essay
Unit 4: Musculoskeletal Disorders Gould: Chpt. 26: Porth: Chpt. 58 Unit 5: Respiratory Disorders Gould: Chpt. 19: Porth: Chpt.28, 29 The main function of the respiratory system is gas exchange which provides body tissues with adequate O2 for cellular metabolism, and removes CO2, a by-product of metabolism The respiratory system works in conjunction with the renal system to maintain blood pH and acid-base balance: Facts for Review: normal pH: 7.35 – 7.45 reflected in a HCO3- to H2CO3 ratio of 20:1 normal serum HCO3-: 24-31 mmol/L normal serum CO2: 24-29 mmol/L, Pa CO2: 35-42 mm Hg normal PaO2: 95-100 mm Hg arterial O2 saturation (SaO2) : 96%-98% Base excess or deficit is essentially a measurement of HCO3- excess or deficit, and describes the amt of acid or base that must be added to bring the blood pH to 7.4 O2 saturation (SaO2) reflects the degree to which O2 is bound to available sites on hemoglobin and therefore the oxygenation of the blood CO2 + H2O H2CO3 H+ + HCO3- lungs kidneys * -H2CO3: carbonic acid -acidic conditions push the equation to the right: more CO2 from resp. acidosis leads to higher H+ levels and decreased pH -the above equation represents the main buffer system in the body: the bicarbonate-carbonic acid buffer system: acts to buffer blood pH (Corwin) -allows excess H+ in the system to be converted to carbonic acid, resulting in fewer free H+ remaining in solution, preventing blood pH from falling -Carbonic acid can also be converted to CO2: hence, excess H+ can be removed from the system as CO2 -base excess represents (metabolic) alkalosis, and base deficit represents (metabolic) acidosis -PaO2 represents the amount of O2 dissolved in the plasma -O2 saturation: amount of oxygen bound to hemoglobin in comparison with the amount of oxygen Hb can carry -adequate oxygenation of the blood is from 100 mm Hg to 60 mmHg (down from 100): in this range, saturation is still high, ~ 90% Respiratory System Review: Anatomy Upper Respiratory Tract: passageways that conduct air between the atmosphere and lungs: nose, nasal cavity, pharynx, larynx Lower Respiratory Tract: trachea, bronchi, bronchioles and lungs (alveoli) Lungs: right, three lobes; left, two lobes; lobes are divided into lobules Each lung resides in a pleural cavity and is surrounded by a double-layered pleura parietal pleura attaches the lung to the thoracic wall and diaphragm; the visceral pleura covers the lung surface layers are separated by a pleural cavity containing pleural fluid fluid creates surface tension that helps to keep the naturally recoiling lungs inflated and reduces friction Figure 23-12 Marieb Figure 9-2 Mader * Respiratory System Review: Anatomy Cont’d Each lobe has a bronchiole which brings air to many alveoli Alveoli: sac of simple squamous epithelium surrounded by capillaries where gas exchange occurs Figure 9-5 Mader Figure 23-9D Marieb The walls of the alveoli with their fused basement membranes form the respiratory membrane across which gas exchange occurs endothelial cell Respiratory membrane Nucleus of squamous epithelial cell Red blood cell Capillary * Ventilation-Perfusion Coupling The ventilation:perfusion ratio (VE/Q) reflects the match of air flow through the alveoli to blood flow in the adjacent pulmonary capillaries Gas exchange is most efficient when ventilation matches perfusion The pulmonary arterioles will constrict or dilate in order to match ventilation with perfusion Figure 27-21 Porth Mismatch occurs when: ventilated alveoli are not well perfused perfused alveolic are not well ventilated Figure23-19 Marieb * -ventilation: the exchange of gases in the resp, system (Porth) -two types: pulmonary ventilation ~ total exchange of gases between the atmosphere and the lungs; alveolar ventilation ~ exchange of gases within the alveoli -mismatch: poor perfusion e.g. embolism; poor ventilation e.g. atelectasis Respiratory Dysfunction Respiratory Failure occurs when the lungs fail to adequately oxygenate the blood and prevent CO2 retention results from conditions that: impair ventilation e.g. disease of the airways and lungs impair fx’n of resp. center e.g. drug overdose hypoventilation