The document discusses various topics related to artificial respiration and acclimatization to high altitudes. It describes different manual methods of artificial respiration including Schafer's method, Sylvester's method, and Holger-Neilson method. It then discusses the physiological effects of high altitudes including hypoxemia, decreased PO2 and PCO2 levels, and the body's compensatory responses like increased respiration and red blood cell production to acclimatize over time through processes like angiogenesis and cellular changes. Fast climbing of mountains can lead to conditions like cerebral edema and pulmonary edema if proper acclimatization does not occur.
Hypoxia :types , causes,and its effects Aqsa Mushtaq
hypoxia :oxygen defecincy at tissue level.in these slides you are going to in touch with its types ,causes effects.share whatever you wanted to say comment us .
these notes are provided by our loving mam MAM SANIA .thanks to teach us mam :)
Hypoxia :types , causes,and its effects Aqsa Mushtaq
hypoxia :oxygen defecincy at tissue level.in these slides you are going to in touch with its types ,causes effects.share whatever you wanted to say comment us .
these notes are provided by our loving mam MAM SANIA .thanks to teach us mam :)
Hypoxia is O2 deficiency at the tissue level. A pathological condition in which the whole body as a whole or a region of the body is deprived of adequate oxygen supply. It is the decrease below normal levels of oxygen in inspired gases, arterial blood, or tissues, without reaching anoxia.
2. High altitude. Low hemoglobin level. Decreased oxygen supply to an area. Low oxygen carrying capacity. P
Introduction
Transport of O2 in the blood
Oxygen movement in the lungs and tissues
O2 dissociation curve
Bohr effect
Applied
Transport of CO2
The haldane effect
Chloride Shift or Hamburger Phenomenon
Reverse Chloride Shift
Surfactant & compliance, LAW OF LAPLACE, Work of Breathing (the guyton and ha...Maryam Fida
It is a lipoprotein mixture present in thin layer of fluid lining the alveoli at the air fluid interface.
COMPOSITION
It is composed of
Apoprotein
Calcium ions
Phospholipids i.e. dipalmitoyl lecithin
Surfactant is secreted by
1. Mainly type II alveolar cells in the lungs.
2. Clara cells, which are situated in the bronchioles.
It lowers the surface tension of fluid lining the alveoli.
Surface tension is inversely proportional to surfactant concentration.
During inspiration surfactant molecules move apart as lungs are expanded and during expiration surfactant molecules become concentrated as lungs shorten.
When there is no surfactant, Surface Tension is 50 dynes/cm. when surfactant is present it is 5-30 dynes/cm depending upon the concentration
Prevents collapse of lungs
Stabilize size of alveoli
Surfactant helps to keep lungs expanded. If there is deficiency of surfactant then the pressure of -20 to -30 mm of Hg will be required to keep the lungs expanded
Surfactant also helps to keep the alveoli dry and prevent development of pulmonary edema.
Surfactant is also helpful in lung expansion at birth. If there is deficiency then there is Respiratory Distress Syndrome.
LAW OF LAPLACE:
pressure required to keep a hollow viscous distended = 2 T/R
Where T is tension and R is radius.
During expiration, size of alveoli decreases so R is decreased and if T does not decrease, much higher pressure will be required to keep the alveoli distended.
When adequate amount of surfactant is there T also decreases so increased pressure is not required. This prevents the collapse of lungs and also stabilizes the equal size of alveoli
Definition:
“Compliance is the measure of expansibility or distensibility of the lungs. It indicates with how much ease lungs can be expanded”.
Work of Breathing
In certain diseases there is increased work of breathing and depending upon the nature of breath there will be specific increase in work of breathing.
In asthma there is increase in work of breathing to overcome airway resistance
In restrictive lung diseases there is increase work of breathing in both tissue resistance and elastic recoil.
Transport of oxygen (the guyton and hall physiology)Maryam Fida
Supply of oxygen to tissues mainly involves two systems i.e. respiratory system and the cardiovascular system.
