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Pulmonary Physiology: Respiratory Failure

Overview

Looks like this is it, Dr West’s last lecture.  This one is only 56 minutes long and covers various forms of lung failure. 

https://www.youtube.com/watch?v=yet-VyVEPKw&feature=relmfu

Details

The primary function of the lung is gas exchange. 

Dropping pO2 from 100 to 60 mm Hg doesn’t change % Hb saturation that much, from the oxygen dissociation curve.  After that, it falls quickly. 

Three Anchor Points:

100mm Hg pO2 97%, 40 mixed venous blood 75%, and 50% at 27 mm. 

Causes of Hypoxemia

Headache, somnolscence, vision difficulties, tachycardia, hypertension, CNS issues, sodium retention, proteinuria.

Diaphragm Fatigue

Striated skeletal muscle with slow tweitch oxidative and fast twitch oxidate glycocolytic fibers.  The work of breathing can overwhelm the muscle if hyperventilation is extended.  Relieve bronchospasm, treat infection, O2 therapy. 

Types of Respiratory Failure

Acute Overwhelming Lung Disease

Many acute diseases can lead to respirtory failure if severe enough.  Can be caused by chlorine gas.  Often carried on trains. 

Neuromuscular Disease

Acute on chronic lung disease is a patient with a long standing disease.  Treat with 24-48% O2 and monitor the arterial blood gases, venturi mask. 

Adult respiratory distress syndrome is the end result of many pathlogical processes.  Lungs show proteinaceous edema, cellular debris, and hyaline membranes. 

Factors in Tissue Hypoxia

Arterial pO2, Hb concentration, cardiac output, local blood flow, O2 affinity of Hb

Hazards of O2 Therapy

CO2 retention, O2 toxicity, lund atelectasis, retroental fibroplasia

a rule of thumb is no more than 50% O2 for more than 48 hours

Mechanical Venting

Intubation put in by the mouth or nose, a cuff makes it an airtight seal.  Constant volume and constant pressure ventilator. 

IPPV intermittant positive pressure ventilation

PEEP positive end expiratory pressure

CPAP continious positive airway pressure

CO2 Retention

increased cerebral blood flow, headache, papilledema, restlessness, tremor, mood fluctions,

Hypoventilation

VP inequality

Hypoventilation

Diffusion Impairment

Shunt

Ventilation Perfusion Inequality

Reduction in Inspired pO2

Review

Nitrate NO3-

  • Stay relaxed
  • Weapon moves first
  • Accelerate the weapon
  • Move towards the target
  • Penetrate

Acetyl COCH3

Thionyl chloride SOCl2

Barchan Dune 35 degrees down, 15 up

R-N=N-R Azo

Ambush – linear, L, V

C=S Thioketone

H2N(C=O)NH2 Urea

cash-futures = basis

+ basis negative carry

– basis positive carry

4 carbons overwhelm hydrogen bonding

Atmosphere: troposphere, stratosphere, mesosphere, thermosphere, ionosphere, exosphere

CTLSC 7 12 554

Sextuple Bond: Mo2, W2

Intermolecular Bonding: electrostatic, h bonding, dipole dipole, van der Waals

Hydrogen Bonding: FON Cl

Mandatory Refusal – when communications are lost, no one is trusted. A breach is assumed.

Gain Band Width Product = Gain x Bandwidth

CARVER is an acronym that stands for Criticality, Accessibility, Recuperability, Vulnerability, Effect and Recognizability.

Wind Speed Beaufort Category How to Judge the Wind
1-3 mph Light Air Smoke drifts. Wind cannot be felt.
4-7 mph Light Breeze Wind felt on face. Leaves rustle. Weather vanes move.
8-12 mph Gentle Breeze Leaves and twigs in motion. Light flags are extended.
13-18 mph Moderate Breeze Wind raises dust and loose papers. Small branches move. Flags flap.
19-24 mph Fresh Breeze Small trees in leaf sway slightly. Wavelets form on ponds and lakes.
25-31 mph Strong Breeze Large branches move. Telephone lines sing.

Visible Light – 400 to 700 nm

adam boy charles david edward frank george henry ida john kevin lincoln mary nora ocean paul queen robert sam tom union victor william xray young zebra
bull spread buy near, sell far
bear spread sell near, buy farcash – futures = basis

spreads are differences between futures contract months
cashpostive carry
cash>futures negative carry (inverted)
Basis: time space quality

Aromatic: planar, cyclic, Huckels Rule – 4n+2 electrons

Fibrous – sclera, cornea

Sensory – retina

Vascular – choroid, iris, pupil, ciliary body

Kingdoms – monera, protista, fungi, plant, animal

HSbF6 pKa = 25

Electrophiles are positive, nucleophiles are negative

EDTA is a tetraprotic acid.

C-C=O-C Ketone

Ketones containing alkene and alkyne units are often called unsaturated ketones.

Ph2CO Benzophenone

Sunflower 8 benzenes fused together

(H3C)(CO)(CO)(CH3) Diacetyl

Butanone MEK

Acetoin (H3C)(CO)(COH)CH3

Tissue: nervous muscular epithelial connective

Epithelial: simple stratified pseudostratifed/ cuboidal columnar

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