Notes in Arterial Blood Gas II

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Published	10/26/2023	Major determinants of alveolar gas exchange: 1 - {{c1::Surface of diffusion}} 2 - {{c1::Partial pressure gradients of gases}} 3 - {{c1::Matchin…
Published	10/29/2023	{{c1::Dalton's}} Law- partial pressure in a space = sum of all partial pressures of individual gases within (alveolar) space - partial press…
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Published	10/27/2023	Alveolar Gas EquationPAO2: partial pressure of O2 in {{c3::alveoli}}PaO2: partial pressure of O2 in {{c3::arterial blood}}FiO2: fractional concentrati…
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Published	10/27/2023	PCO2 and PO2 always have an {{c1::inverse}} relationship within the same space
Published	10/27/2023	{{c1::Fick's}} Law of Diffusion- diffusion depends on...→ difference in {{c3::partial pressures}} of specific gas (direct)→ {{c2::surface area}} avail…
Published	10/27/2023	in pulmonary emphysema, loss of lung {{c1::surface area}} for gas exchange → decreased rate of diffusionin interstitial lung disease (pulmonary fibros…
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Published	10/29/2023	{{c1::Henry's}} Law- describes concentration of gas is dependent on its solubility and partial pressure
Published	10/29/2023	{{c1::Boyle's}} Law- describes that if volume increases, {{c3::pressure}} decreases and vice versa*with these changes... when partial pressure gr…
Published	10/27/2023	solubility of CO2 is 20x {{c1::higher::higher/lower}} in comparison to that of O2
Published	10/27/2023	{{c1::Ohm's}} Law: {{c3::Flow (Q)}} is directly proportional to the {{c2::pressure gradient}} and inversely proportionaly to the airway {{c2::res…
Published	10/29/2023	{{c4::Poiseuille's}} Law- describes that airway {{c1::radius}} has the greatest affect on the flow of air in respiratory system/airways- radius i…
Published	10/27/2023	Minute ventilation: volume inspired per minuteVE = VT x f→ VE  = expired minute ventilation → VT  = {{c1::tidal volume}} (normal: 500 ml) → …
Published	10/27/2023	Physiologic Dead Space: Anatomic DS + Alveolar DSAnatomic Dead Space- total volume of {{c1::conducting}} airways from the nose or mouth down to t…
Published	10/27/2023	{{c1::Bohr}} Equation• VD  = volume of gas coming from dead space• VT =  tidal volume• PACO2 = partial pressure of CO2 in alveolar…
Published	10/29/2023	Alveolar Ventilation Equation- can use partial pressure of CO2 and the normal ventilation of CO2 to determine {{c1::alveolar ventilation}}*{{c1::alveo…
Published	10/27/2023	Use alveolar ventilation equation to solve this:
Published	10/27/2023	In upright lung, {{c1::lower::higher/lower}} 1/3 gets the highest ventilation
Published	10/29/2023	Oxygen Transport- effective delivery of oxygen to the tissues depends on CO and oxygen content of blood *oxygen in blood (loading of O2 into bloo…
Published	10/27/2023	Dissolved O2- amount of O2 free in the {{c1::plasma}}, only about 2% of total O2 content of blood - determines the {{c2::partial pressure}} that drive…
Published	10/27/2023	O2 bound to Hgb• {{c1::98}}% of O2 content of blood is bound to hemoglobin• hemoglobin is a globular protein with {{c2::four}} subunits, each subunit …
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Published	10/27/2023	O2 binding/carrying capacity = {{c1::20}} ml O2 / 100ml
Published	10/27/2023	Oxygen-Hemoglobin Equilibrium (Dissociation) Curve• PO2 of the blood determines degree of {{c1::saturation}} of hemoglobin → O2-hemoglobin dissociatio…
Published	10/27/2023	Loading/Unloading O2In lungs: • ≈ 100% saturation of Hb via “{{c2::cooperativity}}” affinity → O2 tightly bound • {{c1::dissolved}} O2 in plasma is re…
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Published	10/29/2023	Carbon Monoxide (CO)- has {{c1::250}}x affinity for Hb than O2 does → decreases O2 bound to Hb and decreases O2 saturation- {{c2::left}} shift because…
Published	11/02/2023	CO2 Transported in three forms:• {{c1::Dissolved}} CO2 = {{c5::5}}% of total CO2 in blood • {{c2::Carbaminohemoglobin}} = {{c5::5}}% of total • {{c3::…