cause ventilation-perfusion mismatch e.g. obstructive or restrictive disease involve chest wall injury/deformities impair diffusion e.g. edema disrupt blood flow in the lungs e.g. pulmonary embolus involve resp. muscle failure e.g. muscular dystrophy Defined by blood gases of: PO2< 50="" mm="" hg="" (hypoxemia)="" pco2=""> 50 mm Hg (hypercapnia) and resp. acidosis Respiratory Insufficiency: state when blood gases are abnormal but cell fx’n can continue Respiratory Arrest: cessation of respiratory activity * -obstructive disease e.g. cystic fibrosis, cancer, aspiration, asthma -restrictive disease: those in which lung expansion is impaired and total lung capacity is reduced e.g. kyphosis, pulmonary fibrosis, pleural effusion Hypoxemia Hypoxemia: condition of reduced arterial O2 concentration Causes: decreased O2 in air (hypoxia) hypoventilation impaired diffusion e.g. edema shunt hypoperfusion e.g. embolus anemia Manifestations: ~ tissue hypoxia and compensatory mechanisms PO2 < 50 mm hg, ph tachycardia, slight bp, pale, cool, clammy skin ~ sns compensation hyperventilation ~ low o2 stimulation of peripheral chemoreceptors impaired mental fx’n e.g. confusion, delirium impaired sensory fx’n e.g. visual impairment stupor and coma (late) bradycardia and bp (late) cyanosis (late) * -decreased ph ~ anaerobic metabolism by cells -shunt: blood moves from the venous side to the arterial side without first passing through the lungs -recall; mild hypoxemia produces few manifestations because at 6o mm hg, the o2 saturation is still ~90% -peripheral chemoreceptors respond to o2 levels: create respiratory drive -bradycardia and hypotension are considered preterminal conditions, indicating failure of compensatory mechanisms hypoxemia cont’d compensations: tachycardia, slight bp, pale, cool, clammy skin ~ sns activity hyperventilation ~ low o2 stimulation of peripheral chemoreceptors polycythemia is only beneficial if hypoxemia is not acute or due to anemia cyanosis: bluish coloration of the skin and mucous membranes when large amts of blood hemoglobin are deoxygenated in the small bvs (5 g or more unsaturated hb per 100 mls blood) in anemia ~ impaired hemoglobin synthesis (e.g. iron-deficiency anemia), hb is low, and the hb present is oxygenated above 5 g /100 ml; no cyanosis cyanosis will also not develop in o2 saturation from carbon monoxide poisoning because the co binds to hb (i.e. the hb is saturated) those who are polycythemic may also be cyanotic without being hypoxic d/t hb bluish coloration of skin is hard to detect in dark-skinned individuals: can be observed in nail beds or testing blood gas o2 levels in providing o2 therapy for hypoxia, rate of administration must be closely monitored to prevent oxygen toxicity ~ body disturbances (lung damage, visual and hearing abnormalities, fatigue while breathing, anxiety, confusion twitching, convulsions) * -anemia: decrease in # of circulating functional rbc, abnormal hb; both result in impaired oxygen carrying capacity -carbon monoxide poisoning: co displaces o2 and binds to heme: manifests as bright red coloring of the skin and mucous membranes -note: normal saturation (~98%) is 14.7 g /100 ml -o2 toxicity: alveolar injury caused by high oxygen concentrations (lewis); is believed that high concentrations of o2 may inactivate surfactant and lead to acute respiratory distress syndrome systemic hypoxia systemic hypoxia can result from: hypoxia results in reduced atp synthesis impaired cellular fx’n, membrane integrity, waste removal cell swelling, toxification, ph, loss of enzymes and enzyme fx’n, release of destructive enzymes necrosis compensation mechanisms include: switch to anaerobic metabolism, sns, erythropoietin secretion heart, brain and kidney cells are most susceptible to hypoxia ~ high metabolic rate and o2 requirements inadequate o2 in air respiratory disease or pulmonary edema causing impaired oxygenation in the lungs ischemia anemia: low concentration of functional hemoglobin or rbcs o2 carrying capacity generalized edema * -hypoxia: decrease below normal levels of o2 in inspired gases, arterial blood or tissues; in this case, the tissue hypoxia