oxygenation

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Anonymous
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247248
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oxygenation
Updated:
2013-11-17 12:18:29
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oxygen
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oxygen curve
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  1. illustrates relationship of hemoglobin saturation vs. partial pressure
    oxyhemoglobin dissociation curve
  2. vertical axis
    hemoglobin saturation
  3. horizontal axis
    partial pressure
  4. as PO2 increases .... what increases
    dissolved content
  5. forms an S shaped curve
    saturation of hemoglobin
  6. the shape of the curve is related to the ....
    change in shape & affinity of Hb as 02 loads & unloads from the molecule
  7. the middle steep portion of the curve reflects the ....
    rapid loading & unloading of additional 02 molecules after the first is bound to Hb
  8. Small changes in PO2 cause....
    large increases in content
  9. on flat top part of curve, large increases in PO2 cause ....
    very small changes in content
  10. flat part of curve acts like a ....
    safety zone
  11. Hb will still be 90% saturated at a PO2 of ....
    60
  12. upper flat part is the ....
    association portion
  13. association portion is because ....
    oxygen uptake in lungs occurs in PO2 range
  14. lower part (PO2 <60) can be thought of as .... and why?
    the dissociation portion, because 02 release to tissues occurs at these PO2's
  15. Pa02 reflects .... much more sooner than Sa02
    oxygenation problems
  16. what is the gold standard for evaluating oxygenation
    ABG
  17. steep dissociation part of curve is suited for ....
    releasing oxygen to the tissues
  18. 02 delivery depends on ....
    Hgb saturations
  19. 02 uptake by the tissues ....
    requires diffusion
  20. Pa02 determines the ....
    amount of diffusion that can occur
  21. 02 combined with hemoglobin .... & ....
    exerts no pressure & does not contribute to diffusion
  22. in order for the 02 transported by hemoglobin to contribute to 02 diffusion it must be ....
    released from the Hgb
  23. the P50 is the point on the curve where the Hb is ....
    50% saturated (normal P02 of 27mmHg)
  24. P50 is a measure of ....
    hemoglobin's affinity for oxygen
  25. when curve is shifted to the right, the P50 .... & this is related to a ....
    increases & decreased affinity of Hb for 02
  26. when curve shifts to the left, the P50 ...., indicating an ....
    deceases & increased affinity of Hb for 02
  27. In pH shift: acidosis causes shift to .... & alkalosis causes shift to ....
    right & left
  28. in temperature shift: increased shifts .... & decreased shifts ....
    right & left
  29. in C02 shifts: increased shifts .... & decreased shifts ....
    right & left
  30. in 2,3 DPG shift: increased shifts .... & decreased shifts ....
    right & left
  31. 2,3 DPG levels are affected by ....
    hypoxia, anemia, pH, stored blood
  32. 2,3 DPG is produced by .... & reduces ....
    RBC's & Hgb affinity for oxygen
  33. without 2,3 DPG hemoglobin's affinity would be so great that normal release at tissues ....
    would not occur
  34. changes in blood pH cause .... & lessens the affect of ....
    counteracting changes in 2,3 DPG & shifting of the curve by pH
  35. decreases 2,3 DPG
    acidosis
  36. increases 2,3 DPG
    alkalosis, anemia, & chronic hypoxemia
  37. these shifts of oxyhemoglobin curve ....
    increases loading of oxygen at lungs & increases the unloading at the tissues
  38. the P02 at the capillaries is reduced, causing ....
    Hb to release 02 according to the curve
  39. at the same time, tissue metabolism causes ....
    heat production & production of C02 (which decreases pH)
  40. the main effect of this right shift is that the additional oxygen released, ....
    increases the P02, increasing diffusion gradient into the cells
  41. the right shift caused by PC02 levels is ....
    the Bohr effect
  42. effects of right shifts will cause .... but ....
    more oxygen to be released to tissues for a given P02, but less oxygen to be loaded at lungs
  43. left shifts cause .... but ....
    more oxygen loading at the lungs but less release at the tissues
  44. abnormal hemoglobin's affect ....
    02 delivery
  45. HgbS (sickle cell) has ....
    less affinity for 02 than normal Hgb
  46. HgbS is less soluble in .... & can ....
    plasma & crystallize
  47. 02 carrying capacity of HgbS is .... & there is an ....
    reduced & increased risk for thrombus formation
  48. MetHgb is caused when ....
    iron atom in Hgb is oxidized from ferrous state to ferric state
  49. ferric form of iron (rust) in Hgb ....
    can not bind 02
  50. Met Hgb is caused by .... & ....
    nitrite poisoning & too much lidocaine
  51. Met Hgb must be detected by ....
    co-oximetry
  52. carboxy hemoglobin (COHgb) is caused by ....
    inhalation of carbon monoxide (CO)
  53. carbon monoxide is produced by ....
    the burning of organic material
  54. C0 in the blood combines with Hgb .... more easily than 02
    200 x's
  55. small amounts of C02 greatly .... the 02 carrying capacity
    reduce
  56. COHgb .... carry 02
    can not
  57. C0 shifts 02Hgb curve to the ...., reducing the ....
    left, 02 carrying capacity
  58. C0Hgb is detected by ....
    co-oximetry
  59. don't rely on .... or .... when smoke inhalation or fire is suspected
    pulse oximetry or conventional ABG
  60. Pa02's may be normal or elevated, but 02 delivery is ....
    severely compromised
  61. treatment for C0Hgb is .... & may require ....