Supply of oxygen to tissues depends upon
Adequate PO2 in atmospheric air
Adequate pulmonary ventilation
Adequate gaseous exchange in the lungs
Adequate uptake of oxygen by the blood
Adequate blood flow to the tissues
Adequate ability of the tissues to utilize oxygen
Oxygen diffuses from the alveoli into the pulmonary capillary blood because the oxygen partial pressure (Po2) in the alveoli is greater than the Po2 in the pulmonary capillary blood.
In the other tissues of the body, a higher Po2 in the capillary blood than in the tissues causes oxygen to diffuse into the surrounding cells.
The Po2 of the gaseous oxygen in the alveolus averages 104 mm Hg,
whereas the Po2 of the venous blood entering the pulmonary capillary at its arterial end averages only 40 mm Hg
Therefore, the initial pressure difference that causes oxygen to diffuse into the pulmonary capillary is 104 – 40, or 64 mm Hg.
About 98 percent of the blood that enters the left atrium from the lungs has just passed through the alveolar capillaries and has become oxygenated up to a Po2 of about 104 mm Hg.
Another 2 per cent of the blood which supplies mainly the deep tissues of the lungs and is not exposed to lung air. This blood flow is
called “shunt flow,” meaning that blood is shunted past the gas exchange areas
One gram of Hb can bind 1.34 ml of Oxygen
Normal level of Hb is 15 grams/dL
Thus 15 grams of hemoglobin in 100 milliliters of blood can combine with a total of almost exactly 20 milliliters of oxygen if the hemoglobin is 100 per cent saturated
This is usually expressed as 20 volumes per cent
Hemoglobin is a conjugated protein consisting of heme and globin.
The ferrous form can bind oxygen.
Hemoglobin molecule consists of four subunits each consists of one heme and one polypeptide chain
Each subunit can bind one molecule of Oxygen
Oxygenation is a very rapid and reversible process and it can occur in 0.01 seconds
When PO2 is high, oxygen binds with Hb to form Oxyhemoglbin
When PO2 is low oxygen leaves Hb to form Deoxy Hb.
Factors that shift the oxygen hemoglobin dissociation curve
Hypoxia is O2 deficiency at the tissue level. A pathological condition in which the whole body as a whole or a region of the body is deprived of adequate oxygen supply. It is the decrease below normal levels of oxygen in inspired gases, arterial blood, or tissues, without reaching anoxia.
2. High altitude. Low hemoglobin level. Decreased oxygen supply to an area. Low oxygen carrying capacity. P
Introduction
Transport of O2 in the blood
Oxygen movement in the lungs and tissues
O2 dissociation curve
Bohr effect
Applied
Transport of CO2
The haldane effect
Chloride Shift or Hamburger Phenomenon
Reverse Chloride Shift
Surfactant & compliance, LAW OF LAPLACE, Work of Breathing (the guyton and ha...Maryam Fida
It is a lipoprotein mixture present in thin layer of fluid lining the alveoli at the air fluid interface.
COMPOSITION
It is composed of
Apoprotein
Calcium ions
Phospholipids i.e. dipalmitoyl lecithin
Surfactant is secreted by
1. Mainly type II alveolar cells in the lungs.
2. Clara cells, which are situated in the bronchioles.
It lowers the surface tension of fluid lining the alveoli.
Surface tension is inversely proportional to surfactant concentration.
During inspiration surfactant molecules move apart as lungs are expanded and during expiration surfactant molecules become concentrated as lungs shorten.
When there is no surfactant, Surface Tension is 50 dynes/cm. when surfactant is present it is 5-30 dynes/cm depending upon the concentration
Prevents collapse of lungs
Stabilize size of alveoli
Surfactant helps to keep lungs expanded. If there is deficiency of surfactant then the pressure of -20 to -30 mm of Hg will be required to keep the lungs expanded
Surfactant also helps to keep the alveoli dry and prevent development of pulmonary edema.
Surfactant is also helpful in lung expansion at birth. If there is deficiency then there is Respiratory Distress Syndrome.
LAW OF LAPLACE:
pressure required to keep a hollow viscous distended = 2 T/R
Where T is tension and R is radius.
During expiration, size of alveoli decreases so R is decreased and if T does not decrease, much higher pressure will be required to keep the alveoli distended.