is due to decreased perfusion (ischemic) -inadequate o2 in air~ reduced atmospheric pressure, carbon monoxide poisoning -lung disease: hypoxic hypoxia: results from a defective mechanism of oxygenation in the lungs -ischemia: ischemic hypoxia; tissue hypoxia d/t arterial obstruction or vasoconstriction -anemia: anemic hypoxia hypoxia resulting from a decreased concentration of functional hb or a reduced # of eryrthrocytes -edema increases diffusion distance in tissues - sns manifests as tachycardia, bp~ tpr -neurons cannot last longer than 5 minutes, cardiac muscle not longer than 20 minutes -o2 requirements in brain: nrg in brain mainly provided by atp: brain receives 1/6 of co and accounts for 20% of o2 consumption (porth, pg 1160) hypercapnia blood pco2; occurs with hypoxia causes: same as hypoxia, esp. hypoventilation and ventilation-perfusion mismatch; also cellular metabolism or high carbohydrate diet central chemoreceptors respond to co2 by respiration rate; over time these receptors become less sensitive peripheral receptors control respiration by responding to levels of o2 (hypoxic respiratory drive) in persons with resp. disease causing chronic hypoxia and hypercapnia, administration of o2 may suppress respiratory drive ~ peripheral receptors respiration rate and further hypercapnia manifestations: respiratory acidosis: co2, ph, hco3- (renal compensation) vasodilation: headache, flushed skin suppression of neural fx’n: lethargy, drowsiness, disorientation, coma air hunger and rapid breathing * -note: co2 has vasodilator effects as a metabolite of cellular metabolism -headache: ~ vasodilation of neural bvs -high carb diet: increases production of co2 (porth) -respiratory drive: decreased sensitivity means that the central receptors no longer regulate respiration based on co2 levels (there is a compensatory increase in bicarbonate secretion into the csf, which buffers the h+ ions); therefore rely on stimulation for ventilation by low o2 levels; hypoxia is the main stimulus for ventilation in those with chronic hypercapnia; administration of o2 at a level sufficient to increase po2 above that needed to stimulate the peripheral receptors can lead to depression of ventilation -vasodilation: recall that metabolites cause dilation of local arterioles -suppression of neural fx’n: ~ acidosis as well as hypoxia aspiration aspiration: the passage of food, fluid or other foreign material into the trachea or lungs usually, the cough reflex removes material from the upper tract and passage into the lower tract is prevented by the vocal cords and epiglottis complete obstruction of upper tract inhibits the ability to speak or cough; blockage of the trachea is life-threatening ~ inadequate oxygenation sharp pointed objects and fatty or irritating solids cause inflammation which causes swelling, edema and bronchoconstriction block air flow pointed objects may also form a “bridge” upon which other materials collect and cause obstruction peanuts and legumes may swell and become more firmly lodged the right lower lung is usually the lodging site of aspirated objects wherever in the tract the object lodges, it obstructs air flow beyond that point obstruction of a bronchus no air delivery and collapse distal to the obstruction (atelectasis) figure 19-20c gould * -cough: inspire air, close the glottis, then forcefully expel the air against the glottis causing the unwanted material to move upward and out of the mouth or to swallow it -milk ~ oil, vomitus ~ acid -right lung: due to anatomy of bronchioles which go “straight” down compared to the left fluid aspiration if the alveoli are affected by inflammation, gas exchange is impaired; severe inflammation with the accompanying build up of fluids is called 50="" mm="" hg,="" ="" ph="" tachycardia,="" slight="" ="" bp,="" pale,="" cool,="" clammy="" skin="" ~="" sns="" compensation="" hyperventilation="" ~="" low="" o2="" stimulation="" of="" peripheral="" chemoreceptors="" impaired="" mental="" fx’n="" e.g.="" confusion,="" delirium="" impaired="" sensory="" fx’n="" e.g.