Diffusion and Gas Transport Lecture 5 Flashcards

1
Q

Identify factors that determine exchange rates of gases across membranes.

A
  1. Pressure difference - the gas between the two sides of the membrane
  2. Thickness - respiratory membrane
  3. Surface area - the membrane
  4. Diffusion coefficient - the gas in the substance of the membrane
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2
Q

Define Fick’s Law

A

Describes how particles under random thermal motion tend to spread form a region of higher concentration to a region of lower concentration. This law describes the time course of the transfer of a solute between two compartments that are seperated by a thin membrane.

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3
Q

Identify two factors which determine the concentration of a gas in a solution using Henry’s Law

A
  1. Partial pressure of gas
  2. Solubility coefficient
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4
Q

Compare solubility coefficients for oxygen, carbon dioxide, carbon monoxide, and nitrogen

A

O2 - 0.024

CO2 - 0.018

CO - 0.018

N - 0.012

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5
Q

Using Henry’s Law, calculate the amount of oxygen dissolved in blood for PO2 of 50, 100, and 600 mmHg

A

Concentration of dissolved gas = Partial pressure of gas x Solubility coefficient

Cgas= K x Pgas

K of oxygen dissolved in blood = 0.003

  • If PO2 is 100 mmHg – 0.003 x 100 = 0.3 mL O2/100 mL blood
  • If PO2 is 50 mmHg – 0.003 x 50 = 0.15 mL O2/ 100 mL blood
  • If PO2 is 600 mmHg – 0.003 x 600 = 1.8 mL O2/ 100 mL blood
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6
Q

Identify the mechanism responsible for most carriage of oxygen in the plasma

A
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7
Q

Describe the effects of increasing FiO2 from 100 to 600 mmHg on oxygen carrying capacity

A

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8
Q

Identify the average capillary exposure/transit time

A

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9
Q

Identify the normal time period required for diffusion to occur

A

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10
Q

Describe the effect of lower alveolar PO2 on diffusion and arterial PO2

A

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11
Q

Compare arterial and tissue PO2 and the effect on diffusion

A

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12
Q

Discuss the mechanism of diffusion of carbon dioxide across the alveolar septa

A
  • Carbon dioxide crosses the alveolar septa via simple diffusion based on a concentration gradient
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13
Q

Discuss the mechanism of diffusion of oxygen across the alveolar septa

A

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14
Q

Define Graham’s Law

A

When gases are dissolved in liquids, the relative rate of diffusion of a given gas (diffusion capacity) is

  • Proportional to solubility in the liquid
  • Inversely proportional to the suare root of its molecular weight
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15
Q

Compare the diffusion capacity of oxygen relative to carbon dioxide, nitrous oxide, carbon monoxide, and nitrogen

A

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16
Q

Describe the two major elements of diffusion capacity and their components

A
  1. Membrane capacity (DM)
    • Affected by factors involving movement of gas between alveoli and blood
  2. Reaction time with hemoglobin (O - VC)
    • Affected by factors involving movement into capillary and uptake by RBC
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17
Q

List four conditions that decrease diffusing capacity

A
  1. Thickening of the barrier
    • Interstitial or alveolar edema
    • Interstitial or alveolar fibrosis
      • Sarcoidosis
      • Scleroderma
  2. Decreased surface area
    • Emphysema
    • Tumors
    • Low cardiac output
    • Low pulmonary capillary blood volume
  3. Decreased uptake by erythrocytes
    • Anemia
    • Low pulmonary capillary blood volume
  4. Ventilation - perfusion mismatch
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18
Q

Calculate the amount of oxygen dissolved in the plasma given a PO2

19
Q

Identify the maximum amount of oxygen which may combine with a gram of hemoglobin

A
  • Maximum amount is 1.34 ml/gram of hemoglobin
20
Q

Identify the determinant of the equilibrium point of reaction that determines the amount of oxygen that binds to hemoglobin in the red blood cell.

