ml perfusion solution contain: 0.8766 g sodium chloride
The Safe Use and Prescription of Medical Oxygen. Luke Howard
The Safe Use and Prescription of Medical Oxygen Luke Howard Consultant Respiratory Physician Imperial College Healthcare NHS Trust & Co-Chair, British Thoracic Society Emergency Oxygen Guideline Group
SEP-1 Additional Notes for Abstraction for Version 5.0b
SEP-1 Additional Notes for Abstraction for Version 5.0b Data Element Administrative Contraindication to Care Blood Culture Collection Date Blood Culture Collection Time Broad Spectrum or Other Antibiotic
Learning Objectives 9/12/2012. Chapter 30. Environmental Emergencies. Chapter Goal
Chapter 30 Environmental Emergencies Chapter Goal Use assessment findings to formulate field impression & implement treatment plan for patients with environmentally induced or exacerbated emergencies Define
Welcome to Alpharetta Wellness Clinic Mild Hyperbaric Oxygen Therapy! We are committed to providing quality and affordable therapy to our clients!
Welcome to Alpharetta Wellness Clinic Mild Hyperbaric Oxygen Therapy! Below you will find many answers to your questions about Mild Hyperbaric Oxygen Therapy. If you do not find the answers please feel
Paramedic Resource Manual
ONTARIO BASE HOSPITAL GROUP Paramedic Resource Manual OXYGEN DELIVERY SECTION TWO 2005 Update by Ontario Base Hospital Group Education Subcommittee Copyright 2005, Ministry of Health and Long Term Care
AP Biology. Chapter 42. Gas Exchange. Optimizing gas exchange. Gas exchange. Gas exchange in many forms. Evolution of gas exchange structures
alveoli Chapter 42. Gas Exchange gills elephant seals Gas exchange & C exchange exchange between environment & cells provides for aerobic cellular respiration need moist membrane need high surface area
660 mm Hg (normal, 100 mm Hg, room air) Paco, (arterial Pc02) 36 mm Hg (normal, 40 mm Hg) % saturation 50% (normal, 95%-100%)
148 PHYSIOLOGY CASES AND PROBLEMS Case 26 Carbon Monoxide Poisoning Herman Neiswander is a 65-year-old retired landscape architect in northern Wisconsin. One cold January morning, he decided to warm his
VENTILATORS PURPOSE OBJECTIVES
VENTILATORS PURPOSE To familiarize and acquaint the transfer Paramedic with the skills and knowledge necessary to adequately maintain a ventilator in the interfacility transfer environment. COGNITIVE OBJECTIVES
b. Provide consultation service to physicians referring patients. c. Participate in weekly wound care clinic and biweekly diving medicine clinic.
Curriculum: 1. Required clinical activities: a. Participate in HBO 2 clinical operations by monitoring daily treatment sessions and emergency on-call treatments at least 4 days/week, b. Provide consultation
Physical Chemistry of Gases: Gas Exchange Linda Costanzo, Ph.D.
Physical Chemistry of Gases: Gas Exchange Linda Costanzo, Ph.D. OBJECTIVES: After studying this lecture, the student should understand: 1. Application of the gas laws to pulmonary physiology. 2. How to
Transport of Oxygen and Carbon Dioxide in Blood and Tissue Fluids
C H A P T E R 4 Transport of Oxygen and Carbon Dioxide in Blood and Tissue Fluids Once oxygen has diffused from the alveoli into the pulmonary blood, it is transported to the peripheral tissue capillaries
Aerospace Physiology MARYLAND. Cardiopulmonary Physiology. Musculoskeletal Vestibular Neurological. Respiratory Cardiovascular U N I V E R S I T Y O F
Cardiopulmonary Physiology Respiratory Cardiovascular Musculoskeletal Vestibular Neurological 2003 David L. Akin - All rights reserved http://spacecraft.ssl.umd.edu The Human Circulatory System Lung Measurements