♥Dx Quiz 4

1. We need to know the 4 levels of a Shunt.
• •

< 10 % Shunt → Normal Clinical Shunt 10 % to 20 % Shunt → Mild intrapulm. Shunt.

< 20 % We can extubate

• •

20 % to 30 % Shunt → Significant Pulm. Shunt > 30 % Shunt → Critical/Severe Pulm. Shunt  High Mortality

Extra Info we might need to know about Shunts:

Conditions that ↑ physiologic Shunt  Pneumonia  Pneumothorax  Pulm. Edema  Atelectasis  It will never be Pulm. Eboli.

• Classic Shunt Equation:

QSp / QT = CcO2 - CaO2 = % CcO2 - CvO2

2. We need to know about the Pulse Ox.

• Measures the saturation of Hb. • By red & infrared light • Non-invasive • Advantage → Quick and Easy • As long as Spo2 > 65%, High Accuracy Level • Conditions that affect the reading of a Pulse Ox.  Abnormal Perfusion ↓ C.O. poor perfusion  Hypothermia  ↑ CoHb or MetHb level (Histotoxic hypoxia = ↑ levels b/c not using O2)  Cardiogreen or Methylene Blue Dye (Used to measure C.O.) • Normal readings (SpO2) does not guarantee adequate O2 delivery to the tissues Extra info about Pulse Ox:  Things that Affect Pulse Ox Readings that We already Know.  Dark Nail Polish  Poor Perfusion  Ambient light  Anemia  Ethnic Skin  ↓ BP 3. We need to know about the Respiratory Quotient (R.Q.) • Respiratory Quotient (R.Q.) → is the internal respiration @ the tissue level. • Normal R.Q. = 0.8 • R.Q. = VCO2 = . VO2  Remember VO2 → is O2 consumption 1. This is the amount of O2 extracted by the peripheral tissue in 1 min. 2. Also, measures up take of O2 in the lungs. 4. We need to know how to calculate C(a-v)O2. • C(a-v)O2 = CaO2 - CvO2 = Vol% • Normal Ranges → 4 to 6 vol% • Extra info about C(a-v)O2

C(a-v)O2 → The difference between Atrial and Venous blood at the tissue level, where it is dropped off and starting to be used.  It is calculated → Drawing an Atrial and Mixed Venous sample at the same time (One Rt draws the ABG and the other draws the Mixed Venous)  Increased Values 1. > 8 vol% is ↑ value 2. ↓ C.O. 3. ↑ VO2  Decreased Values 1. < 4 vol% is ↓ value 2. Septic Shock 3. ↑ C.O. 4. Anemia 5. Left Shift (anything that causes a Left Shift)  C(a-v)O2 useful in assessing 1. Affects of CMV & PEEP on C.O. 2. See if there is a need for additional circulatory support (Fluids, inotropic drugs (↑contractility (+), or ↓ contractility (-)). 5. We need to know how to calculate CaO2. • CaO2 = (Hb X 1.34) SaO2 + (PaO2 X 0.003) = vol% • CaO2 → The total amount of O2 available in the peripheral tissues to be used up by the tissue. • Normal value → 20vol%  0.003 → amount of O2 dissolved in the plasma  1.34 → amount of O2 bound to Hb • Clinical situations that impair oxygenation  V/Q mismatch (most common)  Diffusion → Rare diffusion blocks  Hypoventilation  Shunt 6. We need to know how to calculate the CvO2
 •

CvO2 = ( Hb X 1.34)SvO2 + ( PvO2 X 0.003) = vol%

• • •

Normal value → 4 to 6 vol% CvO2 → mixed venous oxygen content CvO2 → is the oxygen content of the venous blood. This reflects the amount of O2 returning to the right side of the ♥ after the tissues have extracted the O2 from CaO2.
 

SvO2 →this is the saturation of venous blood PvO2 → this is the venous oxygen tension