HYPOXIAS & ASPHYXIA

By Dr. M. Anthony David MD, Professor of Physiology
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HYPOXIA

A condition where there is decreased Oxygen supply to the tissues is called as “hypoxia”

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HYPOXIA: CLASSIFICATION
1. Hypoxic Hypoxia:

Arterial P O2 is less. Decreased Hemoglobin causing O2 carriage Due to slow & low blood flow. Tissue toxins deny O2 to the cells.
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2. Anemic Hypoxia:

3. Stagnant Hypoxia:

4. Histotoxic Hypoxia:

TYPES OF HYPOXIA
1. HYPOXIC HYPOXIA 2. ANEMIC HYPOXIA 3. STAGNANT HYPOXIA 4. HISTOTOXIC HYPOXIA

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HYPOXIC HYPOXIA
 

The arterial PO2 is decreased. This may be due to:
1. Decreased Atmospheric PO2:
High Altitude  Closed room

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Arterial PO2 decreased due to:
2. Decreased Ventilation:
Respiratory Paralysis.  Bronchial Asthma  Emphysema

3. Defective Gas exchange:
Pulmonary Edema  Pneumoconiosis

All these cause a decreased partial pressure of Oxygen and so Hypoxic Hypoxia.
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HYPOXIC HYPOXIA
 

Commonest type. CAUSES: PHYSIOLOGICAL:
• High altitudes. • > 3000 Mts above MSL: Alv. PO2: 60mm Hg. • Causes irritability

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HYPOXIC HYPOXIA: PATHOLOGICAL CAUSES

Lung Failure due to:
• Pulmonary Fibrosis. • Ventilation/Perfusion imbalance.

Ventilatory Pump Failure:
• Fatigue • Mechanical defects • Depression of respiratory centers.

Shunts.
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TYPES OF HYPOXIA
1. HYPOXIC HYPOXIA 2. ANEMIC HYPOXIA 3. STAGNANT HYPOXIA 4. HISTOTOXIC HYPOXIA

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ANEMIC HYPOXIA
A decrease in hemoglobin or RBC count causes decreased Oxygen carriage and so hypoxia.  Can also be due to CO Poisoning.

• CO combines irreversibly with Hb.

Abnormal Hemoglobins such as Sickle Hb can also cause Anemic Hypoxia.
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TYPES OF HYPOXIA
1. HYPOXIC HYPOXIA 2. ANEMIC HYPOXIA 3. STAGNANT HYPOXIA 4. HISTOTOXIC HYPOXIA

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STAGNANT HYPOXIA
  

Also called “Ischemic” or “Hypo-perfusion Hypoxia”. Blood flow to tissues is slow or low. The Oxygen reaching the tissues per unit time is less. This situation is seen in:
• • Heart failure Venous obstruction

May lead to Adult Respiratory Distress Syndrome if it occurs in the lungs.
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TYPES OF HYPOXIA
1. HYPOXIC HYPOXIA 2. ANEMIC HYPOXIA 3. STAGNANT HYPOXIA 4. HISTOTOXIC HYPOXIA

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HISTOTOXIC HYPOXIA
Oxygen is available at tissue levels  But the cells cannot use it due to a toxic agent.  Seen in Cyanide poisoning.

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HISTOTOXIC HYPOXIA

Cyanide inhibits the intracellular enzyme, “Cytochrome oxidase” This problem can be treated with Methylene Blue.
• Methylene blue converts Cyan Hb into CyanmetHb which is nontoxic.

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EFFECTS OF HYPOXIA EFFECTS OF HYPOXIA

Severe Hypoxia < 20mm Hg
• In 10 – 20 seconds: Loss of consciousness. • In 4 – 5 minutes: DEATH

Mild Hypoxia:
• Symptoms are similar to alcoholism • Impaired Judgment. • Drowsiness. • Dulled sensitivity to pain.
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EFFECTS OF MILD HYPOXIA
 

   

Headache. Nausea & Vomitting. Tachycardia. Anorexia Disorientation. Excitement.
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CYANOSIS

Bluish discoloration of the skin & mucous membranes. Cause: the presence of Reduced Hemoglobin in the blood. Seen only when the absolute amount of Reduced Hb is > 5 Grams/dLt. Is more common therefore in Polycythemias.
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OXYGEN THERAPY
 

Given to patients of Hypoxic hypoxia Can be given through:
• A Nasal catheter. • Venturi mask.

  

Pure Oxygen is not given A mixture of Air & Oxygen is given. Useful in all cases of Hypoxic Hypoxia.
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ASPHYXIA

“Improper aeration of blood continued for sometime produces two pathological changes:
• Hypoxia : O2 • Hypercapnia :  CO2

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TYPES OF ASPHYXIA

LOCAL: Due to obstruction of blood supply:
• Too tight tourniquet, for too long. • Blue painful, swollen congested limb.

GENERAL:
• ACUTE:
Strangulation: Occlusion of trachea  Airtight room: suffocation.

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GENERAL ASPYXIA: CHRONIC
  

Chronic Lung Disease. Chronic Bronchiectasis. Emphysema
• Decreased Alveolar Ventilation
 

 CO2 content O2 content

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ASPHYXIA: STAGES

I STAGE:
• • • • Violent Respiratory Efforts Tachypnea & Hyperpnea. Hypoxia Loss of consciousnesss.

II STAGE:
 Sympathetic discharge • Hypertension & Tachycardia • Ventricular fibrillations • Convulsions
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ASPHYXIA : STAGE III

Gasping :
• Slow deep inspiration

     

Hyporeflexia Pupillary Dilatation Hypotension Bradycardia Cardiac Arrest Death.
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FAILURE OF ONE, IS FAILURE OF ALL!
CARDIAC FAILURE BRAIN FAILURE RESPIRATORY FAILURE

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