When adequate amount of surfactant is there T also decreases so increased pressure is not required. This prevents the collapse of lungs and also stabilizes the equal size of alveoli
Definition:
“Compliance is the measure of expansibility or distensibility of the lungs. It indicates with how much ease lungs can be expanded”.
Work of Breathing
In certain diseases there is increased work of breathing and depending upon the nature of breath there will be specific increase in work of breathing.
In asthma there is increase in work of breathing to overcome airway resistance
In restrictive lung diseases there is increase work of breathing in both tissue resistance and elastic recoil.
Transport of oxygen (the guyton and hall physiology)Maryam Fida
Supply of oxygen to tissues mainly involves two systems i.e. respiratory system and the cardiovascular system.
Supply of oxygen to tissues depends upon
Adequate PO2 in atmospheric air
Adequate pulmonary ventilation
Adequate gaseous exchange in the lungs
Adequate uptake of oxygen by the blood
Adequate blood flow to the tissues
Adequate ability of the tissues to utilize oxygen
Oxygen diffuses from the alveoli into the pulmonary capillary blood because the oxygen partial pressure (Po2) in the alveoli is greater than the Po2 in the pulmonary capillary blood.
In the other tissues of the body, a higher Po2 in the capillary blood than in the tissues causes oxygen to diffuse into the surrounding cells.
The Po2 of the gaseous oxygen in the alveolus averages 104 mm Hg,
whereas the Po2 of the venous blood entering the pulmonary capillary at its arterial end averages only 40 mm Hg
Therefore, the initial pressure difference that causes oxygen to diffuse into the pulmonary capillary is 104 – 40, or 64 mm Hg.
About 98 percent of the blood that enters the left atrium from the lungs has just passed through the alveolar capillaries and has become oxygenated up to a Po2 of about 104 mm Hg.
Another 2 per cent of the blood which supplies mainly the deep tissues of the lungs and is not exposed to lung air. This blood flow is
called “shunt flow,” meaning that blood is shunted past the gas exchange areas
One gram of Hb can bind 1.34 ml of Oxygen
Normal level of Hb is 15 grams/dL
Thus 15 grams of hemoglobin in 100 milliliters of blood can combine with a total of almost exactly 20 milliliters of oxygen if the hemoglobin is 100 per cent saturated
This is usually expressed as 20 volumes per cent
Hemoglobin is a conjugated protein consisting of heme and globin.
The ferrous form can bind oxygen.
Hemoglobin molecule consists of four subunits each consists of one heme and one polypeptide chain
Each subunit can bind one molecule of Oxygen
Oxygenation is a very rapid and reversible process and it can occur in 0.01 seconds
When PO2 is high, oxygen binds with Hb to form Oxyhemoglbin
When PO2 is low oxygen leaves Hb to form Deoxy Hb.
Factors that shift the oxygen hemoglobin dissociation curve
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
3. Why artificial respiration?
To maintain vitality of the nerve centers, heart
To maintain circulation
To stimulate respiratory centers
To help respiratory centers to take-up their own
spontaneous rhythm
5. Schafer’s method
Subject is laid in prone position
Pillow is placed underneath the chest
Head is turned to one side
Operator kneels down by the side of subject facing
towards his head
Two hands are placed on the two sides of the lower part
of the chest
Operator puts his body weight leaning forwards and
presses the loins of the subject
6. Schafer’s method
Increase in the intra-abdominal pressure
Diaphragm pushed up
Air is forced out of lungs
Operator releases the pressure and comes back to erect
position
Abdominal pressure falls
Diaphragm descends
Air enters the lungs (procedure repeated for 12 times a
minute)
8. Sylvester’s method
Subject placed in supine position
Operator kneels at the head end
Holds the two arms of subject
Operator raises the subject’s hands above the head
Folds the hands back upon the chest
Compressing the chest wall
Repeat the movements
Air enters and leaves lungs
10. Holger-Neilson method
Subject placed in prone position
Arms abducted at the shoulders
Elbows remain flexed
Face is turned to one side and rests on hands
Mouth is cleaned after wiping out mucus
Operator kneels down in front of subject facing towards
head
Two hands placed on two sides of the back of the chest
Operator puts his weight on subjects back by leaning
forward – compression of chest – expiration
11. Holger-Neilson method
Subject arms forwards by holding them above the
elbows
Helps in natural inspiration
Process repeated for 10-12 times a minute
13. Mouth-to-mouth method
Subject is laid in the supine position with extended head
Operator sits by side of subjects head
Operator holds the lower jaw of subject by one thumb
and index finger
Clamps the nostrils with the other thumb and index finger
Operator keeps his mouth over the subjects mouth and
exhales forcibly
Inflation of lungs and thorax (positive pressure breathing)
Operator takes off his mouth
Process repeated 10-20 times for minute
14. Eve’s rocking method
Patient tied on a stretcher
Head and feet are alternatively tilted through an
angle of 45 degrees
8-9 movements are carried out per minute
7 seconds per each movement
4 seconds head down - expiration
3 seconds feet down - inspiration
16. Instrumental methods
Negative pressure breathing – alternatively
compressing and relaxing chest wall
Positive pressure breathing – introducing oxygen
directly into the lungs
17.