    100% & hyperbaric therapy
  62. Fetal Hemoglobin (HgbF) occurs in the ....
    fetus for up to 1 year of life
  63. HgbF has greater affinity for 02 due to ....
    this shifts curve to the ....
    the low P02's available in the fetus in utero

    left
  64. ventilation/perfusion ratio (V/Q) is the ....
    matching of ventilation to blood flow
  65. normal alveolar ventilation is ....
    normal blood flow (cardiac output) is ....
    V/Q ratio of ....
    • 4 l/m
    • 5 l/m
    • 4/5 or 0.8
  66. 0.8 is an average for the ....
    lung as a whole
  67. due to regional differences the lungs overall V/Q ratio may not ....
    accurately reflect lungs ability to exchange gas
  68. more ventilation is directed to the .... than the apices (4x), due to ....
    bases & gravity
  69. more ventilation is directed to the .... & more perfusion to the ....
    apices & bases
  70. a high V/Q ratio is where the amount of .... exceeds the amount of ....
    ventilation , perfusion
  71. high V/Q ratios increase .... & decrease ....
    Pa02 & PaC02 (apices)
  72. a low V/Q ratio is where the amount of .... exceeds the amount of ....
    perfusion , ventilation
  73. low V/Q ratios decrease .... & increase ....
    Pa02 & PaC02 (bases)
  74. due to effects of gravity, the amount of ventilation & perfusion are greater in the .... than the ....
    bases than apices
  75. when blood leaving both parts of the lung is mixed the resulting V/Q ratio is less than the ....
    ideal 1.0
  76. this produces blood with slightly lower .... & slightly higher ...., & accounts for ....
    Pa02 & PaC02 , A-a gradient
  77. in upper lung regions, .... is greatly decreased, V/Q ratio is greater than ....
    blood flow, 1.0 (Zone 1)
  78. in the middle portion, ventilation & blood flow are ...., V/Q ratio is ....
    equal, 1.0 (zone 2)
  79. in lung bases, .... is greatly increased, V/Q ratio is ....
    perfusion, .6  (zone 3)
  80. ventilation .... to the alveoli, while blood flow ....
    adds oxygen , removes oxygen
  81. ratio between ventilation & perfusion determines ....
    alveolar P02
  82. decreased ventilation .... V/Q, decreased blood flow ....
    decreases , increase alveolar P02
  83. a spectrum from no ventilation (shunt) to no perfusion (dead space)
    V/Q relationship
  84. a V/Q ratio of 1:0 indicates ....
    dead space
  85. primary pathology producing dead space is a ....
    pulmonary embolism
  86. in cases of an absolute dead space the V/Q ratio is infinite ...
    1/0
  87. a V/Q ratio of 0:1 indicates a ....
    shunt
  88. primary pathology producing shunting is ....
    ARDS
  89. shunting is refractory to ....
    02 therapy
  90. in cases of absolute shunt, V/Q ratio is ....
    0/1
  91. when ventilation & perfusion are equal, ratio is ....
    1/1
  92. changes in dead space or shunt is always ...., & will alter .... & .... levels
    abnormal, Pa02 & PaC02
  93. increases in V/Q are known as ....
    relative deadspace
  94. decreases in V/Q are ....
    relative shunt (dead space effect or shunt effect)
  95. V/Q mismatch is most common cause of .... in patients with lung disease
    hypoxia
  96. if FI02 > 50% & Pa02 < 50mmHg the problem is ....
    shunting
  97. shunting is .... to 02 therapy
    not responsive
  98. high V/Q ratio indicates .... , low V/Q ratio indicates ....
    blood flow defect , ventilation defect
  99. as V/Q ratio increases the .... increases & .... decreases
    P02 & PC02
  100. as V/Q ratio decreases, .... decreases, & .... increases
    P02 & PC02
  101. .... can be greatly increased in lung disease
    A-a gradient
  102. major effect of low V/Q ratio is ....
    hypoxemia
  103. name 3 major V/Q imbalances causing hypoxemia
    hypoventilation, absolute shunt, V/Q mismatch
  104. causes PACO2 levels to rise, & PA02 levels to decrease
    hypoventilation
  105. Hypoxemia is really a .... problem
    ventilation
  106. when blood flows past unventilated alveoli, no gas exchange can occur
    right to left shunt
  107. shunting can occur .... or ....
    naturally (anatomical) or pathologically
  108. pathological shunt can be anatomic such as a .... or ....
    ventricular septal defect or physiological (pneumonia)
  109. shunting is refractory to ....
    oxygen therapy
  110. difference between alveolar & arterial 02 is ....
