13b - Clinical Correlations of Hypoxemia Flashcards
What are the factors that affect the flux of gas?
Fick’s law: Flux of gas is related to the concentration present at steady state
**Gas moves from regions of high concentration to those of low concentration with a magnitude directly proportional to the concentration gradient
What are 4 clinical causes of pulmonary diffusion defects?
Both acute and chronic conditions:
- thickening or destruction of the interstitial space, alveolar wall, or capillary
- pulmonary edema
- interstitial lung disease (sarcoid, idiopathic pulmonary fibrosis, ARDS)
- emphysema
What do you see on this xray?
Trick question: this is a normal xray (this makes a diffusion defect less likely)
A patient has the following vitals:
pH 7.45, pCO2 25, pO2 70, HCO3- 24, 88% O2 saturation
What is her A-a gradient?
A-a gradient= 150 - (5/4)(pCO2) - (pO2)
150 - (5/4)(25) - (70) = 49
**This A-a is elevated!
What are 3 possible differential diagnoses with an elevated A-a gradient?
- diffusion defect
- V/Q mismatch
- shunting
What is an ideal V/Q ratio?
V/Q= 1 where ventilation and perfusion are perfectly matched
What is an explanation for an area of persusion with low ventilation?
Pulmonary shunt
What is an explanation for an area of ventilation with low perfusion?
Dead space
What are 5 ventilation problems that would decreased the V/Q ratio?
decreased ventilation:
- asthma
- COPD
- pulmonry edema
- pleural effusions
- mucous plugging *barf sound*
What are 2 perfusion problems that would decreased the V/Q ratio?
increased perfusion:
- hepatopulmonary syndrome
- anatomic shunt
What are 3 reasons the V/Q ratio would be increased?
perfusion decreased or ventilation increased:
- PE (most common reason)
- hyperventilation (rarely pathologic)
- dead space
Describe hepatopulmonary syndrome
- normal V, increased Q (decreased V/Q)
- shortness of breath and hypoxemia caused by vasodilation in the lungs of patients with liver disease
- due to arteriovenous malformations (AVMs)
Decribe an intrapulmonary shunt
- normal Q, decreased V
- alveoli are perfused but no ventilation occurs
- main cause of hypoxemia in pulmonary edema and conditions where the lungs become consolidated (e.g. pneumonia)
Describe an anatomic shunt
- normal Q, decreased V
- bronchial arteries and coronary arteries return blood to circulation without passing by the alveoli to participate in gas exchange
- usually accounts for less than 3% of the total circulation
What components of the respiratory system comprise the physiologic dead space?
- mouth
- pharynx
- larynx
- trachea
- conducting airways