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2nd year > Types of hypoxia > Flashcards

Types of hypoxia Flashcards

1
Q

Hypoxia definition

A

inadequate oxygen in a particular part or all of the body or at cellular level
often pathological
variations in arterial oxygen concentrations can be part of the normal physiology - hypoventilation training or strenuous exercise

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2
Q

what is anoxia?

A

no oxygen at all

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3
Q

classification of hypoxia

A

generalised

local

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4
Q

types of hypoxia

A 
inadequate oxygenation of blood in lungs 
pulmonary disease
venous to arterial shunts 
inadequate O2 transport to tissues 
inadequate tissue use of oxygen
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5
Q

inadequate oxygenation of blood in lungs

A

hypoventilation

altitude hypoxia

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6
Q

altitude hypoxia

A

barometric pressure of atmosphere is lower
oxygen molecules in air are further apart so oxygen content is lowered
reduction of available oxygen in the air at height reduces oxygen saturation in blood

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7
Q

what is hypoxaemia ?

A

decreased availability of O2 in inhaled air

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8
Q

hypoventilation

A

neurological weakness
trouble with bellows - movement of air
central drive of respiration centre suppressed

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9
Q

what causes hypoventilation

A 
opiate overdose
motor neuron disease 
severe neuropathy 
muscle weakness 
multiple system atrophy
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10
Q

pulmonary disease

A

airway resistance - asthma
failure of respiratory membrane diffusion
volume of oxygen getting to airways is reduced
gas exchange failure - alveolar dysfunction or membrane dysfunction

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11
Q

venous-arterial shunt

A

cardiac shunt
cyanotic congenital heart disease
mixing of arterial and venous blood
only occurs when right sided heart pressure increases and blood shunts from right to left

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12
Q

inadequate O2 transport to tissues

A

decreased carrying capacity - low Hb - anaemia
generalised circulatory failure - shock
localised circulatory failure - acute MI or stroke

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13
Q

cyanotic congenital heart disease

A

tetralogy of fallot
transposition of great arteries
ASD/VSD

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14
Q

anaemia

A

less O2 carriage to tissue
measure oxygen saturation
less oxygen for target tissues/ organ/ cells

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15
Q

oxygen saturation

A

% of which haemoglobin is saturation with oxygen

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16
Q

inadequate tissue use of oxygen

A

burns

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17
Q

CO poisoning

A

red colour
not cyanotic
oxygen sats appear unaffected

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18
Q

what can cause cyanide toxicity?

A 
burning rubber
pesticides 
battery manufacturing 
gold mining 
jewellery cleaning 
plastic, nylon and fumigant manufacturing 
almonds
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19
Q

who gets cyanide toxicity?

A

35% of fire victims

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20
Q

symptoms/ signs of cyanide toxicity

A 
cyanosis 
low GCS 
normal oxygen saturations 
lactic acidosis 
low BP
low HR
high RR 
depressed mental activity - confusion and coma 
tissue and cell death - ischaemia 
reduced work capacity of muscles
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21
Q

treatment for cyanide toxicity

A

amyl nitrate and sodium thiosulfate and sodium nitrate
goal to create methaemoglobin
hydroxocobalamin infusion - vitamin B12

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22
Q

oxygen therapy

A

helpful if O2 is deficient

if alveolar O2 is increased O2 pressure gradient is increased

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23
Q

type 1 respiratory failure

A

hypoxaemia - PaO2 <8kpa

normocapnia - PaCO2 <6kpa

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24
Q

pathogenesis of type 1 respiratory failure

A

associated with damage to lung tissue which prevents adequate oxygenation of blood
remaining normal lung is sufficient to excrete carbon dioxide

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25
Q

what causes type 1 respiratory failure?

A 
low ambient oxygen/high altitude
ventilation-perfusion mismatch - PE 
alveolar hypoventilation 
diffusion problems - pneumonia/ARDS 
right - left cardiac shunt
26
Q

type 2 respiratory failure

A

hypoxaemia - PaO2 <8kpa

hypercapnia - PaCO2 >6kpa

27
Q

pathogenesis of type 2 respiratory

A

due to alveolar hypoventilation

unable to get O2 into blood and CO2 out of it

28
Q

causes of type 2 respiratory failure

A 
increased airway resistance 
reduced breathing effort
decrease in area of lung available for gas exchange 
neuromuscular problems 
deformed/rigid/flail chest
29
Q

what causes increased airway resistance?

A

COPD
asthma
suffocation

30
Q

what causes reduced breathing effort?

A

drugs
brainstem lesion
extreme obesity

31
Q

what causes a decrease in area of lung available for gas exchange

A

chronic bronchitis

32
Q

what causes neuromuscular problems?