Published	10/29/2023	Haldane Effect• binding of O2 to Hb reduces Hb-CO2 {{c1::affinity}} • release of O2 at tissue level results in increased ability of Hb to carry {…
Published	10/27/2023	ABG values: pH = 7.27pCO2 = 56  the primary acid base disturbance: {{c1::respiratory acidosis}}
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Published	10/27/2023	Buffering system- {{c4::minimizes}} changes in pH that occur when acids or bases are added- metabolism of carbohydrates and fats generates 15000 mmol …
Published	10/27/2023	Role of lungs in acid base homeostasis- {{c1::ventilation}} increases or decreases through stimulation of {{c3::respiratory}} center in response to Pa…
Published	10/27/2023	Sites for Obtaining ABGs• {{c1::Radial}} artery (most common)*easy to access, superficial, has collateral blood circulation • {{c2::Brachial}} artery …
Published	10/27/2023	{{c1::Allen’s}} test: test done to determine that {{c2::collateral}} circulation is present from {{c3::ulnar}} artery in case thrombosis occ…
Published	10/27/2023	Information Needed to Interpret ABGs• {{c1::Fraction of inspired oxygen}} (FiO2) • {{c2::Barometric}} pressure • Clinical data including age of patien…
Published	10/27/2023	Partial Pressure of Oxygen (PaO2): oxygen molecules dissolved in {{c1::plasma}} (not bound to {{c2::hemoglobin}}) Arterial Oxygen Saturation (SaO2):&…
Published	11/02/2023	Steps in Interpreting ABGs1. Is the blood acidemic or alkalemic? (blood pH)2. Is the disturbance respiratory or metabolic? (PaCO2, HCO3)3. If respirat…
Published	10/27/2023	Respiratory Acidosis: Acute vs Chronic?• Acute: little {{c1::kidney}} involvement, for 10mmHg increase in PaCO2...→ pH decreases by {{c3::0…
Published	10/27/2023	Causes of acute respiratory acidosis:- inadequate alveolar ventilation ({{c1::hypo}}ventilation) → increased {{c2::CO2}} retention → decreased&nb…
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Published	10/27/2023	Alveolar-arterial (A-a) O2 gradient*the difference between the {{c1::alveolar}} oxygen (PAO2) and {{c2::arterial}} oxygen (PaO2)• {{c2::Arterial}} oxy…
Published	10/27/2023	Alveolar Gas Equation • PiO2 (PP of inspired PO2) = FiO2 (PB - PH2O) → FiO2  = 0.21 (on room air, same at all altitudes) → PB = {{c1::barome…
Published	10/29/2023	Example of A-a O2 gradient calculation:   - normal A-a O2 gradient for age 65: = {{c1::2.5 + 0.21 (age)::formula for A-a gradient with …
Published	10/29/2023	abnormally high {{c2::A-a O2 gradient }} with hypoxemia suggests abnormal lung function (pneumonia, COPD, asthma exacerbation) *{{c1::A-a O2…
Published	10/27/2023	{{c1::high altititude}} and {{c2::hypoventilation}} are causes of hypoxemia with NORMAL A-a gradient
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Published	10/27/2023	common causes of hypoxemia1. decreased inspired {{c5::O2}} (air travel) 2. hypo{{c4::ventilation}} (sedatives) 3. {{c3::VQ mismatch}} (pulmo…
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Published	11/02/2023	→ acid base disturbance: {{c1::respiratory alkalosis}}→ acute or chronic: 12 mmHg drop in CO2 → ~2 drop in HCO3 (like in this case) → {{c2::acute}} {{…
Published	10/29/2023	(Renal) Compensation for Respiratory Alkalosis*method: decreased bicarbonate {{c4::reabsorption}} and decreased ammonium {{c4::excretion}} to normaliz…
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Published	10/27/2023	Respiratory alkalosis• increased {{c1::ventilation}} (hyper{{c1::ventilation}}) → decreased PaCO2 → increased pH *persists ONLY as long as the incitin…
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Published	11/02/2023	Metabolic alkalosis, chloride sensitive → {{c1::vomiting}} (gastric fluid loss), diuretics
Published	11/02/2023	{{c1::nalaxone}} (Narcan) for drug overdose  aspirin overdose → respiratory {{c2::alkalosis}} and metabolic {{c2::acidosis}}
Published	11/02/2023	alveolar gas equation measures the partial pressure of {{c1::oxygen}} in the alveoli *can be used to test proper oxygen transfer into the blood
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