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Respiratory Part 8

QuestionAnswer
What determines the percent of sites on hemoglobin occupied by O2? The PO2 in blood. As you raise the PO2, saturation of hemoglobin increases. Hemoglobin concentration has no affect on the PO2.
What is the maximal saturation of hemoglobin when PO2 is 100mmHg? It is 97.5%, no matter how much hemoglobin is in the blood.
When PO2 is 40mmHg what is the saturation of hemoglobin? 75% hemoglobin saturation.
How many binding sites does hemoglobin have? 4 binding sites
How much can each gram of hemoglobin combine of O2? Each gram can combine 1.34ml of O2.
Hyperventilating causes what changes in PaO2 and HbO2 content? It can significantly increase PaO2 but will have no effect on HbO2 content. Healthy units does not add significant amounts of O2 to the blood leaving those units.
Name causes of hypoxemia Pulmonary: VA/Qc mismatch and shunt. Non-Pulmonary: CNS depression, neuropathies, skeletal disorders, muscular disorders, obesity
Describe VA/Qc mismatch Regional variation. VA/Qc of the diseased units is less than ideal, but not 0. Some lung units are hypoventilated and others are ventilated.
What is dyspnea? Labored breathing
Why does VA/Qc mismatch always lead to hypoxemia? Because hyperventilation of healthy lung unit does not add significant quantities of O2 to blood. Oxygen therapy & supplementation is useful.
Describe a shunt A region in the lungs that receives no ventilation, VA/Qc= 0. Right to left shunt. It is not treatable with O2 therapy.
How can you tell if someone has a shunt? If you give them 100% oxygen and it doesn't raise to 663, there is a shunt somewhere.
Describe non-pulmonary hypoventilation Conditions in which the entire lung is hypoventilated. Always leads to hypoxemia. Supplemental O2 will increase the PaO2
Bohr Effect Increase in PaCO2, H+ or temp of blood shifts HbO2 dissociation curve to the right, indicating a decrease in affinity of O2 for Hb. (tissue metabolically active). A shift to the left indicates an increase in affinity of O2 to Hb.
Describe the role of 2,3 DPG (Diphosphoglyceric acid) in Hb binding An increase in 2,3 DPG shifts curve to the right. Major stimulus is hypoxemia. 2,3 DPG decreases in outdated blood. Fetal Hb does noto bind 2,3 DPG and is shifted to the left.
Diffusing Capacity of Lung for O2 Indicates how many ml of O2 diffuses across the lung per minute. Determined by surface area, solubility of O2, diffusivity of O2 and distance O2 molecule must travel (alv to RBC)
What is the equation mlO2/min/mmHg equal to? (area*solubility*diffusivity)/distance
What is the DLO2 represent? The parameters that are difficult to measure. So DLO2= mlO2/min/mmHg
When is DLO2 increased? When is it decreased? Increased during exercise. Decreased in emphysema, fibrotic lung disease, pulmonary edema.
Does carbon monoxide have a partial pressure? No, none of CO dissolves it immediately binds to hemoglobin.
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