18.
19. Normal Pressures
Normally atmospheric pressure or barometric
pressure is about 760 mmHg
Out of this, contribution of oxygen is 21% that is
pressure of oxygen is 160 mmHg (out of 760 mmHg)
Alveolar PO2 is 104 mmHg
As per diffusion, the PO2 should be same in
atmosphere and alveoli. Why it is not same?
20. What happens in high altitudes
Pressure of oxygen in the atmosphere drops (less
than 160 mmHg)
Imagine it becomes 130 mmHg
PO2 of alveoli decreases significantly
Imagine it may decrease to 60 mmHg or less
What is the problem??
21. PO2 at high altitude
1. Atmospheric PO2 is 130 mmHg
2. Alveolar PO2 is 60 mmHg
3. PO2 of the Blood entering the lungs is 40 mmHg
4. PO2 of the Blood leaving the lungs is 60 mmHg
5. This is called hypoxemia - abnormally low level of
oxygen in the blood.
22. Effect of hypoxemia
When PO2 less than 60 mmHg (stimulus)
Stimulation of peripheral chemo receptors
Inactivation of potassium channels
Opening of calcium channels
Release of neurotransmitter
Stimulation of nerves (cranial nerves IX and X)
Sends signals to respiratory centers
increase in the frequency of motor signals
23. Effect of hypoxemia
Increase in the frequency of stimulation of
diaphragm
Increase in the contraction
Increase in alveolar ventilation
Increase in the rate and depth of respiration
Tries to bring more air in
Imagine it increases PO2 to 80 mmHg
24. PO2 after hypoxemia effect
1. Atmospheric PO2 is 130 mmHg
2. Alveolar PO2 is 80 mmHg
3. PO2 of the Blood entering the lungs is 40 mmHg
4. PO2 of the Blood leaving the lungs is 80 mmHg
25. What happens to stimulus to
PCR?
1. When alveolar PO2 is 80 mmHg
2. PO2 of the Blood entering the lungs is 40 mmHg
3. PO2 of the Blood leaving the lungs is 80 mmHg
4. The movement PO2 increases to 80 mmHg, the
stimulus to PCR goes away
5. No stimulation to DRG and respiration slowdown
26. PCO2 at high altitude
1. As we move to high altitudes, PCO2 also decreases
slightly
2. Say Atmospheric PCO2 decreased to 25 mmHg
3. Alveolar PCO2 is 25 mmHg
4. PCO2 of the Blood entering the lungs is 45 mmHg
(pressure gradient increased)
5. PCO2 of the Blood leaving the lungs is 25 mmHg (more
CO2 goes out)