="" visual="" impairment="" stupor="" and="" coma="" (late)="" bradycardia="" and="" ="" bp="" (late)="" cyanosis="" (late)="" *="" -decreased="" ph="" ~="" anaerobic="" metabolism="" by="" cells="" -shunt:="" blood="" moves="" from="" the="" venous="" side="" to="" the="" arterial="" side="" without="" first="" passing="" through="" the="" lungs="" -recall;="" mild="" hypoxemia="" produces="" few="" manifestations="" because="" at="" 6o="" mm="" hg,="" the="" o2="" saturation="" is="" still="" ~90%="" -peripheral="" chemoreceptors="" respond="" to="" o2="" levels:="" create="" respiratory="" drive="" -bradycardia="" and="" hypotension="" are="" considered="" preterminal="" conditions,="" indicating="" failure="" of="" compensatory="" mechanisms="" hypoxemia="" cont’d="" compensations:="" tachycardia,="" slight="" ="" bp,="" pale,="" cool,="" clammy="" skin="" ~="" sns="" activity="" hyperventilation="" ~="" low="" o2="" stimulation="" of="" peripheral="" chemoreceptors="" polycythemia="" is="" only="" beneficial="" if="" hypoxemia="" is="" not="" acute="" or="" due="" to="" anemia="" cyanosis:="" bluish="" coloration="" of="" the="" skin="" and="" mucous="" membranes="" when="" large="" amts="" of="" blood="" hemoglobin="" are="" deoxygenated="" in="" the="" small="" bvs="" (5="" g="" or="" more="" unsaturated="" hb="" per="" 100="" mls="" blood)="" in="" anemia="" ~="" impaired="" hemoglobin="" synthesis="" (e.g.="" iron-deficiency="" anemia),="" hb="" is="" low,="" and="" the="" hb="" present="" is="" oxygenated="" above="" 5="" g="" 100="" ml;="" no="" cyanosis="" cyanosis="" will="" also="" not="" develop="" in="" ="" o2="" saturation="" from="" carbon="" monoxide="" poisoning="" because="" the="" co="" binds="" to="" hb="" (i.e.="" the="" hb="" is="" saturated)="" those="" who="" are="" polycythemic="" may="" also="" be="" cyanotic="" without="" being="" hypoxic="" d/t="" ="" hb="" bluish="" coloration="" of="" skin="" is="" hard="" to="" detect="" in="" dark-skinned="" individuals:="" can="" be="" observed="" in="" nail="" beds="" or="" testing="" blood="" gas="" o2="" levels="" in="" providing="" o2="" therapy="" for="" hypoxia,="" rate="" of="" administration="" must="" be="" closely="" monitored="" to="" prevent="" oxygen="" toxicity="" ~="" body="" disturbances="" (lung="" damage,="" visual="" and="" hearing="" abnormalities,="" fatigue="" while="" breathing,="" anxiety,="" confusion="" twitching,="" convulsions)="" *="" -anemia:="" decrease="" in="" #="" of="" circulating="" functional="" rbc,="" abnormal="" hb;="" both="" result="" in="" impaired="" oxygen="" carrying="" capacity="" -carbon="" monoxide="" poisoning:="" co="" displaces="" o2="" and="" binds="" to="" heme:="" manifests="" as="" bright="" red="" coloring="" of="" the="" skin="" and="" mucous="" membranes="" -note:="" normal="" saturation="" (~98%)="" is="" 14.7="" g="" 100="" ml="" -o2="" toxicity:="" alveolar="" injury="" caused="" by="" high="" oxygen="" concentrations="" (lewis);="" is="" believed="" that="" high="" concentrations="" of="" o2="" may="" inactivate="" surfactant="" and="" lead="" to="" acute="" respiratory="" distress="" syndrome="" systemic="" hypoxia="" systemic="" hypoxia="" can="" result="" from:="" hypoxia="" results="" in="" reduced="" atp="" synthesis="" ="" impaired="" cellular="" fx’n,="" membrane="" integrity,="" waste="" removal="" ="" cell="" swelling,="" toxification,="" ="" ph,="" loss="" of="" enzymes="" and="" enzyme="" fx’n,="" release="" of="" destructive="" enzymes="" ="" necrosis="" compensation="" mechanisms="" include:="" switch="" to="" anaerobic="" metabolism,="" ="" sns,="" ="" erythropoietin="" secretion="" heart,="" brain="" and="" kidney="" cells="" are="" most="" susceptible="" to="" hypoxia="" ~="" high="" metabolic="" rate="" and="" o2="" requirements="" inadequate="" o2="" in="" air="" respiratory="" disease="" or="" pulmonary="" edema="" causing="" impaired="" oxygenation="" in="" the="" lungs="" ischemia="" anemia:="" low="" concentration="" of="" functional="" hemoglobin="" or="" rbcs="" ="" ="" o2="" carrying="" capacity="" generalized="" edema="" *="" -hypoxia:="" decrease="" below="" normal="" levels="" of="" o2="" in="" inspired="" gases,="" arterial="" blood="" or="" tissues;="" in="" this="" case,="" the="" tissue="" hypoxia="" is="" due="" to="" decreased="" perfusion="" (ischemic)="" -inadequate="" o2="" in="" air~="" reduced="" atmospheric="" pressure,="" carbon="" monoxide="" poisoning="" -lung="" disease:="" hypoxic="" hypoxia:="" results="" from="" a="" defective="" mechanism="" of="" oxygenation="" in="" the="" lungs="" -ischemia:="" ischemic="" hypoxia;="" tissue="" hypoxia="" d/t="" arterial="" obstruction="" or="" vasoconstriction="" -anemia:="" anemic="" hypoxia="" hypoxia="" resulting="" from="" a="" decreased="" concentration="" of="" functional="" hb="" or="" a="" reduced="" #="" of="" eryrthrocytes="" -edema="" increases="" diffusion="" distance="" in="" tissues="" -="" ="" sns="" manifests="" as="" tachycardia,="" ="" bp~="" ="" tpr="" -neurons="" cannot="" last="" longer="" than="" 5="" minutes,="" cardiac="" muscle="" not="" longer="" than="" 20="" minutes="" -o2="" requirements="" in="" brain:="" nrg="" in="" brain="" mainly="" provided="" by="" atp:="" brain="" receives="" 1/6="" of="" co="" and="" accounts="" for="" 20%="" of="" o2="" consumption="" (porth,="" pg="" 1160)="" hypercapnia="" ="" blood="" pco2;="" occurs="" with="" hypoxia="" causes:="" same="" as="" hypoxia,="" esp.="" hypoventilation="" and="" ventilation-perfusion="" mismatch;="" also="" ="" cellular="" metabolism="" or="" high="" carbohydrate="" diet="" central="" chemoreceptors="" respond="" to="" ="" co2="" by="" ="" respiration="" rate;="" over="" time="" these="" receptors="" become="" less="" sensitive="" peripheral="" receptors="" control="" respiration="" by="" responding="" to="" levels="" of="" o2="" (hypoxic="" respiratory="" drive)="" in="" persons="" with="" resp.="" disease="" causing="" chronic="" hypoxia="" and="" hypercapnia,="" administration="" of="" o2="" may="" suppress="" respiratory="" drive="" ~="" peripheral="" receptors="" ="" ="" respiration="" rate="" and="" further="" hypercapnia="" manifestations:="" respiratory="" acidosis:="" ="" co2,="" ="" ph,="" ="" hco3-="" (renal="" compensation)="" vasodilation:="" headache,="" flushed="" skin="" suppression="" of="" neural="" fx’n:="" lethargy,="" drowsiness,="" disorientation,="" coma="" air="" hunger="" and="" rapid="" breathing="" *="" -note:="" co2="" has="" vasodilator="" effects="" as="" a="" metabolite="" of="" cellular="" metabolism="" -headache:="" ~="" vasodilation="" of="" neural="" bvs="" -high="" carb="" diet:="" increases="" production="" of="" co2="" (porth)="" -respiratory="" drive:="" decreased="" sensitivity="" means="" that="" the="" central="" receptors="" no="" longer="" regulate="" respiration="" based="" on="" co2="" levels="" (there="" is="" a="" compensatory="" increase="" in="" bicarbonate="" secretion="" into="" the="" csf,="" which="" buffers="" the="" h+="" ions);="" therefore="" rely="" on="" stimulation="" for="" ventilation="" by="" low="" o2="" levels;="" hypoxia="" is="" the="" main="" stimulus="" for="" ventilation="" in="" those="" with="" chronic="" hypercapnia;="" administration="" of="" o2="" at="" a="" level="" sufficient="" to="" increase="" po2="" above="" that="" needed="" to="" stimulate="" the="" peripheral="" receptors="" can="" lead="" to="" depression="" of="" ventilation="" -vasodilation:="" recall="" that="" metabolites="" cause="" dilation="" of="" local="" arterioles="" -suppression="" of="" neural="" fx’n:="" ~="" acidosis="" as="" well="" as="" hypoxia="" aspiration="" aspiration:="" the="" passage="" of="" food,="" fluid="" or="" other="" foreign="" material="" into="" the="" trachea="" or="" lungs="" usually,="" the="" cough="" reflex="" removes="" material="" from="" the="" upper="" tract="" and="" passage="" into="" the="" lower="" tract="" is="" prevented="" by="" the="" vocal="" cords="" and="" epiglottis="" complete="" obstruction="" of="" upper="" tract="" inhibits="" the="" ability="" to="" speak="" or="" cough;="" blockage="" of="" the="" trachea="" is="" life-threatening="" ~="" inadequate="" oxygenation="" sharp="" pointed="" objects="" and="" fatty="" or="" irritating="" solids="" cause="" inflammation="" which