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Guyton and Hall Chapter 40

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1.

At a PaO2 of 40 in tissure capillaries, what is the


dissolved state?: 0.12 mL so , 0.17 mL of O2/dl in dissolved
state transported to cells versus 5 mL of O2/dL transported by Hb

2.

13.

Normal value: 200 mL / L x 5 L = 1000 mL


14.

At a PaO2 of 95 how many mL of O2/dl in dissolved sate?:


Could all resting metabolic needs come from dissolve

Per cent of O2 given up as it passes through the tissues

O2?: ...
4.

Describbe the metabolic use of oxygen.: As long as PO2 is >

15.

Limiting factor is rate of ATP to ADP conversion

CO can deceive the pulse oximeter


How??

Describe fetal Hgb (HbF)?: In placenta curve shifts left (Bohr


effect)
16.

6.

If curve shifts right O2 bond with Hb becomes weaker


17.

Describe how oxygen is perfusion limited: Within the

Partial pressure of O2 (PO2) determines how much O2 binds


with hemoglobin (Hb)
Hb is 100% saturated with a PO2 of 250 mmHg
8.

Within pulmonary system diffusion limited if


PaO2 does not equilibrate with PAO2 within the time blood is in
the pulmonary capillary
pna, atelectisis, tumor, increased secretions

Describe parital pressures in dissloved state of Oxygen


transport.: Only physically dissolved gas contributes to partial
pressure (PO2)

18.

19.

How much oxygen is bound to Hb? plasma?: 97% bound to

20.

In the oxygen hb dissociation curve, what will cause the

Hb, 3% bound to plasma


curve to shift LEFT?: increased pH
decreased hydrogen ions
decreased CO2
decreased 2,3 DPG
decreased temperature
fetal hemolglobin

50% saturated

9.

21.

Each gram of Hb can bind to how many mls of O2: 1.34 mL


Holw long does blood stay in the pulmonary capillaries?:
Blood stays in the pulmonary capillaries 3X longer (0.8 sec if
normal CO) than necessary to become fully oxygenated

11.

How do you calculate oxygen consumption?: VO2 = DO2 oxygen return (CvO2)
Normal value: 1000 mL - 750 mL = 250 mL

12.

How do you calculate oxygen content (CaO2)?: CaO2 =


(SaO2 X Hb X 1.31 mL / dL) +
(.003 mL O2 / dL x PaO2)
CaO2 = (.95 x 15 x 1.31) + (.003 x 96)
18.67 + .228 = 18.96 mL / dL

Int eh oxygen Hb dissociaiton curve, what will cause the


curve to shift RIGHT?: decreased pH (Bohr effect)
increased hydrogen ions
increased CO2 (Bohr effect)
increased temperature
increased 2,3 DPG (byproduct fo RBC glycolysis)

of O2
10.

How many mmHg of O2 pressure required for full


support of metabolic processes of cell?: 1 to 3 mmHg

Describe the values to the P50, what is it?: Hemoglobin is

PaO2 = 26.6 mm Hg (Miller)


26.0 mm Hg (Berne & Levy, p 462; Lumb, p 205)
25.0 mm Hg (Costanzo)
Dahlin says that its 26

How is oxygen diffusion limited?: If cells are > 50


micrometers from a capillary then O2 utilization is diffusion
limited

pulmonary system perfusion limited if


PaO2 does equilibrate with PAO2 within the time blood is in the
pulmonary capillary
7.

How does the bond change with right and left shifts?: If
curve shifts left O2 bond with Hb becomes stronger

Once in fetal circulation curve shifts right


(double Bohr effect)
By 4 months of age 90% of circulating
Hb is HbA

How does carbon monoxide bind to Hb?: CO binds with


Hb at the same sites as O2 but with 250x the tenacity
High FiO2 can displace CO much faster than low
FiO2

1 to 3 mmHg
O2 is not the limiting factor in cell activity

5.

How do you calculate the utilization coefficient?:


Utilization coefficient
250 / 1000 = .25 x 100 = 25%

0.29 mL
3.

How do you calculate oxygen delivery?: DO2 = CaO2 x CO

22.

Tissue PO2 is determined by...?: Tissue PO2 is determined


by a balance between:
Rate of O2 transport to the tissues
Rate of O2 utilization by the tissues

23.

What are calculations and normal values to consider when determining oxygen content?: CaO2 = (Hb x 1.34 x SaO2) + (PaO2
x 0.003)
Normal arterial value: 20 mL / dL
Normal venous value: 15 mL / dL
kO2 = 0.003 (solubility coefficient for O2)

24.

What are the normal O2 consuption values for newborn, 8 y/o and adult?: newborn 6 mL/kg/min
8y/o 5 mL/kg/min
adult 3.4 mL/kg/min

25.

What does dL mean?: ...

26.

What does O2 and CO2 transport depend on?: Diffusion through respiratory membrane
Cardiac output (CO)

27.

What is absorbed in infrared light?: HbH, methemoglobin, & HbO2 absorbed


940 nm

28.

What is absorbed in redlight?: HbH, HbCO, HbO2 & methemoglobin absorbed


660 nm

29.

What is another example of how tissue utilization can be calculated? (a-v difference for HbO2): = (97.5% - 75%) X 20.3 mL /
O2 / dL =
4.5 mL O2 / dL blood

30.

What is fractioanl SaO2=: HbO2/(HbO2 + HHb+ HbCO + metHb) x 100

31.

What is the normal SvO2 with a PO2 of 40?: 75%

32.

What occurs to the O2 Hb diss. curve as the blood passes through the lung?: CO2 diffuses from blood to alveoli
PaCO2 & H+ concentrations drop reducing
H2CO3 in blood
Both of above cause curve to shift left
CO2 + H2O

H2CO3

H+ + HCO3-

33.

What occurs when the curve shifts to the left?: ...

34.

What occurs when the curve shifts to the right?: ...

35.

What will cause the curve to shift left or right>: Curve may shift left or right d/t systemic or local factors

36.

Whats functional oxymetry?: Functional SaO2 = HbO2 / (HbO2 + HbR) x 100

Active muscle activity can

temp up to 40 C

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