The document discusses respiratory failure, its causes, types, and mechanisms. Respiratory failure occurs when the respiratory system cannot perform gas exchange of oxygenation and/or carbon dioxide elimination. It can be caused by issues in the central nervous system, peripheral nervous system, neuromuscular system, thorax, airways, lungs, cardiovascular system, blood, or cells/tissues. There are two main types: type 1 involves hypoxemia without hypercapnia, and type 2 involves both hypoxemia and hypercapnia. Mechanisms contributing to respiratory failure include ventilation-perfusion mismatching, shunting, diffusion limitations, and hypoventilation.
The document discusses the microscopic structure of the alveolar wall and lung anatomy. It describes the thin barrier between the alveolar air spaces and capillaries that allows for efficient gas exchange. It also mentions there are approximately 30 million alveoli in the human lung. Furthermore, it discusses factors that can disrupt the ventilation/perfusion ratio in the lungs such as areas with low oxygen and high carbon dioxide levels or reduced blood flow from embolisms.
The respiratory control system comprises sensors in the brain and carotid bodies that detect levels of oxygen, carbon dioxide, hydrogen ions, and pH in the blood and cerebrospinal fluid. This information is sent to the central controller in the brain which coordinates the diaphragm and respiratory muscles as effectors to regulate breathing. Central chemoreceptors in the medulla are directly stimulated by increased carbon dioxide and hydrogen ions in the cerebrospinal fluid, triggering faster breathing. Peripheral chemoreceptors in the carotid and aortic bodies also sense decreased oxygen and increased carbon dioxide in the blood to stimulate the respiratory control center.
This document discusses the physiology of deep sea diving. It describes two types of underwater diving: ambient diving where the diver is exposed to water pressure, and diving in a pressurized vehicle. It outlines the challenges of diving including biological effects of high gas pressures, physical problems caused by pressure changes, and drowning. Specifically, it discusses nitrogen narcosis, oxygen toxicity, carbon dioxide toxicity, helium effects, decompression sickness, changes in gas density and airflow resistance with depth, barotrauma and air embolisms.
Oxygen is essential for life and deprivation leads most rapidly to death. Oxygen therapy is useful for diseases that interfere with normal oxygenation. Hypoxia refers to insufficient oxygen in tissues and can be caused by problems delivering oxygen to the lungs, abnormal lung function, or inadequate oxygen delivery to tissues. Effects of hypoxia include increased respiration, increased heart rate and blood flow, impaired brain function, and cellular metabolic changes. Oxygen inhalation can reverse hypoxia but excessive amounts can cause toxicity, especially in the central nervous system and lungs.
This document discusses the physical laws governing gas behavior and their application to physiology and pulmonary ventilation. It covers Boyle's law relating gas pressure and volume, Charles' law relating gas volume and temperature, Gay-Lussac's law relating gas pressure and temperature, Dalton's law of partial pressures, and Laplace's law relating alveolar pressure and size. These laws help explain how changes in intrathoracic pressure allow for inhalation and exhalation during breathing. The document also provides sample questions for students to analyze how these laws relate to various pulmonary and physiological processes and phenomena.
Exercise increases ventilation through both deeper breathing (increased tidal volume) and faster breathing (increased respiratory rate). The lungs and heart work together to supply oxygen to working muscles and remove carbon dioxide. During intense exercise, ventilation increases mainly through faster breathing since deeper breaths are not sufficient to provide enough oxygen.
The document discusses control of breathing and neonatal respiratory diseases. It covers the respiratory center in the medulla, chemoreceptors, respiratory reflexes, lung mechanics, definitions of terms like tidal volume and compliance. It then summarizes several neonatal respiratory diseases like hyaline membrane disease, transient tachypnea of the newborn, pneumothorax, pulmonary interstitial emphysema, persistent pulmonary hypertension of the newborn, meconium aspiration syndrome, and chronic lung disease. For each disease it discusses clinical features, etiology, treatments and methods of prevention.
The document discusses the key components and functions of the respiratory system. It describes that respiration involves the exchange of oxygen and carbon dioxide through ventilation, perfusion, diffusion, and regulation. The respiratory tract includes the nose, pharynx, larynx, trachea, and bronchi which filter, warm, and humidify air. Gas exchange occurs in the alveoli, which are lined with surfactant to prevent their collapse and allow for efficient oxygen and carbon dioxide transfer between blood and air. The nervous system regulates breathing through the medulla oblongata and stimulates coughing. Common respiratory disorders include infections, allergies, and obstructive diseases like asthma or COPD.
The document discusses the microscopic structure of the alveolar wall and lung anatomy. It describes the thin barrier between the alveolar air spaces and capillaries that allows for efficient gas exchange. It also mentions there are approximately 30 million alveoli in the human lung. Furthermore, it discusses factors that can disrupt the ventilation/perfusion ratio in the lungs such as areas with low oxygen and high carbon dioxide levels or reduced blood flow from embolisms.
The respiratory control system comprises sensors in the brain and carotid bodies that detect levels of oxygen, carbon dioxide, hydrogen ions, and pH in the blood and cerebrospinal fluid. This information is sent to the central controller in the brain which coordinates the diaphragm and respiratory muscles as effectors to regulate breathing. Central chemoreceptors in the medulla are directly stimulated by increased carbon dioxide and hydrogen ions in the cerebrospinal fluid, triggering faster breathing. Peripheral chemoreceptors in the carotid and aortic bodies also sense decreased oxygen and increased carbon dioxide in the blood to stimulate the respiratory control center.
This document discusses the physiology of deep sea diving. It describes two types of underwater diving: ambient diving where the diver is exposed to water pressure, and diving in a pressurized vehicle. It outlines the challenges of diving including biological effects of high gas pressures, physical problems caused by pressure changes, and drowning. Specifically, it discusses nitrogen narcosis, oxygen toxicity, carbon dioxide toxicity, helium effects, decompression sickness, changes in gas density and airflow resistance with depth, barotrauma and air embolisms.
Oxygen is essential for life and deprivation leads most rapidly to death. Oxygen therapy is useful for diseases that interfere with normal oxygenation. Hypoxia refers to insufficient oxygen in tissues and can be caused by problems delivering oxygen to the lungs, abnormal lung function, or inadequate oxygen delivery to tissues. Effects of hypoxia include increased respiration, increased heart rate and blood flow, impaired brain function, and cellular metabolic changes. Oxygen inhalation can reverse hypoxia but excessive amounts can cause toxicity, especially in the central nervous system and lungs.
This document discusses the physical laws governing gas behavior and their application to physiology and pulmonary ventilation. It covers Boyle's law relating gas pressure and volume, Charles' law relating gas volume and temperature, Gay-Lussac's law relating gas pressure and temperature, Dalton's law of partial pressures, and Laplace's law relating alveolar pressure and size. These laws help explain how changes in intrathoracic pressure allow for inhalation and exhalation during breathing. The document also provides sample questions for students to analyze how these laws relate to various pulmonary and physiological processes and phenomena.
Exercise increases ventilation through both deeper breathing (increased tidal volume) and faster breathing (increased respiratory rate). The lungs and heart work together to supply oxygen to working muscles and remove carbon dioxide. During intense exercise, ventilation increases mainly through faster breathing since deeper breaths are not sufficient to provide enough oxygen.
