Respiration - Pharynx, Larynx, Trachea, Bronchi, Alveoli - Part 1

right today we are going to talk about that how oxygen is transported from the lungs to the tissues where oxygen play a big role in metabolism right now let's start with the diagram very simple diagram here is your lung fine of course there are two visited you want me to draw two longer one lung two lung okay so suppose these are simple air spaces right now what really happens that here is your left heart right it is receiving the blood from the lungs I think rather than to land well make one big law right that is much better proposition make one big long right this is let's let's pose airspace now from the right heart blood is going to the lung and from the lung blood is going to that left heart is that right so let's draw here right heart right ventricle and this is the blood going to the lungs this is present in pulmonary capillaries right if we start from here left ventricle then there is pulmonary artery after the pulmonary artery there are pulmonary capillaries and after the pulmonary capillaries they continue and eventually they can convert into pulmonary yeah pulmonary veins the right pulmonary vein bring the blood to the left heart right all of you must be knowing that between the right heart and the left heart there is pulmonary circulation this isn't right then blood from the left heart this is arterial blood this is RT that right it is going through the tissues let me make a very big muscle okay this is a muscle suppose let's suppose our arterial blood is moving to the muscle right and in the muscle naturally it will go into where into capillaries it will go into capillaries first from major arteries and then the arterioles and then into capillaries right and from the triple Ray's eventually it will be drained into yes please when you then waves and waves will eventually drain to the major venous drainage system right now what we need to learn in this diagram is that how oxygen let's suppose this is your oxygen right what we have to learn today is how oxygen from the alveolar space is going to the blood right and how blood transport oxygen from the lungs through the left heart through the arterial system eventually to the systemic capillaries and in the from the systemic capillary oxygen is supplied to the tissues and of course carbon dioxide is picked up from there and then carbon dioxide is taken back through venous system to the right hard right hard bumped carbon dioxide loaded blood to the lungs and in the lungs carbon dioxide will be lost out to the alveolar system and again blood will gain more oxygen right so we have to learn all this process step by step fine now one of the major role which is played by the most important rule the transport of oxygen is played by a very important protein called hemoglobin that is hemoglobin so first I will talk about the structure of hemoglobin right who is good at structure of and raise your hand you are rooted structure of hemoglobin okay you draw on your copy I will draw on the board we'll compare later right okay so let's come back now what is the basic structure of hemoglobin actually hemoglobin synthesis start with what is this structure called by rolling what is it called spiral ring actually for for pyro reins are assembled together you know this occurs in the retro blast you know the throw blast eventually make RBC's so within that it's a blast this is a retro blast this is nucleus of retro blast of course this erythroblast is in the bone marrow so within that retro blast first of all their synthesis of pyro rank this spiral ring right for pyro rings are put together and now this structure is called yes please proto for fire in what is the structure called protoporphyrin now this protoporphyrin I can represent in a simple way like a very decent what is this flower this is protoporphyrin structure or simply we call it pour firing now in the heart of pour firing you put iron what you put iron right so protoporphyrin plus iron now this structure is called yes him the structure is called him again you take the pyro ring put pour for pyro ring in a structure that is called pour fire in the heart of pour fire in you put iron and that is called same then what you do that cell will synthesize a peptide chain and this beautiful flower should have one peptide chain and this peptide chain of course made of amino acid and this is called globin so heme plus this peptide chain peptide chain together their car it is Carl yes he mo global complete the name hemoglobin monomer it is not the complete hemoglobin it is just hemoglobin monomer this is that right am i clear to everyone now let's go to further detail of hemoglobin structure because we have to talk about hemoglobin it's most important molecule with transferred oxygen right now what are the different types of hemoglobins again you will tell me rapidly what is the structure yes please put fire in what is this now it is him and what is this peptide chain globin chain now actually there are many different types of globin chains which can be synthesized in a throw blast right now if we make let's suppose this is the retro blast this is just nucleus this is a gene to synthesize alpha globin chain this is a gene to synthesize beta globin chain there is another gene to synthesize gamma globin chain there is another gene to synthesize Delta globin chains this concept should be very clear in every restore blast there are genes multiple genes which can make different types of globin chains is that right now alpha a alpha genes are all the time active so what really happens that this is your yes another him and with the same there is one more alpha chain so alpha alpha these are now this is one mo globin monomer this is another hemoglobin monomer yet it is not complete molecule