6. PCO2 decreases in the blood (very bad??)
28. CO2 – Normal Mechanism
CO2 easily cross Blood brain barrier
When PCO2 increases in interstitial fluid of medulla
and CSF, the CO2 reacts with water of the tissues and
forms carbonic acid
Carbonic acid dissociates and releases hydrogen ions
Hydrogen ions stimulates the chemo sensitive area
and thus respiration
29. CO2 –Mechanism at high altitude
PCO2 decreases
Decrease in H+ ions
Inhibition of central chemo receptors
Inhibition of DRG
Inhibition of VRG
Decrease in the frequency of action potentials
Decrease in the alveolar ventilation
Decrease in the rate and depth of respiration
30. What is happening
Initially there is hypoxemia
Increase in ventilation
Brings PO2 back to normal
In this process more CO2 moves out
PCO2 decreases
Inhibition of CCR
Decrease in the ventilation
OPPOSITE ACTIONS
31. Lost more CO2 from body?
If we breath out more CO2
Respiratory alkalosis
PH is very high due to low PO2
32. How your body deals this condition?
Acclimatization
Kidney comes into the role
kidney consists of intercalated cells
When PH increases in blood (decrease in H+ ions)
Intercalated cells pumps H+ ions out (into blood)
Increase in H+ ions (PH back to normal)
Stimulation of CCR
Stimulation of respiratory centers
Increase in the rate and depth of respiration
33. Is this enough?
No …. Not enough
Kidney again comes into the role
When the PO2 decreases (hypoxia)
When PH increases in blood (decrease in H+ ions)
Hypoxia inducing factor is released from PCT
Production of hormone - erythropoietin
Stimulation of bone marrow
Increase in RBC (polycythemia) – increase in HB
Increase in oxygen carrying capacity
34. Is this enough?
No …. Not enough
Due to polycythemia there is increase in the
perfusion
Due to hypoxemia there is increase in the
ventilation
Increase in ventilation and perfusion
Good V/P coupling there
Efficient gaseous exchange
35. Is this enough?
Yes for short periods stay
If stay for longer periods angiogenesis takes place
Angiogenesis - formation of new blood vessels
36. Angiogenesis
In high altitude PO2 decreases
Less oxygen supply to tissues
Endothelial cells of blood vessels releases
vascular endothelial growth factor (VGF)
Sprouts blood vessels
More blood vessels
Angiogenesis
37. Is this enough?
If stay still very longer periods the shape of chest
wall also changes to large or barrel shape.
Increase in the diffusion capacity due to increase in
the pulmonary capillary blood volume and increase
in the lung air volume.
In permanent natives of high altitudes, the number
of mitochondria and cellular enzymes is plentiful
than the sea level habitants. (cellular
acclimatization)
38. Acclimatization
1. Increase in the rate and depth of respiration
2. Increase in the RBC (polycythemia)
3. Normal V/P ratio (efficient gas exchange)
4. Angiogenesis
5. Change in shape of chest
39. How long it takes to climb Everest
1. Entire climb takes 6-9 weeks
2. First week – arrive to base camp
3. Next 3-4 weeks – going up and down the
mountain to establish camps with food, fuel and
oxygen
4. Acclimatization process can not be rushed
40. If you climb Everest very fast???
Acclimatization will not takes place
Cerebral edema
Pulmonary edema
Called as Acute mountain sickness
41. Cerebral edema at high altitude?
Low PO2 in systemic circulation
Vasodilation of blood vessels
Increase in the blood flow through cerebral blood
vessels
More fluid loss
Increase in fluid accumulation
Cerebral edema
42. Cerebral edema at high altitude?
Increase in intra cranial pressure
Head ache
Increase in Pulse rate
Herniation of brain that compresses the respiratory
centers
Death
43. What medications should I carry?
Acetazolamide (inhibits carbonic anhydrase) and
increases CO2 (stimulates RC)
Mannitol (relieves cerebral edema)
Dexamethasone (steroid) – relieves cerebral
edema
Oxygen supplements
44. pulmonary edema at high altitude?
Low PO2 in pulmonary circulation
Vasoconstriction of blood vessels
Blood is diverted to medium constricted or normal
blood vessels
Increase in blood flow
Increase in leak of fluid
Accumulation of fluid
Pulmonary edema
45. Chronic mountain sickness
Seen in individuals who stays for long at high altitudes
Polycythemia increases viscosity of blood and decreases
the blood flow to the tissues ( oxygen delivery decreases)
All alveoli now becomes low oxygen state, so
vasoconstriction of all pulmonary blood vessels results in
increase in the arterial pressure and failure of right side of
heart.
