HYPOXIA

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A condition where there is decreased Oxygen supply to the tissues is called as hypoxia
OR Inadequate O2 delivery to body tissues hypoxia

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TYPES OF HYPOXIA
1.HYPOXIC HYPOXIA 2. ANEMIC HYPOXIA 3. STAGNANT HYPOXIA 4. HISTOTOXIC HYPOXIA
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1. HYPOXIC HYPOXIA

The arterial PO2 is decreased. This may be due to: 1. Decreased Atmospheric PO2: High Altitude Closed room 2. Decreased Ventilation: Respiratory Paralysis. Bronchial Asthma(chronic inflammatory
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condition of airways 3 characters - airflow limitation, airway hyper responsiveness, inflammation of the bronchi.)
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Arterial PO2 decreased due to

Emphysema (Lungs loss elasticity and

alveoli turn to air sacs due to smoking )

3. Defective Gas exchange: Pulmonary Edema Pneumoconiosis All these cause a decreased partial pressure of Oxygen and so Hypoxic Hypoxia
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HYPOXIC HYPOXIA

Commonest type.
Characterized by a low PaO2 (hypoxaemia) % Hb saturation CaO2

(when PaO2 60 mm Hg, CaO2 )

CAUSES: PHYSIOLOGICAL: High altitudes. > 3000 Mts above MSL: Alv. PO2: 60mm Hg. Causes irritability
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HYPOXIC HYPOXIA: PATHOLOGICAL CAUSES

Lung Failure due to:

Pulmonary Fibrosis. Ventilation/Perfusion imbalance.

Ventilatory Pump Failure: Fatigue Mechanical defects Depression of respiratory centers.

Shunts-.cyanotic congenital heart Diseases

Collapse of lung atelectasis due to absent or inactive surfactant, pneumothorax, haemothorax, hydrothorax
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2. ANEMIC HYPOXIA

A decrease in hemoglobin or RBC count causes decreased Oxygen carriage and so hypoxia. Inability of Hb to bind O2 eg in CO Poisoning.
CO combines irreversibly with Hb.

Abnormal Hemoglobins such as Sickle Hb can also cause Anemic Hypoxia.

In anaemic hypoxia, the CaO2 but the PaO2 normal ()
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3. STAGNANT HYPOXIA

Also called Ischemic or Hypo-perfusion Hypoxia. Blood flow to tissues is slow or low. The Oxygen reaching the tissues per unit time is less. This situation is seen in:
Heart failure Venous obstruction

May lead to Adult Respiratory Distress Syndrome if it occurs in the lungs.

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STAGNANT HYPOXIA.

CaO2 normal & PaO2 are normal () Can be restricted to a limited area as a result of a local vascular spasm or localised blockage or the body may experience stagnant hypoxia in general as a result of low CO eg. in severe haemorrhage
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HISTOTOXIC HYPOXIA

O2 delivery to the tissues is normal but the cells are unable to use the O2 eg.
cyanide poisoning Toxic reaction to some drugs

CaO2 & PaO2 normal () PvO2, CvO2 and SvO2 are elevated since O2 is not drawn out by the tissue cells

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HISTOTOXIC HYPOXIA

Cyanide inhibits the intracellular enzyme, Cytochrome oxidase This problem can be treated with Methylene Blue.
Methylene blue converts Cyan Hb into CyanmetHb which is nontoxic.

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EFFECTS OF HYPOXIA

Brain wide variety of mental symptoms eg. inability to concentrate, disorientation, nausea, sleepiness >15 secs. without O2 unconscious

5 min. without O2 irreversible damage to brain

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O2 therapy (administration of O2) very beneficial in hypoxia due to PIO2 , hypoventilation, diffusion impairment Given to patients of Hypoxic hypoxia Can be given through:
A Nasal catheter. Venturi mask.

OXYGEN THERAPY

Pure Oxygen is not given A mixture of Air & Oxygen is given.

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OXYGEN THERAPY

Useful in all cases of Hypoxic Hypoxia. Histotoxic hypoxia - not beneficial Stagnant hypoxia, anaemic hypoxia ( PaO2 normal) O2 therapy is of much less value (Hb nearly saturated with O2)
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CARBON MONOXIDE (CO)

Colourless, odourless gas, non-irritating gas produced during the incomplete combustion (burning) of carbon products such as petrol, coal, wood, tobacco CO poisoning is commonly caused by motor vehicles exhaust fumes due to suicide attempts, smoke inhalation or defective indoor heaters Smokers higher level of carboxyhaemobgobin in blood (5 -10% COHb) CO + Hb carboxyhaemoglobin
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CO TOXICITY

CO competes with O2 for the hemebinding sites on haemoglobin but CO binds Hb with an affinity 200 to 250 times greater that for O2 to form carboxyhaemoglobin (COHb)
CaO2 tissue hypoxia

Binding of CO to Hb causes a leftward shift in the oxyhaemoglobin dissociation curve & release of O2
worsens hypoxia

Moderate CO poisoning:
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PaO2 normal

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TREATMENT OF CO POISONING

Administration of 100 % O2

Hyperbaric O2 therapy for severe CO poisoning

(100% O2 given at v. high pressure PO2 to v. high value) amount of dissolved O2 in blood Enhances the clearance of COHb Half-life of carboxyHb < 30 minutes
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ASPHYXIA

Improper aeration of blood continued for sometime produces two pathological changes:
Hypoxia : O2 Hypercapnia : CO2

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TYPES OF ASPHYXIA

LOCAL: Due to obstruction of blood supply:

Too tight tourniquet, for too long. Blue painful, swollen congested limb.

GENERAL: ACUTE:

Strangulation: Occlusion of trachea Airtight room: suffocation.

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CHRONIC GENERAL ASPYXIA:

Chronic Lung Disease. Chronic Bronchiectasis. Emphysema

Decreased Alveolar Ventilation

CO2 content O2 content

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ASPHYXIA: STAGES

I STAGE:
Violent Respiratory Efforts Tachypnea & Hyperpnea. Hypoxia Loss of consciousnesss.

II STAGE:
Sympathetic discharge Hypertension & Tachycardia Ventricular fibrillations Convulsions
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ASPHYXIA: STAGES

STAGE III
Gasping :
Slow deep inspiration

Hyporeflexia Pupillary Dilatation Hypotension Bradycardia Cardiac Arrest Death.

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Cyanosis

Dusky bluish discoloration of tissues due to reduced haemoglobin more than 5g/dl. capillary oxygen saturation is less than 85%. Depend on Total haemoglobin in blood Degree of unsaturation State of capillary circulation
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Cyanosis..

Easily seen in Nail bed, mucous membranes, lips, earlobes Not occur in anaemic hypoxia low HB Carbon monoxide poisoning obscured by cherryred colour carbonmonoxyhaemoglobin. occurs easily in excess red blood cells, as polycythemia vera.
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Central cyanosis

seen in the tongue and lips (with peripheral places)

cardiac and respiratory disorders with shunting of deoxygenated blood, (a right toleft heart shunt).
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Peripheral cyanosis

seen in the hands and feet (Also in centrally cyanosed person) In conditions with peripheral vasoconstriction and stasis of blood in the extremities Eg - congestive heart failure, circulatory shock, exposure to cold temperatures and abnormalities of the peripheral circulation.
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