The document discusses control of breathing and neonatal respiratory diseases. It covers the respiratory center in the medulla, chemoreceptors, respiratory reflexes, lung mechanics, definitions of terms like tidal volume and compliance. It then summarizes several neonatal respiratory diseases like hyaline membrane disease, transient tachypnea of the newborn, pneumothorax, pulmonary interstitial emphysema, persistent pulmonary hypertension of the newborn, meconium aspiration syndrome, and chronic lung disease. For each disease it discusses clinical features, etiology, treatments and methods of prevention.
The document discusses the key components and functions of the respiratory system. It describes that respiration involves the exchange of oxygen and carbon dioxide through ventilation, perfusion, diffusion, and regulation. The respiratory tract includes the nose, pharynx, larynx, trachea, and bronchi which filter, warm, and humidify air. Gas exchange occurs in the alveoli, which are lined with surfactant to prevent their collapse and allow for efficient oxygen and carbon dioxide transfer between blood and air. The nervous system regulates breathing through the medulla oblongata and stimulates coughing. Common respiratory disorders include infections, allergies, and obstructive diseases like asthma or COPD.
This document discusses non-malignant lymphocyte disorders, including both acquired and congenital types. Acquired disorders are quantitative in nature and include infectious mononucleosis caused by the Epstein-Barr virus and toxoplasmosis. Infectious mononucleosis commonly affects young adults and is characterized by lymphocytosis, reactive lymphocytes, and elevated liver enzymes. Toxoplasmosis is transmitted through undercooked meat or contact with cat feces and poses risks to unborn children.
Contents :
Age group for diseases
Dentition
Developmental milestones
Gestational weeks
Important days
Important duration
Important years
Infectious diseases and incubation period
Paranasal sinuses
Period of communicability
Primitive reflexes
Psychosexual stages of development
Other important timelines
Best time for surgery
Trimesters
For more details, visit www.medpgnotes.com
You can send your queries to medpgnotes@gmail.com
Contents :
Amyloid
Apoprotein
Arthritis
Avascular necrosis
Bone graft
Brain
Bronchogenic carcinoma
Census
Clotting factors
Contraception
Inflammatory bowel disease
Cerebrospinal fluid
Culture media
Dementia
Electroencephalogram
Engaging diameter
Estrogen
Familial hyperlipoproteinemia
Features of fibroid
Firearm
Gastric motility
Absorption in gut and nephron
Hormones
Hypersensitivity
Immunoglobulin
Inborn errors of metabolism and deficient enzymes
Kidney stones
Lithium
Lung volumes and capacities
Metabolic acidosis
Mosquito
Nerve fibers
Muscles and nerve supply
Changes in pregnancy
Methods for proteins
Protooncogenes and tumor suppressor genes
Radioisotopes
Rickettsial zoonoses
Root values for reflexes
Rapidly progressing glomerulonephritis
Small intestinal biopsy
Specimen preservation in poisoning
Sexually transmitted diseases
Sterilization and disinfection
Tetanus
Toxins in food
Management of poisoning
Vaccination
Vaginal cytology
Vitamins
For more details, visit www.medpgnotes.com
You can send your queries to medpgnotes@gmail.com
This document provides clinical management protocols for various types of intoxications and poisonings. It includes protocols for hydrocarbons, organophosphorus compounds, opioids, acetaminophen, calcium channel blockers, beta blockers, digitalis, theophylline, carbon monoxide, food poisoning, and more. For each type of intoxication, it outlines the examples, mode of intoxication, symptoms, signs, diagnostic tests, treatment approaches, and monitoring needed.
Contents :
Sensitive and specific antibodies
Specific calcification
Cast / brace/ splint
Enzymes of mitochondria and cytosol
Human leucocyte antigen
Inhibitors in biochemistry
Types of joints
Longest and shortest acting drugs
Male and female analogue
Male and female preponderance
Mode of inheritance
Named fractures
Important tables in nutrition chapter
Specific names in orthopedics
Rate limiting enzymes
Physiology of receptors
Right and left laterality
Sensitive and resistive to radiation
Sensitive and specific investigation
Condition and specific terms
Names of staging/grading/prognostic system
Surgery names
Tumor marker
Vectors
X ray views
Important lists
Important tables in anesthesiology
Important tables in dermatology
Important tables in embryology
Clarke’s grouping of heart diseases in pregnancy
Forrest classification
Classification of leprosy
For more details, visit www.medpgnotes.com
You can send your queries to medpgnotes@gmail.com
Contents :
Anticholinesterase
Autacoids
Beta blockers
Bisphosphonates
Cataract nuggets
Condition and specific drug
Condition and specific surgery
Diabetes nuggets
Different usage of drugs
Drug of choice
Drug kinetics
Few drug interactions
Mechanism of action of drugs
Monoclonal antibodies
Nitrates nugget
Opioid nugget
Prodrugs
Safest drugs in pregnancy nugget
Steroid drugs
Treatment of choice
For more details, visit www.medpgnotes.com
You can send your queries to medpgnotes@gmail.com
This document provides an overview of hematology and various blood disorders. It begins with approaches to analyzing blood films and clinical approaches to anemia. It then discusses iron metabolism and deficiencies in detail. Specific topics covered include the phases of hemostasis, hematologic malignancies such as leukemias and lymphomas, and approaches to common blood disorders and anemias. The document provides a comprehensive hematology reference with sections on various blood-related topics, diagnostic indicators, and clinical management approaches.
Contents :
Most commons
Most common type
Most common cause
Most common form
Most common lesion
Most common complication
Most common Joint
Most common indication
Most common manifestation
Most common mode
Most common nerve
Most common side effect
Most common presentation
Most common site
Most common tumor
The document provides guidelines for managing paracetamol poisoning through a flowchart approach. The flowchart guides medical professionals on assessing factors such as dosage, time of ingestion, and patient risk to determine appropriate treatment which may include administering activated charcoal, observing the patient, testing blood levels, or treating with intravenous N-acetylcysteine. It also provides dosing instructions for N-acetylcysteine and indicators for contacting specialist care.
This document discusses neutropenia, a type of leukopenia characterized by an abnormally low number of neutrophils. There are two main types - quantitative disorders involving decreased bone marrow production or increased cell loss, and qualitative disorders affecting neutrophil function. Major causes of decreased bone marrow production include chemotherapy, radiation, drugs, and stem cell or myeloid failures. Increased cell loss can result from severe infections overwhelming production. Pseudoneutropenia involves neutrophils moving from circulating blood to tissue pools, appearing as low neutrophil counts. Morphological abnormalities seen in neutrophils provide diagnostic clues about underlying conditions.
Vaccines are preparations of pathogens that induce immunity against diseases. They are considered a form of primary prevention and work by eliciting an active immune response. Different types of vaccines include live attenuated, killed whole organisms, and fragments of organisms. The UK immunization schedule outlines which vaccines children should receive at various ages to protect against diseases. High-risk groups like asplenic patients require additional vaccines. Vaccines are important for both individual and public health by providing direct protection and herd immunity.