Poorly oxygenated blood
These individuals recover within days or weeks when they
are moved to low altitudes
46. Deep sea diving
Descending beneath the sea, the pressure
increases tremendously
To prevent collapse of lungs, air must be supplied at
very high pressures
This will expose the blood in the lungs to extremely
high pressure – hyper-barism
Beyond certain limits, these high pressures cause
major alterations in the body physiology and can be
lethal
47. Physiological effects of deep sea
diving
Nitrogen narcosis at high nitrogen pressure
Oxygen toxicity at high pressure
Carbon dioxide toxicity due to deep sea diving
48. Nitrogen narcosis
At the sea level pressure, the nitrogen has no significant
effect on body functions
When the diver remains beneath the sea for an hour or
more and breathing compressed air, the depth at which
the first symptom occurs is 120 feet
At 120 feet, diver begins to be jovial
At 150-200 feet, he becomes drowsy
At 200-250 feet, his strength wanes considerably (
unable to do required work)
Beyond 250 feet, he becomes useless
49. Nitrogen narcosis
Similar as alcoholic intoxication
Also called raptures of the depths
Mechanism is same as any other gas anesthetics
Nitrogen dissolves in the fatty substances in the
neural membranes, alters the neuronal excitability
50. Oxygen toxicity at high pressures
When PO2 of blood increases (say 100 mmHg), there
will be increase in the dissolved oxygen in addition to
that bound to hemoglobin
Extremely high PO2 (when oxygen is breathed at high
pressures) is detrimental to body tissues
Causes brain seizures and coma in 30-60 minutes
These seizures occurs with out warning sign and are
lethal
Nausea, muscle twitchings, dizziness, disturbance of
vision, irritability and disorientation
51. Oxygen toxicity at high pressures
Molecular oxygen converts into active form of oxygen called
oxygen free radicals
One of the most important form of oxygen free radicals is
super oxide free radical and other is peroxide free radical
Even at normal PO2, these free radicals will be continuously
formed
Body is equipped with enzymes to remove these free radicals
(oxidases, catalases, superoxide dismutase)
But when PO2 is above the critical levels, there will be
excessive oxygen free radicals
52. Oxygen toxicity at high pressures
Free radicals oxidizes the polyunsaturated fatty
acids that are essential components of many of cell
membranes
Also oxidizes cellular enzymes and damages the
cellular metabolic processes
Nervous tissues are highly susceptible due to
high lipid content
Most lethal effect of oxygen toxicity is brain
dysfunction
53. Carbon dioxide toxicity
Depth alone does not increase the rate of CO2 production in
the body
As long as diver continues to breath normal tidal volume and
expires the CO2 as it is formed, Alveolar PCO2 will be
normal.
In certain types of diving gear, diving helmet and some type
of rebreathing apparatus, CO2 will build up.
Beyond 80 mmHg PCO2, the respiratory centers will be
depressed.
Respiratory acidosis, narcosis, lethargy and even anesthesia.
54. Decompression sickness
If a diver stays longer periods beneath the sea,
nitrogen is dissolved in the body
If he comes to surface suddenly, nitrogen bubbles
are formed in the body fluids (intra or extra cellular)
Cause minor to serious damage to any area of the
body
This is called as Decompression sickness
Also called as Bends, compressed air sickness,
Caisson disease, Diver’s paralysis, Dysbarism
55. Symptoms of Decompression
sickness
Gas bubbles blocks many blood vessels in different
tissues
Tissue ischemia and death
In 85-90% of people, pain in the joints and muscles
of legs and arms (bends)
In 5-10% of people, paralysis, dizziness or
unconsciousness
in 2% of people, chokes, shortness of breath,
pulmonary edema and death
56. Prevention and management of
Decompression sickness
Slow ascent
Tank decompression
Using helium oxygen mixture in spite of nitrogen
Why??
57. Why helium??
Has only one-fifth of narcotic effect of nitrogen
The amount of helium dissolves in the body is less
when compared to nitrogen
Low density of helium keeps the airway resistance
minimum (work of breathing less)
58. SCUBA
Self Contained Under Water Breathing Apparatus
Designed by French explorer Jacques Cousteau
Advantage- Only required amount of air enters the
mask and on expiration, the air can not go back to
tank but instead is expired into the sea
Limitation – only limited time one can remain
beneath water