="" causes="" swelling,="" edema="" and="" bronchoconstriction="" ="" block="" air="" flow="" pointed="" objects="" may="" also="" form="" a="" “bridge”="" upon="" which="" other="" materials="" collect="" and="" cause="" obstruction="" peanuts="" and="" legumes="" may="" swell="" and="" become="" more="" firmly="" lodged="" the="" right="" lower="" lung="" is="" usually="" the="" lodging="" site="" of="" aspirated="" objects="" wherever="" in="" the="" tract="" the="" object="" lodges,="" it="" obstructs="" air="" flow="" beyond="" that="" point="" obstruction="" of="" a="" bronchus="" ="" no="" air="" delivery="" and="" collapse="" distal="" to="" the="" obstruction="" (atelectasis)="" figure="" 19-20c="" gould="" *="" -cough:="" inspire="" air,="" close="" the="" glottis,="" then="" forcefully="" expel="" the="" air="" against="" the="" glottis="" causing="" the="" unwanted="" material="" to="" move="" upward="" and="" out="" of="" the="" mouth="" or="" to="" swallow="" it="" -milk="" ~="" oil,="" vomitus="" ~="" acid="" -right="" lung:="" due="" to="" anatomy="" of="" bronchioles="" which="" go="" “straight”="" down="" compared="" to="" the="" left="" fluid="" aspiration="" if="" the="" alveoli="" are="" affected="" by="" inflammation,="" gas="" exchange="" is="" impaired;="" severe="" inflammation="" with="" the="" accompanying="" build="" up="" of="" fluids="" is=""> 50 mm hg, ph tachycardia, slight bp, pale, cool, clammy skin ~ sns compensation hyperventilation ~ low o2 stimulation of peripheral chemoreceptors impaired mental fx’n e.g. confusion, delirium impaired sensory fx’n e.g. visual impairment stupor and coma (late) bradycardia and bp (late) cyanosis (late) * -decreased ph ~ anaerobic metabolism by cells -shunt: blood moves from the venous side to the arterial side without first passing through the lungs -recall; mild hypoxemia produces few manifestations because at 6o mm hg, the o2 saturation is still ~90% -peripheral chemoreceptors respond to o2 levels: create respiratory drive -bradycardia and hypotension are considered preterminal conditions, indicating failure of compensatory mechanisms hypoxemia cont’d compensations: tachycardia, slight bp, pale, cool, clammy skin ~ sns activity hyperventilation ~ low o2 stimulation of peripheral chemoreceptors polycythemia is only beneficial if hypoxemia is not acute or due to anemia cyanosis: bluish coloration of the skin and mucous membranes when large amts of blood hemoglobin are deoxygenated in the small bvs (5 g or more unsaturated hb per 100 mls blood) in anemia ~ impaired hemoglobin synthesis (e.g. iron-deficiency anemia), hb is low, and the hb present is oxygenated above 5 g /100 ml; no cyanosis cyanosis will also not develop in o2 saturation from carbon monoxide poisoning because the co binds to hb (i.e. the hb is saturated) those who are polycythemic may also be cyanotic without being hypoxic d/t hb bluish coloration of skin is hard to detect in dark-skinned individuals: can be observed in nail beds or testing blood gas o2 levels in providing o2 therapy for hypoxia, rate of administration must be closely monitored to prevent oxygen toxicity ~ body disturbances (lung damage, visual and hearing abnormalities, fatigue while breathing, anxiety, confusion twitching, convulsions) * -anemia: decrease in # of circulating functional rbc, abnormal hb; both result in impaired oxygen carrying capacity -carbon monoxide poisoning: co displaces o2 and binds to heme: manifests as bright red coloring of the skin and mucous membranes -note: normal saturation (~98%) is 14.7 g /100 ml -o2 toxicity: alveolar injury caused by high oxygen concentrations (lewis); is believed that high concentrations of o2 may inactivate surfactant and lead to acute respiratory distress syndrome systemic hypoxia systemic hypoxia can result from: hypoxia results in reduced atp synthesis impaired cellular fx’n, membrane integrity, waste removal cell swelling, toxification, ph, loss of enzymes and enzyme fx’n, release of destructive enzymes necrosis compensation mechanisms include: switch to anaerobic metabolism, sns, erythropoietin secretion heart, brain and kidney cells