of hemoglobin because one hemoglobin molecule is tetrameric one hemoglobin molecule is tetrameric so it is not a complete molecule it needs two more arrangement and let's pose with it now gene is expressing beta so beta chain and B touch now this structure is one hemoglobin molecule this is one single hemoglobin molecule which consists of four hemoglobin monomers and this hemoglobin molecule should be called it has two alpha chains plus yes please yes two beta chains such hemoglobin molecule is called yes please hemoglobin a why we call hemoglobin a a strand for adult this is adult hemoglobin that if I take I hope all of you are adult right so if we take your hemoglobin and study their alpha the different peptide chains that most of your hemoglobin will molecules will have two alpha chains and two beta-globulin which has two alpha chains and two British in this is called hemoglobin a then there is another hemoglobin which is also present in very small amount in adult that is called hemoglobin a two in that hemoglobin what really happens there are two alpha chains again now I'll make it rapidly there are four monomers and remember alpha chains are always there alpha alpha but this time in the second molecule alpha rather than beta chain there are Delta chains you know this gene is expressing Delta chains and this molecule of hemoglobin now this molecule is different than that of course I should not forget to put what is that iron right now this is a hemoglobin tetramer this is a hemoglobin to a trauma it is to alpha this is two alpha but this is to beta and that is true Delta right when with two alpha there are two beta we call it hemoglobin a but when with two alpha there are two Delta we call it hemoglobin a - we call it hemoglobin a - is that clear then another important type of hemoglobin you are supposed to know is hemoglobin F fetal hemoglobin right which is present mainly in the fetus right now fetal hemoglobin is again okay I will make the structure and you will tell me I think that's not difficult to remember these flowers everywhere and again what is there here we are watching that there and what is added now Gammage in in the fetus this didn't you remember alpha is alpha gene is expressing throughout alpha gene expressed for adult hemoglobin for hemoglobin a - as well as hemoglobin F the differences in other genes when with alpha there are two beta just become adult with alpha with 2 Delta it become adult - when with alpha there are 2 gamma it become fetal right so put two gamma so what is the structure of fetal hemoglobin is that there are 2 alpha plus there are 2 gamma gamma clear so this was the first discussion that when we talk about the transport of oxygen the most important molecule which is involved in transport of oxygen is hemoglobin and we must know hemoglobin molecules single hemoglobin molecule is at tetrameric molecule right and every monomer is made of one heme component in one global chain him component is made of porphyrin ring who having a in the center an iron which is present here is always in which form ferrous forms you have to remember iron in the he mean ferrous form not in ferric form the iron should be in this form and not in this form if in hemoglobin in him component if I is not ferrous rather it is ferric then hemoglobin is called met hemoglobin have you heard of metamer globin so what has met hemoglobin simply a hemoglobin molecule in which iron has been changed from his ferrous pond into ferric form is it right and once iron changes from Ferris form to ferric form then it does not bind oxygen so it says useless similar right meta mo globin is useless mo globin because it does not bind oxygen oxygen bind only with the ferrous form this is there clear now another important thing hemoglobin molecule is highly toxic molecule the FEMA global molecules are free injure circulation hemoglobin molecule will leak into kidney tubules into nephron and damage your nephrons they are highly toxic molecule so Nature has packed the hemoglobin in RBC membranes so that no global molecules do not produce toxicity to the body this is it right so this is an RBC and it should be having millions and millions of hemoglobin molecules right in my discussion I will show mo globin molecule in a different way let's suppose this is one pocket where oxygen will bind this is second pocket where oxygen will bind this is third pocket where oxygen will bind and this is the fourth pocket where oxygen can bind so in one mo globin molecule how many pockets are there four pockets right so rather than making this structure I will show the structure in a simple way here like one pocket second pocket third pocket for pocket this is our hemoglobin right actually hemoglobin is not like this but hypothetically this structure which is their true hemoglobin I will be showing like this and this is the pocket where which should settle oxygen should settle so actually this pocket is heme component what is this M component and in this pocket at the bottom of this pocket there must be iron in the ferrous ball is there right so now symbolically I'm making hemoglobin molecule in this way and it has four pockets into which oxygen is supposed to fit in this is a right now let's come over here now we start our proper lecture on transport of oxygen we know that oxygen should be transported mainly in the pockets of hemoglobin which is present in our beaches of course right now let me make one RBC here I'm making the RBC black colored do you have any objection right and hemoglobin out make inside red color and this is one pocket second third and four pocket okay this is one hemoglobin molecule this is there right now what really happens that we know that oxygen should transfer from alveolar space to the plasma and from the plasma to the RBC and within