Liver enzymology is used to evaluate liver injury and function. Elevations in "leakage enzymes" like ALT and AST indicate hepatocyte injury, while increases in "induction enzymes" like ALP and GGT suggest cholestasis or impaired bile flow. ALT is the most specific indicator of hepatocyte injury in dogs and cats. ALP and GGT are useful for detecting cholestasis, with GGT being more specific but less sensitive than ALP in dogs, and more sensitive but less specific in cats. Bilirubin levels rise with increased RBC breakdown, decreased hepatic uptake or conjugation, or disrupted bile flow. Together these tests provide insight into the type and severity of liver disease.
1) In the case of PT&T vs. Grace de Guzman, the Supreme Court ruled that PT&T's policy of not hiring married women was invalid and discriminatory, and that Grace's dismissal based on this policy was illegal.
2) In Estrada vs. Escritor, the Supreme Court ruled that Escritor could not be penalized for living with her partner without marriage, as her religious beliefs as a Jehovah's Witness allowed such arrangements.
3) In Balogbog vs. CA, the Supreme Court upheld the legitimacy of private respondents as the children of Gavino, even though there was no marriage certificate, as testimonial evidence proved Gav
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Contents :
Development of respiratory system
Anatomy of respiratory system
Physiology of respiratory system
General features of respiratory physiology
Inspiration and expiration
Surfactant
Gaseous exchange
Ventilation perfusion ratio and compliance
Hypercarbia and alveolar hypoventilation
Hyperventilation
High oxygen tension
Hypoxia
Features of hemoglobin
Oxyhemoglobin dissociation curve
Regulation of respiration
Lung volumes, capacities and alveolar ventilation
Acclimatisation
Mountain sickness
Caisson’s disease
Signs and symptoms of respiratory system
General signs and symptoms of respiratory system
Hemoptysis
Cyanosis
Clubbing
Pancoast tumor
Caplan syndrome
Pulmonary edema
ARDS
Pulmonary embolism
Pulmonary hypertension
Pulmonary venous hypertension
Cor pulmonale
Respiratory failure and pulmonary disease
Respiratory failure
Emphysema
Obstructive and restrictive lung disease
Respiratory curves
Bronchial asthma
Management of asthma
Chronic bronchitis
Bronchiectasis
Interstitial lung disease
Pneumoconiosis
Occupational lung disease
Asbestosis
Silicosis
Pulmonary hemosiderosis
Hypersensitive pneumonitis
Eosinophilia
Aspergillosis
Bronchiolitis
Laryngotracheobronchitis
Bronchial foreign body
Bronchoscopy
Solitary nodule
Pleural effusion, pneumothorax and mediastinitis
General features of pleura
Pleural effusion
Hemothorax
Pneumothorax
Lung sequestration
Mediastinum
Bronchopleural fistula
Pneumonia
General features of pneumonia
Causes of pneumonia
Morphology of pneumonia
Viral pneumonia
Staphylococcal pneumonia
Streptococcal pneumonia
Atypical pneumonia
Community acquired pneumonia
CMV pneumonia
Legionnaire’s pneumonia
Klebsiella pneumonia
Pneumocystis carnii pneumonia
Empyema
Lung abscess
Brochiolitis obliterans
Management of pneumonia
Tuberculosis
Mycobacterium tuberculosis
Epidemiology of tuberculosis
Features of tuberculosis
Morphology of tuberculosis
Tuberculin test
Sputum examination
Culture of mycobacterium
Diagnosis of tuberculosis
Treatment of tuberculosis
Sarcoidosis
Bronchogenic tumors
General features of brochogenic tumor
Small cell carcinoma of lung
Non small cell carcinoma of lungs
Management of bronchogenic tumor
Bronchial adenoma and bronchial cyst
Cystic fibrosis
Kartagener syndrome
Ventilator
For more details, visit www.medpgnotes.com
You can send your queries to medpgnotes@gmail.com
This document summarizes information about affective disorders including major depressive disorder and bipolar disorder. It discusses the role of serotonin in major depressive disorder and the use of tryptophan supplements to elevate serotonin levels. Symptoms of major depressive disorder are outlined. The heritability and biosynthetic pathway of serotonin are also summarized. Information is provided about various antidepressant medications including their mechanisms of action, efficacy, side effects and prevalence of use. Electroconvulsive therapy and cognitive behavioral therapy are discussed as treatments for depression. Diagnosis and treatment of bipolar disorder including the use of lithium is also summarized briefly.
pathology of the respiratory system plus review of anatomy and physiology
No copy right infringement is intended. This is a lecture note handout by Carey Francis Okinda
The document provides information on respiratory emergencies for different levels of medical training. It covers topics like anatomy of the upper and lower airways, respiratory physiology and pathophysiology, patient assessment of the respiratory system, management of airway obstructions and other respiratory conditions, and mechanical airway techniques. Key points include the definitions of terms like hypoxia and atelectasis, factors that can affect respiration, signs to assess the respiratory system, abnormalities in ventilation and perfusion, management of conditions like asthma and pneumonia, and indicators for endotracheal intubation. The document aims to equip medical responders with knowledge to recognize and treat a variety of respiratory distress presentations.
Respiratory anatomy and physiology faculty versionJonathan Downham
The document discusses respiratory anatomy and physiology, including:
1) How air moves from the bronchi to the terminal bronchioles and alveoli through the actions of respiratory muscles and elastic forces within the lungs.
2) How gas exchange occurs across the alveolar-capillary membrane through diffusion driven by partial pressure gradients.
3) How oxygen and carbon dioxide are carried around the body bound to hemoglobin in red blood cells.
This document discusses non-malignant lymphocyte disorders, including both acquired and congenital types. Acquired disorders are quantitative in nature and include infectious mononucleosis caused by the Epstein-Barr virus and toxoplasmosis. Infectious mononucleosis commonly affects young adults and is characterized by lymphocytosis, reactive lymphocytes, and elevated liver enzymes. Toxoplasmosis is transmitted through undercooked meat or contact with cat feces and poses risks to unborn children.
Contents :
Age group for diseases
Dentition
Developmental milestones
Gestational weeks
Important days
Important duration
Important years
Infectious diseases and incubation period
Paranasal sinuses
Period of communicability
Primitive reflexes
Psychosexual stages of development
Other important timelines
Best time for surgery
Trimesters
For more details, visit www.medpgnotes.com
You can send your queries to medpgnotes@gmail.com
Contents :
Amyloid
Apoprotein
Arthritis
Avascular necrosis
Bone graft
Brain
Bronchogenic carcinoma
Census
Clotting factors
Contraception
Inflammatory bowel disease
Cerebrospinal fluid
Culture media
Dementia
Electroencephalogram
Engaging diameter
Estrogen
Familial hyperlipoproteinemia
Features of fibroid
Firearm
Gastric motility
Absorption in gut and nephron
Hormones
Hypersensitivity
Immunoglobulin
Inborn errors of metabolism and deficient enzymes
Kidney stones
Lithium
Lung volumes and capacities
Metabolic acidosis
Mosquito
Nerve fibers
Muscles and nerve supply
Changes in pregnancy
Methods for proteins
Protooncogenes and tumor suppressor genes
Radioisotopes
Rickettsial zoonoses
Root values for reflexes
Rapidly progressing glomerulonephritis
Small intestinal biopsy
Specimen preservation in poisoning
Sexually transmitted diseases
Sterilization and disinfection
Tetanus
Toxins in food
Management of poisoning
Vaccination
Vaginal cytology
Vitamins
For more details, visit www.medpgnotes.com
You can send your queries to medpgnotes@gmail.com
This document provides clinical management protocols for various types of intoxications and poisonings. It includes protocols for hydrocarbons, organophosphorus compounds, opioids, acetaminophen, calcium channel blockers, beta blockers, digitalis, theophylline, carbon monoxide, food poisoning, and more. For each type of intoxication, it outlines the examples, mode of intoxication, symptoms, signs, diagnostic tests, treatment approaches, and monitoring needed.
