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4 types of hypoxia that trauma nurses should understand 0

BY TRAUMA NURSING ON MARCH 10, 2023 TRAUMA NURSING

Hypoxia is any state of low oxygen within body tissues. If

“
the oxygen insu ciency is severe enough, it can be life- The Trauma Nursing

threatening. Most commonly, this life-threatening low column is produced in

oxygen state leads to systemic acidosis in the body, partnership with the
complicating clinical treatment and, ultimately, recovery. Board of Certification
for Emergency Nursing
Trauma and emergency nurses should know the different
(BCEN®), developer of
causes of hypoxia and the related treatment strategies.
the Trauma Certified

1. Hypoxic hypoxia — not enough oxygen enters the Registered Nurse

body (TCRN®) certification.

The most common form of hypoxia is hypoxic hypoxia. It

occurs when not enough oxygen enters the body, either because of low oxygen levels in the
environment or because a medical condition reduces the ability of the lungs to take in oxygen.

Hypoxic hypoxia caused by a low-oxygen environment. The oxygen saturation of the air decreases
as elevation above sea level increases. This effect is important for mountain climbers, but the most
common impact is on airplane passengers. Commercial airplanes are pressurized to match an
altitude of 8,000 feet above sea level, which represents a 4% to 5% reduction in oxygen saturation.
Most healthy individuals can tolerate this drop in available oxygen, but it can cause problems for
people with a cardiopulmonary condition. Treatment: Descend to a lower altitude and/or provide
supplemental oxygen.

Hypoxic hypoxia caused by a medical condition. Pneumonia, pulmonary emboli (PE) and acute
respiratory distress syndrome (ARDS) can all reduce the surface area of the alveoli, the tiny air sacs
in the lungs. This reduces the ability of the alveoli to exchange gas, thereby reducing the diffusion
of oxygen into the lungs. Treatment: Provide supplemental oxygen and treat the causative
pathology.

2. Hypemic hypoxia — the blood cannot carry enough oxygen

Hypemic hypoxia occurs when the blood is unable to carry su cient oxygen. The most common
causes of hypemic hypoxia are anemia and carbon monoxide poisoning.

Hypemic hypoxia caused by anemia. There may be enough oxygen in the atmosphere and the
lungs may be working perfectly, but the patient with anemia does not have enough red blood cells
to transport oxygen throughout the body. Treatment: The current practice is to transfuse packed
red blood cells (PRBCs) when hemoglobin is at or below 7 g/dl. If the patient’s compensatory
mechanisms are insu cient, transfusion may be warranted at a higher base hemoglobin level.
(Note: If the patient is actively bleeding, the time lag between blood draw and lab results may lead
to an overestimation of actual hemoglobin levels.)

Hypemic hypoxia caused by CO poisoning. The hemoglobin-CO a nity is more than 200 times
greater than the hemoglobin-oxygen a nity. This means that when CO is present it will easily
replace oxygen on hemoglobin, blocking the ability of red blood cells to bind with oxygen. Note that
pulse oximetry may show 100% saturation, but this re ects that hemoglobin is saturated with
carbon monoxide, not oxygen. Monitor carboxyhemoglobin levels to guide treatment decisions.
Treatment: Administer 100% oxygen.

3. Stagnant hypoxia — there is not enough blood ow to deliver su cient oxygen

Stagnant hypoxia occurs when the cardiopulmonary system and/or the circulatory system are
unable to circulate enough oxygenated blood throughout the body. Common causes include:

Shock of any type, which is the acute reduction of blood ow to a life-threatening level

Sickle cell disease, in which sickled blood cells can block the ow of healthy red blood cells

Hypothermia, which causes the blood vessels to constrict

Treatment: The initial treatment is supplemental oxygen. Additional interventions are aimed at
treating the underlying cause and providing supportive care. If patient condition deteriorates, non-
invasive ventilation or mechanical ventilation may be necessary.

4. Histotoxic hypoxia — oxygen is delivered to cells, but the cells cannot use it

The main overall cause of histotoxic hypoxia is poisoning. The most familiar scenario is cyanide
poisoning, which prevents cells from using oxygen. Cyanide toxicity typically results from smoke
inhalation in an industrial setting. Treatment: Hydroxocobalamin (Cyanokit).

Note: When treating patient with suspected cyanide poisoning, the safety of medical providers is
the rst priority. Treatment should not begin until you are certain the threat of exposure is
contained. Do not touch a patient with suspected external exposure until you are certain they have
been decontaminated.

Learn more about oxygen delivery: This article is based on The O2 Express:
Understanding Oxygen Delivery, an interactive online course from the Board
of Certi cation for Emergency Nursing (BCEN®). Developed by nursing
experts, this CE-eligible course explains the ventilation and perfusion
systems and what they mean for patient care. To access this course and
other learning opportunities for trauma nurses, visit BCEN Learn.

The O2 Express supports the continuing education requirements of the

Trauma Certi ed Registered Nurse (TCRN®) program. The TCRN credential
is the only national board certi cation for trauma nursing, and it spans the
body of knowledge for care of the injured patient. More than 7,000 nurses
worldwide have earned the TCRN credential. For more information, click here.

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