the RBC's it should bind with hemoglobin now the question is that what is the force which what is the force which moves the oxygen from all evil eye to the plasma and from the plasma to the fluid of RBC and from the fluid of RBC's to the hemoglobin molecule that is the partial pressure of oxygen you know gases are moving from higher partial pressure to lower partial pressure this is that right now what really happens the partial pressure in alveolar space partial pressure of oxygen yes yes who knows what is the normal partial pressure of oxygen in alveolar space what is the normal partial pressure of oxygen in alveolar space anyone it's very easy to remember just say hundred just say 100 hundred is difficult to remember just hundred to be very exact it is 104 but don't try to be that of that and forget everything let's suppose that partial pressure of oxygen here is one hundred word millimeter of mercury this is the partial pressure of oxygen in later lectures we'll discuss why it is one hundred so for a while you just trust me I'm right the partial pressure of oxygen in the alveolar spaces one hundred millimeter of mercury is that right now what really happens the partial pressure of oxygen now this is a plasma this is outside the RBC plasma what is the partial pressure of oxygen in the plasma of the blood which has come in to lung who knows what is listen carefully about the question what is the partial pressure of oxygen in the plasma of the blood which is coming from the right heart to the alveolar capillaries that this this is 40 excellent very good unexpectedly 40 millimeter of mercury so we say that when mixed mixed venous blood you know venous blood which is coming here it is coming from many tissues so this venous blood is coming from multiple tissues we call it mixed venous blood when it is reaching to albula people raised right this blood pulmonary arterial blood but it is deoxygenated it has a partial pressure of oxygen 40 now add the partial pressure of oxygen add the partial pressure of oxygen 40 I am going to make now RBC here this is your RBC and these are these four pockets right I say that partial pressure of oxygen here is 40 millimeter of mercury at this point let's suppose before reaching to the albula when pressure of oxygen is 40 oxygen is pushed to the RBC's and add this pressure out of 4 pocket 1 2 3 & 4 pocket how many pockets are loaded with oxygen who will tell me at the pressure of 40 millimeter of mercury partial pressure of dissolved oxygen because listen oxygen is present in the blood in to form number 1 oxygen which is dissolved in the fluid like in the plasma and oxygen which is bound with the hemoglobin right when we say there's partial pressure of oxygen partial pressure of oxygen is produced by only dissolved oxygen write it down somewhere that oxygen will bind with hemoglobin does not contribute to partial pressure oxygen which is bound with the hemoglobin does not contribute to partial pressure the partial pressure of oxygen which is present in the plasma our blood fluid that is completely determined by the dissolved oxygen right oxygen is present here in to form number 1 dissolved oxygen number 2 a fission which is binding with the hemoglobin this oxygen molecule which is binding with the human globin does not determine partial pressure partial pressure is determined by dissolved oxygen this may be dissolved in plasma or this oxygen may be dissolved in the fluid of RBC right but this is not bound with hemoglobin my question is this this concept is very easy that if you increase the partial pressure more hemoglobin will load on the hemoglobin molecule again if you increase the partial pressure of oxygen more oxygen will bind with the hemoglobin is it right and if you decrease the partial pressure then oxygen will jump out is that right now listen when partial pressure is 40 this number you should remember because all of you right now sitting comfortably resting human beings have partial pressure of oxygen 40 in the blood which is coming back to the lungs right my question is that at the pressure of 40 millimeter of mercury how much how many pockets off oxygen hemoglobin are loaded with oxygen do you think - okay anyone else you think three pockets your concept look there is someone here with a concept there's a lady here who says that when partial pressure is 40 then it means three puck three pockets are already loaded with oxygen so your concept is when hemoglobin molecules are coming back to the lung already they are loaded at three points anyone who differs with her raise your hand whoo-hooo difference from her there's a lady here with the name of Irene Landgraf and she claims that when partial pressure of oxygen is faulty right let us not been partial pressure of oxygen is faulty then she says under this pressure in normal hemoglobin out of four pocket three pockets are already loaded with oxygen this is her concept personal and private concept and who differs raise your hand you are alone all of you you are all so different with her what do you think how many pockets are full you think two pockets are full what about you two pockets what about other people one okay people who believe one pocket should be full raise the hand these are very much wrong people who believe two pockets are full they are also wrong the lady is right this is a very important concept listen carefully attention please attention please listen carefully in a normal resting person when hemoglobin come back to the lungs to get oxygenated already it is oxygenated 75% this is a wrong concept that venous blood has no oxygen is there right so add the pressure of 40 millimeter of mercury of course pressure of oxygen three pockets pocket number one pocket number two pocket number three three pockets are loaded with oxygen all