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Path Secret


1
Cell injury:
-
If the oxygen partial pressure (in the plasma) is decreased, the oxygen saturation (onHb)
MUST also decrease.
-
Thrombosis in a muscular artery is the most common cause of ischemia.
-
Hypoxemia (decrease oxygen partial pressure) is a cause of hypoxia
-
Respiratory acidosis
!
CO2
"

!
pO2
#
ALWAYS (and vice versa).
-
Hypoxemic patient that gets 100% oxygen and hispO2 didnt increase
!
shunt
!
ventilation def ect (ARDS, hyaline membrane disease).
-
Perf usion def ect (PE)
!

"
dead space(100% O2 will get thepO2 up)
-
Dif f usion def ect (sarcoidosis, pulmonary edema)
-
J ref lexinnervated by the Kent nerve, causedyspnea(f luid in lung interstitium irritating the J
receptors).
-
Anemia (Hb related problem)
!
pO2 normal, saturation normal, Hb decreased
!
exertional dyspnea.
-
House f ire produces tissue hypoxia in 2 ways:
CO poisoning
(
!

saturation
!
, give100% oxygen) and CN poisoning. Both inhibit
cytochrome oxidase
.
-
Cyanosisis the clinical evidence of decreased saturation. Red pigment hides the cyanosis
inCO poisoning(most f requent symptom isheadache).
-
MetHb
!
saturation decreasedbecause the Hb isFe
$
and not Fe
%
(chocolate color blood)
!
100% oxygen doesnt improve cyanosis. Treatment is IVmethylene blue,vitmamin C (also
but not main)
-
Sulf a and nitro drugs(oxidizing agent): 1. produceMetHb.2.Hemolytic anemia, G6PD
def iciency.
-
MetHbcommon inHIV, because we use sulf a drugs to treatpneumocystis carinii.
-

Right shif t curve
: 2,3BPG
"
, high altitude, acidosis, f ever.
Lef t shif t curve
: CO, MetHb, HbF, 2,3BPG
#
, alkalosis.
-
Uncoupling agents(mitochondrial membrane permeable to protons):dinitrophenol (wood
preserving),alcohol,salicylates. To compensate, NADH, FAD producing systems (which
produce protons) increase
!
hyperthermia (alcoholics are moresusceptible to heatstroke).
-

Respiratory acidodis
= Hb normal, Saturation
#
, pO2
#

Anemia
= Hb decrease, saturation normal, pO2 normal
CO + MetHb
= Hb normal, saturation
#
, pO2 normal
-
Anaerobic glycolysis
!
lactate acidosis
!
denature proteins + enzymes (cant evenauto digest itself )
!
coagulation necrosis
!
inf arct.Anaerobic glycolysis
!
ATP pump malf unction,decrease ATP
!
Na enters cells
!
water f ollows
!
cellular swelling(reversible!).
-
Irreversible cell damage: ATP decrease
!
Ca ATPase
#

!
intracellular Ca
"

!
activates nuclear enzymes (
!
pyknosis), phosphlipase (
!
cell membrane damage)
!
pancreatitis.
-
Cell death: CK, GOT, GLT, amylase increase.
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