Contents :
Sensitive and specific antibodies
Specific calcification
Cast / brace/ splint
Enzymes of mitochondria and cytosol
Human leucocyte antigen
Inhibitors in biochemistry
Types of joints
Longest and shortest acting drugs
Male and female analogue
Male and female preponderance
Mode of inheritance
Named fractures
Important tables in nutrition chapter
Specific names in orthopedics
Rate limiting enzymes
Physiology of receptors
Right and left laterality
Sensitive and resistive to radiation
Sensitive and specific investigation
Condition and specific terms
Names of staging/grading/prognostic system
Surgery names
Tumor marker
Vectors
X ray views
Important lists
Important tables in anesthesiology
Important tables in dermatology
Important tables in embryology
Clarke’s grouping of heart diseases in pregnancy
Forrest classification
Classification of leprosy
For more details, visit www.medpgnotes.com
You can send your queries to medpgnotes@gmail.com
Contents :
Anticholinesterase
Autacoids
Beta blockers
Bisphosphonates
Cataract nuggets
Condition and specific drug
Condition and specific surgery
Diabetes nuggets
Different usage of drugs
Drug of choice
Drug kinetics
Few drug interactions
Mechanism of action of drugs
Monoclonal antibodies
Nitrates nugget
Opioid nugget
Prodrugs
Safest drugs in pregnancy nugget
Steroid drugs
Treatment of choice
For more details, visit www.medpgnotes.com
You can send your queries to medpgnotes@gmail.com
This document provides an overview of hematology and various blood disorders. It begins with approaches to analyzing blood films and clinical approaches to anemia. It then discusses iron metabolism and deficiencies in detail. Specific topics covered include the phases of hemostasis, hematologic malignancies such as leukemias and lymphomas, and approaches to common blood disorders and anemias. The document provides a comprehensive hematology reference with sections on various blood-related topics, diagnostic indicators, and clinical management approaches.
Contents :
Most commons
Most common type
Most common cause
Most common form
Most common lesion
Most common complication
Most common Joint
Most common indication
Most common manifestation
Most common mode
Most common nerve
Most common side effect
Most common presentation
Most common site
Most common tumor
The document provides guidelines for managing paracetamol poisoning through a flowchart approach. The flowchart guides medical professionals on assessing factors such as dosage, time of ingestion, and patient risk to determine appropriate treatment which may include administering activated charcoal, observing the patient, testing blood levels, or treating with intravenous N-acetylcysteine. It also provides dosing instructions for N-acetylcysteine and indicators for contacting specialist care.
This document discusses neutropenia, a type of leukopenia characterized by an abnormally low number of neutrophils. There are two main types - quantitative disorders involving decreased bone marrow production or increased cell loss, and qualitative disorders affecting neutrophil function. Major causes of decreased bone marrow production include chemotherapy, radiation, drugs, and stem cell or myeloid failures. Increased cell loss can result from severe infections overwhelming production. Pseudoneutropenia involves neutrophils moving from circulating blood to tissue pools, appearing as low neutrophil counts. Morphological abnormalities seen in neutrophils provide diagnostic clues about underlying conditions.
Vaccines are preparations of pathogens that induce immunity against diseases. They are considered a form of primary prevention and work by eliciting an active immune response. Different types of vaccines include live attenuated, killed whole organisms, and fragments of organisms. The UK immunization schedule outlines which vaccines children should receive at various ages to protect against diseases. High-risk groups like asplenic patients require additional vaccines. Vaccines are important for both individual and public health by providing direct protection and herd immunity.
Liver enzymology is used to evaluate liver injury and function. Elevations in "leakage enzymes" like ALT and AST indicate hepatocyte injury, while increases in "induction enzymes" like ALP and GGT suggest cholestasis or impaired bile flow. ALT is the most specific indicator of hepatocyte injury in dogs and cats. ALP and GGT are useful for detecting cholestasis, with GGT being more specific but less sensitive than ALP in dogs, and more sensitive but less specific in cats. Bilirubin levels rise with increased RBC breakdown, decreased hepatic uptake or conjugation, or disrupted bile flow. Together these tests provide insight into the type and severity of liver disease.
1) In the case of PT&T vs. Grace de Guzman, the Supreme Court ruled that PT&T's policy of not hiring married women was invalid and discriminatory, and that Grace's dismissal based on this policy was illegal.
2) In Estrada vs. Escritor, the Supreme Court ruled that Escritor could not be penalized for living with her partner without marriage, as her religious beliefs as a Jehovah's Witness allowed such arrangements.
3) In Balogbog vs. CA, the Supreme Court upheld the legitimacy of private respondents as the children of Gavino, even though there was no marriage certificate, as testimonial evidence proved Gav
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Contents :
Development of respiratory system
Anatomy of respiratory system
Physiology of respiratory system
General features of respiratory physiology
Inspiration and expiration
Surfactant
Gaseous exchange
Ventilation perfusion ratio and compliance
Hypercarbia and alveolar hypoventilation
Hyperventilation
High oxygen tension
Hypoxia
Features of hemoglobin
Oxyhemoglobin dissociation curve
Regulation of respiration
Lung volumes, capacities and alveolar ventilation
Acclimatisation
Mountain sickness
Caisson’s disease
Signs and symptoms of respiratory system
General signs and symptoms of respiratory system
Hemoptysis
Cyanosis
Clubbing
Pancoast tumor
Caplan syndrome
Pulmonary edema
ARDS
Pulmonary embolism
Pulmonary hypertension
Pulmonary venous hypertension
Cor pulmonale
Respiratory failure and pulmonary disease
Respiratory failure
Emphysema
Obstructive and restrictive lung disease
Respiratory curves
Bronchial asthma
Management of asthma
Chronic bronchitis
Bronchiectasis
Interstitial lung disease
Pneumoconiosis
Occupational lung disease
Asbestosis
Silicosis
Pulmonary hemosiderosis
Hypersensitive pneumonitis
Eosinophilia
Aspergillosis
Bronchiolitis
Laryngotracheobronchitis
Bronchial foreign body
Bronchoscopy
Solitary nodule
Pleural effusion, pneumothorax and mediastinitis
General features of pleura
Pleural effusion
Hemothorax
Pneumothorax
Lung sequestration
Mediastinum
Bronchopleural fistula
Pneumonia
General features of pneumonia
Causes of pneumonia
Morphology of pneumonia
Viral pneumonia
Staphylococcal pneumonia
Streptococcal pneumonia
Atypical pneumonia
Community acquired pneumonia
CMV pneumonia
Legionnaire’s pneumonia
Klebsiella pneumonia
Pneumocystis carnii pneumonia
Empyema
Lung abscess
Brochiolitis obliterans
Management of pneumonia
Tuberculosis
Mycobacterium tuberculosis
Epidemiology of tuberculosis
Features of tuberculosis
Morphology of tuberculosis
Tuberculin test
Sputum examination
Culture of mycobacterium
Diagnosis of tuberculosis
Treatment of tuberculosis
Sarcoidosis
Bronchogenic tumors
General features of brochogenic tumor
Small cell carcinoma of lung
Non small cell carcinoma of lungs
Management of bronchogenic tumor
Bronchial adenoma and bronchial cyst
Cystic fibrosis
Kartagener syndrome
Ventilator
For more details, visit www.medpgnotes.com
You can send your queries to medpgnotes@gmail.com
This document summarizes information about affective disorders including major depressive disorder and bipolar disorder. It discusses the role of serotonin in major depressive disorder and the use of tryptophan supplements to elevate serotonin levels. Symptoms of major depressive disorder are outlined. The heritability and biosynthetic pathway of serotonin are also summarized. Information is provided about various antidepressant medications including their mechanisms of action, efficacy, side effects and prevalence of use. Electroconvulsive therapy and cognitive behavioral therapy are discussed as treatments for depression. Diagnosis and treatment of bipolar disorder including the use of lithium is also summarized briefly.