it means what is the saturation how how much what is the percentage of hemoglobin saturated with oxygen at the pressure of forty seventy five percents is the saturation so now listen carefully when a mixed venous blood comes to the lung in the midst mixed venous blood partial pressure of oxygen s forty millimeter of mercury and under the partial pressure of 40 millimeter of mercury out of four sides three sides of hemoglobin are still loaded with oxygen so hemoglobin saturation is 75 percent is there right now so you can say this is oxygen transporter you can imagine this is hemoglobin car animo global car comes it's a four-seater it's a four seater car three passengers are already there it is coming for how many senior here only for one it loves to keep its level four seater so what really happened as soon as you know global molecules within the RBC's reach to the pulmonary circulation into pulmonary capillaries they are already loaded with three oxygen molecules at pocket number one two and three and seventy five percent saturation is already there only 120 only 25 percent of the hemoglobin need to be saturated now pressure here is 100 right here is 40 so naturally oxygen molecules will move from high pressure to low pressure and very rapidly of region will start moving right in a healthy person from where we are from Allah Bueller side to the capella side and from the alveolar air space oxygen will shift immediately to in the capillary we're in the plasma first this is the point to remember it will not directly go to the RBC or not go directly into hemoglobin first oxygen will come into plasma right intense pressure become equal sides oxygen will keep on coming from Alvie light to the alveolar capillaries until pressure here also become partial pressure of oxygen is 100 this is right now when partial pressure of oxygen is 100 here when partial pressure of oxygen is 100 here then more oxygen will enter into of course RBC and under this partial pressure more oxygen will bind with hemoglobin and now hemoglobin becomes saturated at all loaded with the oxygen at all four pockets so this is how it will happen this was a littler surface oxygen shifted from ala Bueller surface from a leaner area to the capillary right just was your capillary from here when oxygen will shift here it will make the partial pressure of faulty limit of mercury to the partial pressure of 100 when oxygen will come down it will take partial pressure of 4200 when partial pressure becomes 100 millimeter of mercury under this pressure of course last site is also filled now we say that it is 100% saturated is that right so the concept which we have to make is that partial pressure of oxygen determines partial pressure of oxygen determines what is the level of saturation of hemoglobin width oxygen is that right now blood will move to the left heart when it is going towards the left heart right what is the partial pressure now you will tell me 100 millimeter of mercury oxygen hemoglobin is how much saturated hundred percent saturation is there right now we have to make another concept which is very important we know that this is the pressure of their dissolved oxygen and we know that all hemoglobin molecules are loaded with oxygen but we do not know that what is the exactly what is the amount of oxygen in 100 ml of blood now we have to calculate another thing that let's suppose this is column of blood from here up to here and this blood which is moving okay this amount of the blood let's suppose it is 100 millimeter of mercury sorry hundred ml not pressure it is a volume let's suppose this is 100 ml blood is the right and originally this 100 ml blood came to the lungs it get oxygenated 100 ml then it moved forward now we have to see develop and other concept what is that concept we have to see that in a healthy normal person 100 ml of the blood can carry how much amount of oxygen because up to now we only say pressure of oxygen is 100 millimeter of mercury we only say all the hemoglobin is loaded with oxygen but we do not know how much total oxygen is there in hundred ml right of course oxygen transporter is hemoglobin if there's more immigrant in 100 ml amount of oxygen will be more and if removal Oban is less than 100 ml of the black then amount of oxygen will be less so we have to develop one more concept that under the sure of 100 millimeter of mercury when hemoglobin 100 percent saturated what is the capacity of blood what is the capacity of blood to carry oxygen and what is the real amount of oxygen there we'll calculate that you can feel you're up to now no confusion maybe you are not listening to lecture some people will sleep well during the lecture somehow they never get confused okay now we'll talk about let's pose this is not a blood vessel this is 100 ml blood okay I'll make a simple diagram you must have seen the beakers let's suppose in this beaker we put 100 ml blood right and here we apply a piston which is pushing the pressure and here is oxygen let's suppose the pressure with which oxygen is pushed into this is 100 millimeter of mercury right so partial pressure of oxygen right is maintained at 100 right and we know whatever amount of let's suppose these are the hemoglobin molecules we now know that under this pressure all the immigrant molecules will be 100% saturated right now if I ask you that with 100% saturation how much total of switchin can be carried in this 100ml of the blood it depends on amount of hemoglobin and also capacity of hemoglobin to bind with oxygen this is that right now experiments have told us that one gram of hemoglobin one gram of hemoglobin buy-ins if it fully binds under percent saturation 800 precision saturation binds 1.34 ml of oxygen now one gram hemoglobin when it is 100 percent saturated can hold how much oxygen 1.34 