Hypoxia

Case 1 (N 46)
A 30-year-old patient K. has been treated in the intensive care unit after
amputation of uterus which was done under an endotracheal ether narcosis.
Suddenly the patient's condition worsened sharply. She developed choking
sensation dyspnea chills psychomotor retardation and apathy. !er skin
turned pale" acrocyanosis became evident. #hysical e$amination showed an
increased respiration rate of %& per minute muffled heart sounds no rales
during auscultation of the chest" the pulse was regular '%0 beats(min" blood
pressure )*(30 mm !g" concentration of !b '00 g(+" hematocrit 0.30 ,-.
0.3)-0./%0. 1he patient was intubated and supplied by o$ygen but this
measure had no effect.
2uestions.
'. 3hat pathologic process,es0 developed in the patient after the surgery4
Substantiate your answer.
%. 5an the worsening of the patient's condition be associated with the
postsurgery development of hypo$ia of.
a0 respiratory type4
b0 circulatory type4
c0 anemic type4
d0 histoto$ic type4
3hat are the possible causes and mechanisms of development of
each of the presumed types of hypo$ia in this case4
3. Are there any signs of the urgent adaptive mechanisms that could
compensate hypo$ia in this patient4 6escribe them if they are present. 3hy
do they appear to be ineffective in this case4
Answers.
'. !ypo$ia due to internal bleeding due to in7ury of her arteries connected
with the amputation. 6uring surgery some arteries temporarily blocked
by thrombus ,but they can be replaced0 arteries start to bleed
,severe0 massive bleeding causes decrease in systemic 8# ,general
circulation disorder0 loss of blood volume.
1he classical signs of general hypo$ia.
1achycardia
1achypnea
5yanosis
%. a0 5irculatory type ,main0
b0 9espiratory type
decrease systemic 8# decrease blood flow to all organs
,including the lungs0 rate of circulation decrease ventilation
less effective
c0 Anemic type ,small anemic contribution0
slightly decrease concentration of !b ,result of surgery0
d0 !istoto$ic type ,serious in7ury to cells0
:nlikely to develop because this type re;uires significant e$tend
of in7ury to cell. <n this case not so much in7ury.
3. Adaptive mechanisms include increase ventilation and increase blood
flow ,tachycardia0. 1hese mechanisms fail because of decrease in 8#
thus blood flow through lungs decrease low saturation of blood
=ven if o$ygen is supplied saturation still not very high. 8ut if high
enough the blood flow through brain still is very slow. 8rain is deficient
of o$ygen ,due to slow blood flow don>t supply enough ;uantities0. <t is
also due to circulatory blood volume is low too.
Summary.
#atient was after surgical operation probably some arteries are in7ured
temporary blocked by blood clot ,thrombus0 this clot can be replaced
bleeding starts in arteries when bleeding gets severe ,continue..0
,5ould be some mechanical effect some movement in organs blood clot
is replaced0
when bleeding gets severe general circulation disorder loss of
circulatory blood volume reflects in low systemic 8# i0 circulatory type
hypo$ia ,primary0" ii0 respiratory type low blood flow in all organs of body
including lung rate of saturation of blood slow blood is poorly saturated
,<n ' minute of blood flow through the lung as much as the saturation by
o$ygen in normal systemic 8#0
Case 2 (N 44)
A 30-year-old-woman has been brought to hospital by ambulance as
emergency case with a preliminary diagnosis of ?rupture of a uterine tube
with internal bleeding due to ectopic pregnancy?. @n the way to hospital the
patient lost consciousness several times. =$amination in hospital showed
that the patient was conscious but confused. She was markedly pale had a
weak rapid pulse" ausculation revealed muffled heart sounds" blood
pressure &0(3* mm !g. =$amination showed the presence of varicous veins
in the e$tremities. 1he patient told the physician that her condition worsened
suddenly when she was eliminating hair on her legs with a depilator.
:ne$pectedly she felt short of breath palpitations and pain in the heart.
+ater on in hospital despite inhalation of o$ygen she went on complaining of
shortness of breath.
2uestions.
'. 3hich of the typical pathologic processes and what type of it could develop
in the patient4 Substantiate your answer.
%. -ame the symptoms caused by this pathologic process. 3hat are the
mechanisms underlying each of the symptoms4
3. 6escribe the causative factors of this pathologic process. 3hich of them
are most likely to occur4
/. 3hy was the inhalation of o$ygen ineffective to alleviate shortness
of breath4
Answers.
'. !ypo$ia ,shortness of breath due to massive bleeding0.
%. 5lassical signs.
1achypnea
1achycardia
5yanosis
3. 1ypes that could develop.
Acute hypo$ia
9egional circulation A <schemia ,decrease systemic 8#0
6isorder of microcirculation A <ntravascular e$cessive
shunting
5ause of hypo$ia.
8leeding due to thrombosis block and enter pulmonary
circulation. 1hromboembolism block pulmonary
circulation.
9upture of uterine
6ifference by heart rate.
BB 1hromboembolism leads to bradycardia
BB :terine bleeding leads to tachycardia
a0 9upture of uterine tube.
So circulatory hypo$ia respiratory nonventilation
hypo$ia anemic hypo$ia ,due to loss of !b0
b0 +ow circulating blood volume. <ncrease 8# blood flow
low <schemia
/. 6ue to low systemic pressure blood flow rate is low.