A

guillain-barre syndrome

motor neuron disease

33
Q

what causes deformed/rigid/flail chest?

A

kyphoscoliosis

ankylosing spondylitis

34
Q

how to treat respiratory failure

A

administer oxygen
mechanical ventilation
treat underlying condition - bronchodilators, steroids, antibiotics etc.

35
Q

different types of oxygen administration

A

venturi mask - 24%

rebreathe mask - 100%

36
Q

when can oxygen therapy be useful?

A

when there is inadequate oxygenation of blood

pulmonary disease

37
Q

how is respiration controlled?

A

central chemoreceptors
peripheral chemoreceptors
brainstem respiratory centres adjust rate and depth of respiration accordingly

38
Q

central chemoreceptors

A

respond to arterial PaCO2

39
Q

peripheral chemoreceptors

A

respond to PaCO2 and pH

40
Q

what should PaO2 be on oxygen?

A

should be 10kpa less than the % inspired O2 concentration

41
Q

what is anxiolysis?

A

level of sedation in which a person is relaxed and may be awake, caused by drugs
to help relieve anxiety
minimal sedation

42
Q

clinical features of COPD

A 
chronically hypoxic 
chronically retain CO2 
high CO2 and bicarbonate 
smoking history 
gaunt
cachectic 
dyspnoea 
minimal cough 
increased minute ventilation 
pink skin 
pursed lip breathing 
accessory muscle use
hyperinflation 
barrel chest
decreased breath sounds 
tachypnoea
43
Q

complications of COPD

A

pneumothorax due to bullae and weight loss due to work of breathing

44
Q

management of COPD

A

no longer rely on detecting high levels of CO2 in their blood to stimulate respiration rather they rely on hypoxic drive
need careful oxygen management - venturi devices
target oxygen sats of 88-92% to avoid loss of ventilation stimulation which would cause hypercapnia and acidosis

45
Q

what to do if someone with COPD becomes acidotic with low O2 and high CO2

A

non-invasive ventilation

46
Q

clinical features of chronic bronchitis

A 
chronic productive cough 
purulent sputum 
haemoptysis 
mild dyspnoea initially 
cyanosis
hypoxaemia 
peripheral oedema - cor pulmonale 
crackles 
wheezes
prolonged expiration
47
Q

complications of chronic bronchitis

A

secondary polycythemia vera due to hypoxaemia
pulmonary hypertension due to reactive vasoconstriction from hypoxaemia
cor pulmonale from chronic pulmonary hypertension

48
Q

asthma attack

A 
inhalers not working 
raised respiratory rate 
tachycardia 
low PaO2 
low PaCO2 
normal pH
49
Q

opioid toxicity clinical features

A 
reduced GCS
reduced respiratory rate 
reduced ventilation 
high CO2 and low O2 
pinpoint/ small pupils 
acidotic on ABG
50
Q

risk factor for opioid toxicity

A

excreted renally so CKD/ impaired renal function

51
Q

management for opioid toxicity

A

naloxone, corrects GCS

52
Q

pulmonary embolism

A 
increases pulmonary vascular resistance 
decreased RV output 
reduced LV preload
fall in CO 
hypoxia occurs due to VQ mismatch
53
Q

VQ mismatch in PE

A

reduced perfusion with normal ventilation

54
Q

treatment for PE

A 
LMWH
warfarin 
DOAC
thrombolysis 
clot extraction
55
Q

guillain barre syndrome

A

acute inflammatory neuropathy

often have a history of gastronenteritis or flu-like illness weeks before onset of neurological symptoms

56
Q

clinical features of guillain barre syndrome

A 
bilateral
affects distal extremities first prior to progression 
1/3 will experience respiratory failure requiring ventilation and airway protection 
hypercapnia and hypoxia are late signs 
falling oxygen sats
low PaO2 
high PaCO2 
impending respiratory arrest
57
Q

testing in Guillain barre syndrome

A

regular spirometry to observe respiratory effort
nerve conduction studies and lumbar puncture should be done
lumbar puncture will show high protein

58
Q

pathogenesis of guillain barre syndrome

A

gastroenteritis or flu-like illness triggers an immune mediated attack on myelin sheaths due to molecular mimicry
affects the motor and sensory nerves

59
Q

pneumonia presentation

A

high PaCO2
low PaO2
reduced alveolar expansion - hypoventilation
crepitations at base

60
Q

treatment for pneumonia

A 
IV antibiotics
IV fluids
oxygen 
analgesia 
chest physio

2nd year (48 decks)

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