21
Q

Calculate oxygen content of the blood given hemoglobin concentration and oxygen saturation

22
Q

Define P50 for hemoglobin saturation

A
  • Point on the curve where 50% saturation occurs
  • This point may move left or right, and represents changes in loading and unloading conditions
  • Affected by temperature, pH, PCO2, DPG levels and type of hemoglobin
23
Q

Calculate the oxygen carrying capacity for varying hemoglobin concentrations and PO2

24
Q

Describe the structure of hemoglobin in relationship to its oxygen carrying capacity

25
Calculate delivery of oxygen given PaO2 and mixed venous PO2 (comparable to tissue PO2)
*
26
Describe rationale for monitoring SVO2
*
27
List five determinants of SVO2
1. Hemoglobin concentration 2. Hemoglobin saturation 3. Cardiac output 4. Oxygen consumption 5. Oxygen utilization
28
List six clinical conditions that may decrease SVO2
1. Cardiac output 2. Oxygen saturation/ ventilation/ shunt, V/Q 3. Tissue metabolism 4. Anesmia/ Hypovolemia 5. Fever, shivering 6. Seizures 7. Pain/ Exercise 8. Hyperthyroidism
29
List five factors taht may alter P50 and how the oxygen-hemoglobin saturation curve is affected
1.
30
Define the Bohr Effect as it relates to shifts in the oxyhemoglobin dissociation curve and oxygen loading/unloading
*
31
List four clinical conditions shifting the oxyhemoglobin dissociation curve to the left
1. Decrease in H+ concentrations 2. Decrease in PCO2 3. Decrase in temperature 4. Decrease in 2,3 BPG * Bank blood has decreased 2,3 BPG * High atitude and hypoxia cause increases in 2,3 BPG 5. Fetal Hb (HbF) 6. Carboxyhemoglobin 7. Methemoglobin
32
List four clinical conditions shifting the oxyhemoglobin dissociation curve to the right
**RIGHTS** 1. **R**ightward shift 2. **I**ncreased PCO2 3. Increased 2,3 BP**G** 4. **H**ydrogen Ions 5. **T**emperature high 6. **S**ickle cell
33
Describe the effect of carbon monoxide poisoning on oxygen carrying capacity and the oxygen dissociation curve
*
34
Discuss mechanisms for dealing with carbon monoxide poisoning
* Carbon monoxide interferes with O2 transport by combining with Hb to form carboxyhemoglobin (COHb) * Hb concentration and PO2 are normal but O2 content is grossly reduced * Oxyhemoglobin dissociation curve shiftts to left * 210 x affinity for hgb as oxygen * **Normal O2 saturation does not exclude possibility of carbon monoxide toxicity** * **Increased FiO2 promotes elimination of carbon monoxide (decreases half-life form 4 hours to \< 1 hour)**
35
Discuss the pathophysiology of methemoglobinemia and clinical considerations.
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36
Describe P50 considerations of abberant hemoglobin's
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37
List six anesthetic considerations for patients with sickle cell
1. Avoid hypoxia and acidemia (FiO2 \> 0.5) 2. Avoid hypovolemia 3. Avoid hypothermia 4. Transfuse the preoperative PCV 30% 5. No tourniquets 6. Symptoms: Microvascular occlusions, cheast or abdominal pain, fever, tachycardia, hematuria.
38
Describe how carbon dioxide is transported in the arterial and venous blood
*
39
Calculate the amount of CO2 dissolved in the blood given a PCO2
*
40
Compare the CO2 carrying capacity of reduced hemoglobin compared to oxyhemoglobin
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41
Define the Haldane effect in relationship to the ability of hemoglobin to carry CO2
*
42
Define "Chloride shift" as it relates to RBC electrical neutrality and carbonic acid
* More bicarb ions leave RBC than H+ ions * Hamburger shifts occurs and allows excess bicarbonate ions to diffuse out of cell in exchange for chloride ions (preserves electrical neutrality)
43
Compare the carboxyhemoglobin dissociation curve to the oxyhemoglobin dissociation curve
*