    increased shunting  (A-a increases)
  111. PCO2 usually remains ....
    normal
  112. V/Q mismatch is a result of .... rather than overall hypoventilation
    regional hypoventilation
  113. V/Q mismatch does not usually cause a ....
    high PCO2
  114. if V/Q ratio is low it is .... if V/Q ratio is high it is ....
    relative shunt , relative dead space
  115. what is the reason PaC02 levels are not normally affected
    hypoxemia stimulates chemoreceptors to increase ventilation
  116. C02 levels usually only increase in patients who can not ....
    increase ventilation to compensate (COPD)
  117. increasing ventilation to these alveoli will .... the P02
    increase
  118. if patient is not able to perform increased work, .... will fall , & .... will rise
    Pa02 & PCO2
  119. as long as patient can do the work of breathing, PCO2 levels will ....
    remain normal
  120. the exhaled C02 levels will lower because ....
    the exhaled C02 level from non perfused lung = 0
  121. what is the dead space equation
    PaC02 - PetC02 / PaC02
  122. to compensate for shunt the low Pa02 of underventilated alveoli causes ....
    localized vasoconstriction redistributing blood flow to well ventilated alveoli
  123. to compensate for deadspace, the low PC02 of poorly perfused alveoli causes ....
    alveolar duct constriction decreasing compliance & ventilation of alveoli & shifting that ventilation to areas with better perfusion
  124. occurs when blood passes from right side of heart to left without exchanging gases in the lungs
    true shunt
  125. true shunt can be divided into .... & ....
    anatomic & capillary shunts
  126. normal anatomic shunts are caused by the ....
    bronchial, pleural, & thebesian veins
  127. abnormal anatomic shunts are caused by .... & ....
    congenital heart defects & certain lung tumors
  128. caused by atelectasis or consolidation or pulmonary edema filling the alveolus (abnormal)
    capillary shunt
  129. total of the anatomic & capillary shunt & is refractory to oxygen therapy
    absolute (true) shunt
  130. shunt like effects is corrected by ....
    oxygen therapy
  131. mixture of shunted blood with oxygenated blood coming from lungs (lowers Pa02 in arterial blood)
    venous admixture
  132. increases in A-a gradient indicate ....
    increase in shunting
  133. normal A-a gradient is .... on room air
    10-25 mmHg
  134. The a/A ratio can be used to predict the .... needed to achieve a desired Pa02
    FI02
  135. Name the 3 indicators of shunt
    A-a gradient, a/A ratio, & P/F ratio
  136. normal range of Pa02/Fi02 is ....
    380-475 on room air for a Pa02 of 80 to 100
  137. easiest quickest indicator to calculate but least accurate
    P/F ratio
  138. what is the major problem of the P/F ratio
    changes in PaC02 affect it
  139. amount of shunted blood as a portion of cardiac output
    shunt equation
  140. name the shunt equation
    Qs/Qr = Cc02 - Ca02 / Cc02 - Cv02
  141. the top half of shunt equation represents ....
    oxygen lost because of mixing of shunted blood with oxygenated blood
  142. bottom half of shunt equation represents ....
    total oxygen uptake by the tissues
  143. Cc02 is calculated by ....
    content formula using 100% saturation
  144. Pa02 must be calculated by ....
    alveolar air equation
  145. Cv02 must be calculated by ....
    a mixed venous blood gas drawn from a swan ganz catheter
  146. Ca02 must be calculated by ....
    current ABG
  147. shunt < .... is normal
    <10%
  148. 10-20% is ....
    abnormal  but not significant
  149. 20-30% is ....
    significant disease
  150. >30% is
    life threatening (mechanical vent)
  151. gas exchange between cells & capillaries is ....
    internal respiration
  152. gas exchange between the lungs & pulmonary capillaries is ....
    external respiration
  153. C02 given off & 02 taken up is called ....
    respiratory exchange ratio (RR)
  154. the RQ is affected by the ....
    substrate being metabolized
  155. carbohydrates of RQ is ....
    proteins of RQ is ....
    lipids of RQ is ....
    • 1.0
    • .8
    • .7
  156. occurs when inadequate oxygen is delivered to the tissues to meet their needs
    hypoxia
  157. there are ... types of hypoxia that can occur
    4
  158. results from inadequate delivery due to low oxygen concentrations in the blood
    hypoxemic hypoxia
  159. hypoxemic hypoxia is caused by ....
    shunting, low PA02, diffusion defect, V/Q mismatch
  160. carrying capacity is reduced because of lack of Hb, oxygen therapy doesn't help but increased cardiac output doe
    anemic hypoxia
  161. amount of oxygen delivered to tissues is insufficient even though content may be normal because blood flow is inadequate
    circulatory hypoxia
  162. caused by inability of tissue cells to utilize oxygen even though adequate oxygen is available (cyanide poisoning)
    histotoxic hypoxia
  163. cyanosis may develop whenever the blood contains ....
    5g% of reduced Hb
  164. cyanosis may be .... or ....
    central or peripheral
  165. .... is much more serious condition indicating a lack of oxygen to core areas
    central

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