pathology of the respiratory system plus review of anatomy and physiology
No copy right infringement is intended. This is a lecture note handout by Carey Francis Okinda
The document provides information on respiratory emergencies for different levels of medical training. It covers topics like anatomy of the upper and lower airways, respiratory physiology and pathophysiology, patient assessment of the respiratory system, management of airway obstructions and other respiratory conditions, and mechanical airway techniques. Key points include the definitions of terms like hypoxia and atelectasis, factors that can affect respiration, signs to assess the respiratory system, abnormalities in ventilation and perfusion, management of conditions like asthma and pneumonia, and indicators for endotracheal intubation. The document aims to equip medical responders with knowledge to recognize and treat a variety of respiratory distress presentations.
Respiratory anatomy and physiology faculty versionJonathan Downham
The document discusses respiratory anatomy and physiology, including:
1) How air moves from the bronchi to the terminal bronchioles and alveoli through the actions of respiratory muscles and elastic forces within the lungs.
2) How gas exchange occurs across the alveolar-capillary membrane through diffusion driven by partial pressure gradients.
3) How oxygen and carbon dioxide are carried around the body bound to hemoglobin in red blood cells.
Ok, heres the story. I was teaching this otherwise sharp EMT-Basic class that bombed two respiratory emergency tests in a ROW!
So this is the remedial lecture I inflicted on them. I don\'t know if they passed because of this fine work, or just because they were afraid of another lecture fo they failed.
Hope its useful to you.
This document summarizes the respiratory system. It begins with an introduction and then discusses the developmental anatomy, functions including ventilation and gas exchange, and regulation of respiration through neural control centers in the brainstem. It also covers applied topics like effects of altitude and diving. The respiratory system works to oxygenate tissues and remove carbon dioxide through four main functions: ventilation, gas diffusion, transport, and regulation. Respiration is regulated by chemoreceptors sensitive to oxygen and carbon dioxide levels, as well as pH levels, to maintain homeostasis.
The document provides an overview of respiratory anatomy and physiology, focusing on the respiratory system, gas exchange, blood flow through the lungs, oxygenation, and sleep apnea. It defines obstructive sleep apnea as repeated cessation of breathing during sleep due to upper airway collapse. Risk factors include obesity, age, male gender, and anatomical abnormalities. Symptoms include loud snoring, witnessed breathing pauses, and daytime sleepiness. Consequences include cardiovascular disease, accidents, and decreased quality of life. Diagnosis involves assessing symptoms, risk factors, and polysomnography. Treatment aims to reduce risks and includes weight loss, positive airway pressure, and surgery.
This document provides an overview of respiratory failure, including its causes, types, symptoms, diagnosis, and management. It begins by defining respiratory failure as the failure of the respiratory system in gas exchange functions of oxygenation and carbon dioxide elimination. Respiratory failure is then classified based on PaO2 and PaCO2 levels into hypoxemic (Type I) and hypercapnic (Type II) types. Common causes, clinical features, investigations, and general management principles are discussed for respiratory failure. Key aspects of managing hypoxemia and hypercapnia are also summarized.
Chronic obstructive pulmonary disease (COPD) refers to two lung diseases, chronic bronchitis and emphysema, that are typically caused by smoking and result in limited airflow. The document discusses the definition, causes, symptoms, diagnosis, and management of COPD. It notes that COPD is the 4th leading cause of death and involves inflammation and narrowing of the airways leading to shortness of breath. Treatment focuses on improving ventilation, removing secretions, managing complications, and improving overall health.
Respiratory failure occurs when the lungs fail to effectively oxygenate the blood or remove carbon dioxide. It can be caused by conditions that decrease lung function or increase oxygen needs. Symptoms include shortness of breath, confusion, and bluish skin. Diagnosis involves assessing symptoms, risk factors, and tests like blood gases, imaging, and pulmonary function tests. Management focuses on treating the underlying cause, correcting gas exchange abnormalities through oxygen supplementation or ventilation, and preventing complications. Nursing care monitors the patient's condition and provides interventions to address issues like impaired gas exchange, low cardiac output, poor nutrition, and anxiety.
Oxygen is essential for life and deprivation leads most rapidly to death. Oxygen therapy is useful for diseases that interfere with normal oxygenation. Hypoxia refers to insufficient oxygen in tissues and can be caused by problems delivering oxygen to the lungs, abnormal lung function, or inadequate oxygen delivery to tissues. Effects of hypoxia include increased respiration, increased heart rate and blood flow, impaired brain function, and cellular metabolic changes. Oxygen inhalation can reverse hypoxia but excessive amounts can cause toxicity, especially in the central nervous system and lungs.
This document provides an overview of the respiratory system, including its functions, anatomy, physiology and related pathologies. It describes the neurochemical control of breathing, the functions of respiration such as gas exchange, and the upper and lower respiratory tract. Details are given about ventilation, perfusion, lung volumes, compliance and resistance. The document also covers acid-base regulation, diagnostic tests like arterial blood gases and chest imaging, physical exam findings, and laboratory studies of the respiratory system.
The document discusses respiratory failure and insufficiency. It defines respiratory failure as inadequate gas exchange by the respiratory system, resulting in abnormal blood levels of oxygen and/or carbon dioxide. Respiratory insufficiency refers to the lungs' inability to function normally. The document then describes different types of respiratory failure including acute vs chronic and hypoxemic vs hypercapnic respiratory failure. It lists and explains various causes of each type of respiratory failure including diseases, injuries, and neurological conditions.
7[1].4 the regulatory mechanism in respirationcikgushaik
The document outlines learning objectives related to human respiration. It describes how the rate of respiration increases during vigorous activity to supply more oxygen and remove more carbon dioxide. It explains the regulatory mechanism of oxygen and carbon dioxide in the body, noting that increased carbon dioxide stimulates breathing centers to increase the breathing rate. Various situations that affect respiratory response are discussed, such as high altitudes, fear, and different components of tobacco smoke that are harmful to the lungs.
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. This disease is characterized by increasing breathlessness
This document summarizes several key physiological concepts related to high altitude physiology:
1. At high altitudes, the lower atmospheric pressure results in lower oxygen levels in the blood (hypoxemia). The body responds through acclimatization mechanisms like increased respiration and red blood cell production.
