HYPOXIA

• A state in which tissues suffer from the effects

of oxygen deficiency. Four types:
– Hypoxic Hypoxia
• High altitude, Lung disorders causing Hypoventilation,
diffusion defects, low ventilation perfusion ratio or
arteriovenous shunts.
– Anaemic Hypoxia
• Anaemia and CO poisoning.
– Stagnant Hypoxia
• Cardiac Failure, Haemorrhage, and Circulatory Shock.
– Histotoxic Hypoxia
• Cyanide poisoning and Diphtheria.
 CYANOSIS
• Bluish discoloration of the skin
• Occurs when conc of deoxygenated blood in small
vessels of skin or mucous memb is more than
5g/100ml.
• Common sites:
• Bucal mucosa
• Lips
• Nail bed
• Sclera
• Palms
• Types:
– Central Cyanosis seen in hypoxic hypoxia
– Peripheral Cyanosis seen in stagnant hypoxia or
vasoconstriction due to cold.
 RESPIRATORY INSUFFICIENCY/
FAILURE
• Occurs when arterial PO2 falls below
60mmHg (Hypoxemia) with or without
arterial PCO2 above 50mmHg
(Hypercapnia)
• Two types
• Type 1
• Type 2
Type 1 Respiratory Insufficiency
• Only Hypoxemia occurs
• Results from poor exchange of gases across
respiratory membranes
• In interstitial lung diseases which thicken the
alveolar-capillary barrier such as:
– Pneumoconiosis
– Asbestosis
– Interstitial pneumonitis
– Pulmonary oedema
– Pulmonary Fibrosis
• CLINICAL MANIFESTATION OF TYPE 1 RI
– Cyanosis
– Tachycardia
– Mental confusion
– Impaired consciousness
Type 2 Respiratory Insufficiency
• There is both Hypoxemia and Hypercapnia
• Often due to ventilatory failure caused by:
– Acute laryngeal oedema
– Acute obstruction of airway by FB
– Paralysis of the respiratory muscles
– Narcotic poisoning
– Asthma
– Chronic bronchitis
– Pleural effusion
– Pneumothorax
– Fibrothorax, etc.
• CLINICAL MANIFESTATION OF TYPE 2 OF RI
• Due to Hypoxaemia
– Cyanosis
– Tarchycardia
– Mental confusion
– Impaired conciousness
• Due to Hypercapnia
– Papiloedema
– Headache
– Slurred speech
– Flapping tremors
• TREATMENT
Oxygen therapy
 OXYGEN THERAPY
• Administration of O2 through respiratory
passageway to assist respiration.
• METHODS OF O2 ADMINISTRATION
– Nasal canular
– Use of O2 mask
– Oxygen tent
– Mechanical ventilator
O2 therapy is not useful in Histotoxic hypoxia
 HYPERBARIC OXYGEN
• Administration of 100% O2 at a higher
pressure than the atmospheric to facilitate
tissue O2 delivery.
• USES
– CO Poisoning
– Gas Gangrene
 OXYGEN TOXICITY
• O2 become toxic to cells when in high levels at tissue level.
• Damage intracellular enzymes
• Produces highly reactive ionic species
• Superoxide radicals
• Hydroxyl radicals
• Hydrogen peroxide
• Body’s natural antioxidants are overwhelmed
• Glutathione
• Catalase
• Tocopherol
• Ascorbate
• Carotene
• Superoxide Dismutase
• CNS and Lungs are most susceptible
• Convulsions
• Pulmonary fibrosis
 CARDIOPULMONARY
RESUSCITATION
• Abrupt cessation of breathing is called respiratory
arrest and may occur in
– Drowning
– Suffocation
– Electrocution
– Myocardial infarction
– CVA
• When occurs with cessation of heart beat
Cardiopulmonary arrest results.
• Death ensues when condition is allowed for few
minutes as O2 supply to brain and heart is cut off.
• Such death can be averted by timely CPR.
• STEPS IN CPR
– Proper positioning of patient
– Clear airways of secretions or foreign bodies
– Press on the chest at the middle but more to
the left rhythmically at about 100 times/minute
– Push in air through the respiratory passageway
after every 4 cardiac massages at ratio of 4:1.
• METHODS OF ARTIFICIAL RESPIRATION
– Mouth to mouth
– Ambubag
 RESTRICTIVE AND OBSTRUCTIVE
LUNG DISEASE
• RESTRICTIVE LUNG DISEASE
– Diseases that reduce lung volume without
reducing airflow.
– CAUSES
• Pulmonary
– Lung fibrosis
• Extrapulmonary
– Pleural effusion
– Fibrotic disease of the thoracic cage.
– FEV1/FVC ratio is not affected
• FVC < 80% -- Mild restriction
• <60% -- Moderate restriction
• <40% -- Severe restriction
• OBSTRUCTIVE LUNG DISEASE
– Diseases that reduce the rate of air flow through
the respiratory passageway as a result of
narrowing or obstruction.
– Volume is not reduced unless there is restrictive
component.
– CAUSES:
• Asthma
• Chronic bronchitis
– FEV1/FVC -- <80% -- Mild
– --<60% -- Moderate
– --<40% -- Severe
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