are most susceptible to hypoxia ~ high metabolic rate and o2 requirements inadequate o2 in air respiratory disease or pulmonary edema causing impaired oxygenation in the lungs ischemia anemia: low concentration of functional hemoglobin or rbcs o2 carrying capacity generalized edema * -hypoxia: decrease below normal levels of o2 in inspired gases, arterial blood or tissues; in this case, the tissue hypoxia is due to decreased perfusion (ischemic) -inadequate o2 in air~ reduced atmospheric pressure, carbon monoxide poisoning -lung disease: hypoxic hypoxia: results from a defective mechanism of oxygenation in the lungs -ischemia: ischemic hypoxia; tissue hypoxia d/t arterial obstruction or vasoconstriction -anemia: anemic hypoxia hypoxia resulting from a decreased concentration of functional hb or a reduced # of eryrthrocytes -edema increases diffusion distance in tissues - sns manifests as tachycardia, bp~ tpr -neurons cannot last longer than 5 minutes, cardiac muscle not longer than 20 minutes -o2 requirements in brain: nrg in brain mainly provided by atp: brain receives 1/6 of co and accounts for 20% of o2 consumption (porth, pg 1160) hypercapnia blood pco2; occurs with hypoxia causes: same as hypoxia, esp. hypoventilation and ventilation-perfusion mismatch; also cellular metabolism or high carbohydrate diet central chemoreceptors respond to co2 by respiration rate; over time these receptors become less sensitive peripheral receptors control respiration by responding to levels of o2 (hypoxic respiratory drive) in persons with resp. disease causing chronic hypoxia and hypercapnia, administration of o2 may suppress respiratory drive ~ peripheral receptors respiration rate and further hypercapnia manifestations: respiratory acidosis: co2, ph, hco3- (renal compensation) vasodilation: headache, flushed skin suppression of neural fx’n: lethargy, drowsiness, disorientation, coma air hunger and rapid breathing * -note: co2 has vasodilator effects as a metabolite of cellular metabolism -headache: ~ vasodilation of neural bvs -high carb diet: increases production of co2 (porth) -respiratory drive: decreased sensitivity means that the central receptors no longer regulate respiration based on co2 levels (there is a compensatory increase in bicarbonate secretion into the csf, which buffers the h+ ions); therefore rely on stimulation for ventilation by low o2 levels; hypoxia is the main stimulus for ventilation in those with chronic hypercapnia; administration of o2 at a level sufficient to increase po2 above that needed to stimulate the peripheral receptors can lead to depression of ventilation -vasodilation: recall that metabolites cause dilation of local arterioles -suppression of neural fx’n: ~ acidosis as well as hypoxia aspiration aspiration: the passage of food, fluid or other foreign material into the trachea or lungs usually, the cough reflex removes material from the upper tract and passage into the lower tract is prevented by the vocal cords and epiglottis complete obstruction of upper tract inhibits the ability to speak or cough; blockage of the trachea is life-threatening ~ inadequate oxygenation sharp pointed objects and fatty or irritating solids cause inflammation which causes swelling, edema and bronchoconstriction block air flow pointed objects may also form a “bridge” upon which other materials collect and cause obstruction peanuts and legumes may swell and become more firmly lodged the right lower lung is usually the lodging site of aspirated objects wherever in the tract the object lodges, it obstructs air flow beyond that point obstruction of a bronchus no air delivery and collapse distal to the obstruction (atelectasis) figure 19-20c gould * -cough: inspire air, close the glottis, then forcefully expel the air against the glottis causing the unwanted material to move upward and out of the mouth or to swallow it -milk ~ oil, vomitus ~ acid -right lung: due to anatomy of bronchioles which go “straight” down compared to the left fluid aspiration if the alveoli are affected by inflammation, gas exchange is impaired; severe inflammation with the accompanying build up of fluids is called>