2. Initially, the low oxygen causes increased breathing while the loss of carbon dioxide inhibits breathing, creating an imbalance. Over time, the kidneys and bone marrow help restore balance.
3. If ascending too quickly, acute mountain sickness can occur from cerebral or pulmonary edema due to the body's inability to properly acclimate to the conditions. Proper acclimatization takes weeks to establish different compensatory mechanisms.
This document discusses disorders of the respiratory function, including disorders of gas exchange like alveolar hypoventilation and hyperventilation. It also discusses ventilation-perfusion imbalance, which can occur when ventilation and blood flow are not well matched within the lungs. This can lead to hypoxemia and hypercapnia. Dyspnea, or shortness of breath, is examined, including the factors that can increase the work of breathing like restrictive lung diseases. Specific obstructive lung diseases like asthma and chronic obstructive pulmonary disease are also overviewed, noting how they increase airway resistance through various mechanisms.
COPD refers to chronic bronchitis and emphysema, two commonly co-existing lung diseases where the airways become narrowed leading to limited airflow. The main causes are smoking, occupational exposures, air pollution, and genetic conditions. Symptoms include chronic cough, sputum production, wheezing, chest tightness, and shortness of breath. Management includes bronchodilators, corticosteroids, oxygen therapy, promoting exercise, and controlling complications to improve lung function and general health.
Chronic obstructive pulmonary disease (COPD) refers to chronic bronchitis and emphysema, diseases where the airways and lungs become damaged and narrowed over time, making breathing difficult. The main causes are smoking, air pollution, and occupational exposures. Symptoms include shortness of breath, chronic cough, and sputum production. It is diagnosed through lung function tests and imaging. Treatment focuses on reducing symptoms through bronchodilators, corticosteroids, and oxygen therapy. Managing exacerbations and preventing complications through vaccination, exercise, and nutrition are also important aspects of care.
The document discusses pathophysiology of respiratory failure, defining it as failure of oxygenation and/or carbon dioxide elimination. It describes four types of respiratory failure: type 1 (hypoxemic) with low PaO2, type 2 (hypercapnic/ventilatory) with high PaCO2, type 3 (peri-operative) common after surgery, and type 4 (shock) secondary to cardiovascular instability. Causes of types 1 and 2 are explored in depth, including V/Q mismatch, shunts, increased dead space, and factors reducing ventilatory capacity or increasing demand leading to hypercapnia.
1. Respiratory Failure Causes of Respiratory Failure
Medicine 2
Noel V. Bautista Organ/System Examples
December 20, 2007 Central Nervous Stroke, Drug overdose, Trauma, Myxedema
System
Peripheral Guillain-Barre syndrome, Spinal cord
Respiration Nervous System compression, Poliomyelitis
- The exchange of gases between the organism and the Neuromuscular Myasthenia gravis, Tetanus, Hypokalemic
environment System paralysis, Multiple sclerosis, Botulism,
Remember that respiration not only involved the lungs but all Organophosphate poisoning, Antibiotics
the organs (Kanamycin, Polymyxin), Curariform drugs
Thorax and Severe kyphoscoliosis, Flail chest, Massive
Respiratory Failure Pleura pneumothorax or pleural effusion
- Respiratory failure is a condition in which the respiratory system Upper Airway Epiglotitis, Tracheobronchitis, Vocal cord
is unable to perform its gas-exchange function i.e. oxygenation paralysis
and/or carbon dioxide elimination Lower Airway Pneumonia, COPD, Asthma, ARDS
and Alveoli
Extended Concept of Respiration Cardiovascular Heart failure
System
Blood Anemia, Polycythemia
Cell/Tissue Sepsis, Cyanide poisoning
We could therefore investigate causes of respiratory failure
according to the structures involved in respiration
Hemoglobin → carries 98% of oxygen to be delivered to body cells
Types of Respiratory Failure
Type 1 (Normocapnic Respiratory Failure) → Hypoxemia with
eucapnia or hypocapnia
- Pure oxygen problem
Type 2 (Hypercapnic Respiratory Failure) → Hypoxemia with
hypercapnia
- Oxygenation and ventilation (e.g. involving CO2) problem
The respiratory system is a pump that facilitates gas exchange → Respiratory Failure
main function: maintain metabolic function
- Ventilation and perfusion of organs should be properly matched
for ideal oxygenation of blood which delivers oxygen to
Hypoxemia Hypercapnia
individual organ systems to maintain optimum metabolic activity
and homeostasis
- Oxygen is important in aerobic glycolysation
- Carbon dioxide should also be effectively eliminiated → or Oxygenation Failure Ventilatory Failure
would lead to acidosis
External Respiration → exchange of gas between environment and
respiratory system
Internal Respiration → exchange of gas at cellular level Respiratory System Ventilatory Pump
Cellular metabolism → driving force of ventilation Disorders Disorders
Aiways Nervous System
Better Definition of Respiratory Failure Lungs Thorax
- Respiratory failure is present when the pulmonary system is Respiratory Muscles
unable to meet the metabolic demands of the body Respiratory System
RF will always produce acidosis. Thus it is important to know
Respiratory Failure oxygenation status (by looking at ABG) and ventilation status (by
looking at CO2 status)
- ABG involves
Acute Acute - Oxygenation status
- Ventilatory status
- Acid-base disturbance
Ventilation failure usually involves CNS, thorax, respiratory muscles;
most of time lungs not affected.
