PBL

RESPIRATORY SYSTEM
ARTERIAL BLOOD GASES

DR M NAEEM AFZAL
MBBS, MCPS, FCPS, DIP-DIABETES (UK)

ASSISTANT PROFESSOR
EAST MEDICAL WARD
KING EDWARD MEDICAL UNIVERSITY/MAYO HOSPITAL,
LAHORE

What we are going to learn

today
Application of ABGs in
cardiorespiratory problems
Understanding Hypoxia due to AV
shunts
Understanding Hypoxia due to
Pulmonary edema

Pre-test Questionnaire

Why exchange is different for two

gases?
Physiology of respiratory
membranes
Pathological changes in
respiratory membranes

Factors affecting alteration of gas

exchange
Blood flow
Air flow
Respiratory membrane

Case Scenario
A middle aged gentleman who is
hypertensive, diabetic and smoker
presents in ER with rapidly worsening
shortness of breath.
His examination shows bibasilar
crepitations indicative of extra fluid
in alveoli of lungs.

Problem
What will happen to gas exchange?
What will be the pathophysiology
behind impaired gas exchange?
Can you give more examples of
shunt?

What will happen to gas exchange?

Decreased
Why?
Fluid in lungs alveoli will impair the
gas exchange

What will happen to gas exchange?

Both gases or one gas?
Type 1 respiratory failure

What will be the pathophysiology

behind impaired gas exchange?
Blood will flow but it will not be
oxygenated
V/Q Ratio?

Can you give more examples of

shunt?

nd

Case scenario

An elderly lady who has been operated

for hip joint replacement one week ago,
suddenly develops sharp excruciating
chest pain on right side of chest along
with shortness of breath?
Examination shows tachycardia,
tachypnea, and mild cyanosis. All findings
are indicative of pulmonary embolism.

Problems?
What will happen to gas exchange?
What will be pathophysiological
mechanism of impaired gas
exchange?

What will happen to gas exchange?

Both gases or one gas?
Type 1 respiratory failure

What will be pathophysiological

mechanism of impaired gas exchange?
Air will come but gases will not be
exchanged

V/Q ratio

Arterial Blood Gases

Type 1 respiratory failure
Effect on other gas
Renal compensation

Post test Questionnaire

Application of knowledge
2 different scenarios

Summarization
Shunt
Dead space
Type 1 respiratory failure