Develops in Develops over Oxygenation failure usually parenchyma of lungs
Minutes to a several hours or
few hours longer Ventilation and PaCO2
Kidneys Ficke equation:
compensate for PaCo2 = VCO2 x 0.863
the respiratory VA
acidosis ↑PaCO2 ~ ↓ VA
Classification of acute and chronic is very arbitrary → there is no - the lower the ventilation, the more CO2 accumulates
defining line
Acute respiratory failure → subcellular level has not yet been able to VE = V A + V D VE – minute ventilation
adapt to the disturbance VE = V T x f VA – alveolar ventilation
Major adaptation in gas exchange is achieved by kidneys → VA = (VT x f) – VD VD – dead space ventilation
however before the kidney participates, a buffer system first tries to VT – tidal volume
compensate f – respiratory rate
Chronic respiratory failure → kidneys have already adapted; kidney
adaptation could happen in a matter of hours or days → which is why
classification into acute or chronic is arbitrary CO2 elimination is usually 250 mL/min
How do get an idea of the status of alveolar ventilation: check
PaCO2
1
2. Minute ventilation affected by: Dalton’s Law:
Tidal volume, respiratory rate, and dead space ventilation PB (barometric pressure) = PN2 + PO2 + PCO2 + PH2O
↑ Respiratory rate (tachypneic) does not assure you adequacy of = 760 mmHg (at sea level)
ventilation normal atmospheric
pressure
Ventilatory Pump Failure Barometric pressure is the sum of all the partial
- Central nervous system pressures of the most important gases in atmosphere
- Peripheral nervous system Nitrogen is an inert gas; we breathe it without any
- Thorax & Pleura physiological consequence
- Respiratory muscles → myasthenia gravis Gas that we inhale is humidified
Hypercapnia results from disturbance in ventilatory pump
PiO2 = FiO2 x PB
Causes of Hypoventilation (Hypercapnia) FiO2 = PiO2/PB = 160/760 = 21%
- Brainstem PiO2 → fraction contributed by O2
- brainstem injury due to trauma, hemorrhage, infarction, FiO2 → available oxygen
hypoxia, infection etc
- metabolic encephalopathy Effects of Altitude on Barometric Pressure
- depressant drugs
- Spinal cord Altitude (Feet) PB (mmHg) PiO2 (mmHg)
- trauma, tumor, transverse myelitis 0 760 159
- Nerve root injury 10,000 523 110
- Nerve 20,000 349 73
- trauma 30,000 226 47
- neuropathy eg Guillain Barre 40,000 141 29
- motor neuron disease 50,000 87 18
- Neuromuscular junction In the urban setting, decreased FiO2 is rarely the reason for
- myasthenia gravis respiratory failure, except in cases of fire, CO poisoning
- neuromuscular blockers
- Respiratory muscles Alveolar Gases
- fatigue - amount O2 that reaches alveoli
- disuse atrophy
- myopathy
- malnutrition
- Respiratory system
- airway obstruction (upper or lower)
- decreased lung, pleural or chest wall compliance Alveolar Air Saturated
O2 100 mmHg (13%)
N2 573mmHg (76%)
Causes of Ventilatory Failure CO2 5mmHg (40%)
H2O 47mmHg (6%)
Increased VCO2 Fever, hypermetabolism
Increased VD and Lung parenchyma disorders e.g. COPD,
Decreased VA asthma, ARDS, pulmonary embolism Alveolar air equation:
Decreased VA Decreased ventilatory drive e.g. sedation or PAO2 = (PB – PH2O) x FiO2 – (PaCO2/RQ)
“Pump” failure e.g. neuromuscular disease = (760 – 47) x FiO2 – (PaCO2/RQ)
If blood gases reveal hypercapnea, try to categorize them into the = 713 x FiO2 – (PaCO2/RQ)
above three pathophysiological processes: = 713 x 0.21 – (40/0.8) = 99.7 mmHg
1. Increased CO2 production; rarely the cause, but can be an
additional factor that adds to hypercapnea Alveolar Capillary Membrane
More important factor is still diminished alveolar ventilation, not - When O2 reaches alveoli, next step is perfusion
increase CO2 production so can forget about this, usually it is - Fick’s law: involves diffusion of gas on surface
only co-conspirator however by itself will not cause hypercapnia
2. Increase in dead space (Minute ventilation is sum of alveolar
ventilation and dead space ventilation) which will decrease
alveolar ventilation. CO2 accumulates. Seen in obstructive
airway diseases
3. Decreased alveolar ventilation
Respiratory System Oxygenation
- Inspired gases (PiO2, PiCO2)
- Alveolar ventilation (Va, PAO2, PACO2)
- Diffusion of gas through the respiratory membrane (DmO2)
- Perfusion of pulmonary capillaries
- Ventilation-perfusion matching (V/Q) Fick’s Law of Diffusion:
Whenever there is hypercapnea, find reason. Do not rely on VO2 = DmO2 x ( PAO2 – PCO2)
respiratory rate → request for PaCO2 Dm = Diffusing Capacity
oxygenation failure – so many causes (Note: D is directly proportional to Area and Diffusion Coefficient for
the gas and inversely proportional to diffusion Distance ~ D = [A x
Inspired Air Dc]/T)
*No need to memorize or apply equation → what is important is that
Inspired Air: dry alveolar membrane should be in tip-top shape for the respiratory gases
O2 160 mmHg (21%) to diffuse through
Tracheal Air: Diffusion is fast → takes only a quarter of a second for desaturated
N2 600 mmHg (79%)
Saturated
CO2 0 mmHg (0%) gas to be completely oxygenated
O2 150 mmHg (20%)
H2O 0 mmHg (0%) So even if you exercise → diffusion or the respiratory system is
N2 563 mmHg (74%)
CO2 0 mmHg (0%) usually not the problem but the cardiovascular system
H2O 47 mmHg (6%) Exercise can improve the cardiovascular system improve oxygen
delivery from 10-15x, but the reserve capacity of the cardiovascular
system is even more (20-25x) in a normal resting physiologic bodies
Bottomline: Diffusion is not a usual cause of hypoxemia
2
3. Ventilation-Perfusion Matching
- The usual cause of hypoxemia Effect of Hypoventilation on Hypoxemia
↓Va → ↓PAO2 → ↓PaO2
↓Va → ↑PaCO2 → ↓PaO2
1mmHg ~ 1.25mmHg
Fixed Variable
PB = PN2 + PH2O + PCO2 + PO2
760 573 47 40 100 mmHg
Example:
Dead space High V/Q Low V/Q Shunt
Ventilation Ventilation Ventilation
PaCO2 = 55 mmHg (change = 55 – 40 = 15)
Expected PaO2 = 80 mmHg (80 – 15 x 1.25) = 61.25
If actual < expected → hypoventilation (plus other)
Normal V/Q ratio = 0.8 Actual PaO2 = 60 mmHg Hypoventilation
VQ matching or mismatching comes in a spectrum of physiologic Ventilation-Perfusion Mismatching
events - Causes:
A → complete ventilation but no perfusion; physiologic dead - Airway disorders
space - Lung parenchymal disorders
B → ideal VQ; ventilation is matched by perfusion. Most common cause of V/Q mismatch: Obstructive airway
Normal VQ → slightly more perfusion than ventilation; some of disease
blood flow goes back to heart unoxygenated.
D→ no ventialtion but complete perfusion; shunt Shunt Defect
Hard to determine A and D from one another; often lumped together Shunt Equation:
Qs = CcO2 – CaO2 = 5-8%
Alveolar-Arterial Oxygen Gradient QT CcO2 – CvO2
Causes:
- Intracardiac
PAO2 = 100 – 115 mmHg
- Right to left shunt e.g. Fallot's tetralogy, Eisenmenger's
syndrome
P(A-a)O2 = 15=20 mmHg
- Pulmonary
- Pneumonia
PaO2 = 80 – 100 mmHg
- Pulmonary edema
- Atelectasis
Mechanisms of Hypoxemia - Pulmonary haemorrhage
- Decreased inspired oxygen tension (FiO2) - Pulmonary contusion
- Hypoventilation*
- Ventilation – Perfusion (V/Q) mismatching* Dead Space Ventilation
- Shunt defect* Ventilation
- Diffusion defect - Causes
*The more common causes of hypoxemia - Pulmonary embolism
- Thrombus
Normal Gas Exchange
Va = 5L/min - Fat
Perfusion - Tumor
- Air
- Septic
Q = 0L/min
- Pulmonary vasculitis
Ventilation
Diffusion Defect
- Causes:
Diffusion - Acute Respiratory Distress Syndrome
- Interstitial lung disease
- Fibrotic lung disease
Tracheobronchial Tree
Perfusion
Hypoventilation
- Hypoventilation can also lead to decrese in arterial oxygen,
even if there’s no problem in parenchyma involved in gas
exchange. Thus hypoxygenation can lead to hypoxemia.
Airways divide dichotomously
Airway decreases in size → ↑ surface area 70m2
80-120mL blood in capillaries for gas exchange
↓Va → ↓PAO2 → ↓PaO2
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4. Diffusion Time
Factors Affecting O2 Dissociation Curve
Carbon Dioxide Dissociation Curve
Extended Definition of Respiratory Failure
Condition Definition
Ventilatory Failure Abnormality of CO2 elimination by the
lungs
Failure of arterial Abnormality of O2 uptake by the lungs
oxygenation
Failure of O2 transport Limitation of O2 delivery to peripheral As PCO2 increases, oxygen carrying capacity diminishes. As PO2
tissues so that aerobic metabolism increases (especially in venous blood) there is decrease in CO2
cannot be maintained carrying capacity → Bohr effect
Failure of O2 uptake Inability of tissues to extract O2 from
and/or utilization blood and use it for aerobic metabolism Oxygen Consumption
O2 Consumption (VO2)
Oxygen Transport VO2 = Q x (CaO2 – CvO2) = 5 L/min x 5 mL/dL
O2 transport (or delivery) (DO2) = 250 ml/min
DO2 = Q x CaO2 = 5 L/min x 20 mL/dL x 10 CvO2 → oxygen content (venous)
= 1,000 ml/min O2 Extraction ratio
Q → cardiac output O2 ER = VO2 / DO2 = 250 mL/min / 1,000 mL/min
O2 content (CaO2) = 0.25 (25%)
CaO2 = (1.39 x Hb x %Sat) + (0.003 x PaO2) Safety mechanism at subcellular level has good application for
= 1.39 x 15 x 0.98 + 0.003 x 98 = 20 ml/dl (vol%) cardiac arrest → must be able to resuscitate within 3-5 min → still
be able to avoid brain damage/death/organ failure
Oxygenation Dissociation Curve
Clinical Manifestations of Respiratory Failure
- Apnea → respiratory failure
- Cyanosis → 5 mg of desaturated Hb already; only 20% of
patients with respiratory failure will present with cyanosis → not
a good parameter to measure
- Altered level of consciousness
- Dyspnea
- Signs of respiratory distress
- Signs/symptoms of hypoxemia
- Signs/symptoms of hypercapnea
- Signs/symptoms of underlying pathology
Manifestations of Respiratory Distress and Respiratory Failure
- Tachypnea and tachycardia
- Flaring of ala nasae
- Use of accessory muscles of respiration
- Supraclavicular fossa excavation
Note points - “Pump” handle breathing
PO2 = 40 mmHg g Saturation → 75% (PvO2 for a normal - Tracheal tug and decreased tracheal length
person at rest) - External jugular venous distension in expiration
PO2 = 60 mmHg g Saturation → 90% - Costal paradox
PO2 = 100 mmHg g Saturation → 97.5% (PaO2 for a normal - Pulsus paradoxus
person at rest and in exercise) - Abdominal paradox and asynchrony Respirator distress; but
P50 = 26 mmHg g Saturation → 50% (for normal Hb - Respiratory alternans there is impending
In sepsis, may have no hypoxemia, but hypoxia - Cyanosis apnea → ventilation
Hypoxemia → <50 mmHg - Altered level of consciousness failure in the next 15min
Respiratory failure is not synonymous with respiratory distress.
If there’s respiratory distress, investigate if there is RF
4
5. Evaluation of Hypoxemia
Signs of Respiratory Distress - Normal P(A-a)O2
- Tachypnea and tachycardia - Decreased FiO2
- Flaring of ala nasae - Hypoventilation
- Use of accessory muscles of respiration - Increased P(A-a)O2
- Intercostal muscle retraction - Ventilation-Perfusion mismatching
- Sternocleidomastoid muscle contraction - Shunt defect
- Costal paradox (Hoover’s sign) - Diffusion defect
- “Pump” handle breathing Most common cause of hypoxemia: hypoventilation, V/Q
- Supraclavicular fossae excavation mismatch & shunt
- External jugular venous distension in expiration If with hypoxemia → calculate first P(A-a)O2 gradient
- Tracheal tug and decreased tracheal length - Normal gradient → no problem in respiratory membrane &
- Abdominal paradox and asynchrony V/Q, it will still go to arterial system
- Respiratory alternans
Indices of Oxygenation
Signs and Symptoms of Hypercapnea
- Symptoms Indices Normal Values
Headache Pa O 2 80 – 100 mmHg
Mild sedation → Drowsiness → Coma Sa O 2 95 – 100 vol%
- Signs P(A-a)O2 25 – 65 mmHg
Vasodilation → redness of skin, sclera and conjunctiva PaO2/PAO2 0.75
secondary to increased cutaneous blood flow; sweating PaO2/FiO2 350 – 450
Sympathetic response → hypertension tachycardia QS/QT <5%
”Antok” PAO2 = (PB – PH2O) x FiO2 – (PaCO2/RQ)
= (760 – 47) x FiO2 – (PaCO2/RQ)
Signs and Symptoms of Hypoxia = 713 x FiO2 – (PaCO2/RQ)
- Symptoms PaO2/PAO2 = 0.15 → severe respiratory failure
Ethanol-like symptoms → confusion, loss of judgment, There are many oxygenation parameters. It is not adequate to look
paranoia, restlessness, dizziness at just PaO2. Must look at other oxygenation parameters
- Signs
Sympathetic response → tachycardia, mild hypertension, Algorithm of Hypoxemia
peripheral vasoconstriction
Non-sympathetic response → bradycardia, hypotension
”Lasing” P(A-a)O2
- Inhibitions depressed
COPD → chronic hypoxemia, irritable
Normal Increased
Diagnosis of Respiratory Failure
- Patient is in respiratory distress
- Hypoxemia (PaO2 < 60 mmHg)
- Hypercapnia (PaCO2 > 50 mmHg)
PaCO2 Challenge with
- Arterial pH shows significant acidemia (respiratory acidosis)
100% FiO2
*At least 2 of the 4 criteria should be fulfilled
Only way to diagnose RF is to do ABG. It is a laboratory
diagnosis, not a clinical diagnosis Increased Normal or Corrected Uncorrected
Decreased PaO2 PaO2
Other Diagnostic Modalities
- Laboratory
Hypo - Decreased V/Q mismatch Shunt
- CBC
ventialtion FiO2 Shunt <10% >10%
- Electrolytes
- Imaging studies Diffusion defect
- Chest x-ray
- CT scan Principles of Treatment
- Ventilation-perfusion scan - Maintain adequate oxygenation
- Support ventilation with mechanical ventilation when needed
Evaluation of Causes of Hypercapnia - Treat underlying illness or pathophysiologic derangements
- Maintain fluid and electrolyte balance
Minute Ventilation (VE) - Provide adequate nutrition
- Avoid complications
Transcribed by: Fred Monteverde
Increased VE Decreased VE
Notes from: Cecile Ong
Lecture recorded by: Lala Nieto
Increased VCO2 Increased VD & Decreased VA
Decreased VA Fred Monteverde Mae Olivarez
Emy Onishi Lala Nieto
Cecile Ong Chok Porciuncula
Airway or Lung Decreased “Pump” Mitzel Mata Section C 2009!
parenchyma ventilatory Regina Luz
disorders
disorders drive
Fever COPD, Sedation Neuromuscular
Hypermetabolism ARDS, Stroke disorder
Asthma, PE Pleural effusion
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