M is the right if this can stick to your mind now we can think of another thing in a healthy person let's suppose however this patient circulation is a healthy person circulation normal person healthy person in 100 ml of the blood how much hemoglobin he has healthy person has how much hemoglobin 100 ml of blood you never count it please tell me 15 gram everyone should know right there's a range female are usually having around 14 grams hemoglobin per 100 ml of the blood males have a little more is that right I will not discuss the causes anywhere so if we talk about this patient now listen carefully in this particular patient there is 15 gram hemoglobin per 100 ml of blood 400 ml of blood now listen we have taken this hundred ml isn't it this is 100 ml amount of blood which is going to travel throughout all the way back right we are going to study dynamics and this that bolus of 100 ml of blood is how much hemoglobin 15 gram 1 gram carries one gram carries how much oxygen one gram hemoglobin carries 1.3 4 ml of oxygen can you calculate and 15 grams mo globin if it is 100% saturated if it is hundred percent saturated fully loaded will have 15 into 1 point 3 4 ma oxygen that will become about 2 1 the point 1 ml oxygen now what did we learn we learn this n right now that if this 100 ml blood with 15 grams of normal hemoglobin has its hemoglobin fully saturated then the total hemoglobin which will be loaded on sorry total oxygen which will be loaded on hemoglobin is twenty point one amount is it flesh no problem in this it means but to remember one thing if there is some more oxygen there because even though most of oxygen is loaded on hemoglobin right this is Posey McGlinn pocket one two three four but there is some of Siegen which is dissolved in plasma that is also present in this hundred and so it means in this 100ml blood some oxygen is present in plasma some oxygen is loaded on hemoglobin so oxygen is in to form hemoglobin bound oxygen which does not play a role in partial pressure and dissolved oxygen oxygen actually if we combine these two that will tell us total oxygen we have calculated how much oxygen is bound with the hemoglobin now we must calculate how much oxygen is present in dissolved form this is it right okay oxygen dissolves poorly it is not highly soluble gas oxygen is not highly soluble gas right for example oxygen dissolve point zero zero three ml oxygen dissolves in 100 ml 100ml blood under pressure of one millimeter of mercury partial pressure of oxygen listen you are putting a pressure and under that pressure some oxygen will dissolve and most of oxygen will bind this is right the oxygen which is binding we have already determined that when pressure is 100 millimeter of mercury 100 percent saturation of hemoglobin occur one gram bind 1.34 ml if it is 15 gram total will be twenty point one ml oxygen which will be held with hemoglobin clear now we have to talk about dissolved oxygen under partial pressure of one millimeter of mercury only point zero zero three ml of fijian dissolves it means effusion is not a very soluble and when pressure is 100 you multiply it by 100 and how much it will become issue multiplied by 100 point zero three Emma what does it mean it means that if you have 100 ml blood attention please if you have let's suppose this is blood column it is 100 ml blood partial pressure in this oxygen partial pressure is 100 millimeter of mercury only 0.3 ml of sisian will be dissolved but 20 point 1 ml oxygen will be held with hemoglobin so total become about twenty point four so it means most of the oxygen which is present there is not the dissolved form most of the oxygen is present in hemoglobin bound form these are right normally in your blood right now in arterial blood 97% of the oxygen is bound with hemoglobin only 2 to 3 percent of fijian is present in this all forms am i clear to everyone no problem up to this but even the dissolved form is only 0.3 ml but you should not under imitates importance because the small point three ml is responsible to create the partial pressure of oxygen in the plasma is there right clear now another thing when blood is moving now listen carefully when how much blah we have noted off fusion here 20 ml with this hemoglobin and point 3 mln dissolve about twenty point four is that right this concept layer to everyone now we have another concept little modification to bring this concept near the reality the reality is this that blood which is moving through the lungs through alveolar capillaries that gets oxygenated but there is another circulation in the lung language to circulation one circulation is pulmonary circulation and other is other is bronchial circulation there are two circulations in the land one is pulmonary circulation other is bronchial circulation actually bronchial are breathe look supply the deep structure of the lungs and they supply the oxygen and bronchial artery is eventually going to bronc your veins and look here these bronchial winds drain into what is this drain into the blood which is coming from the lungs now listen this blood through pulmonary circulation blood which is going to the left heart it is oxygenated but the blood which is missing from bronchial circulation that is not oxygenated again listen carefully lung has two types of circulation one circulation is that blood is coming from the right heart passing through the lungs and gas exchanges occur and after loading the oxygen that blood is going to the left heart but lung broom brought you the another deep structure of the lung also need their own blood supply for that nature has provided the lung with a small miniature circulation which is called bronchial circulation this bronchial circulation supplies oxygen to deeper tissues of the lung and then bronchial wayans bronchial waves drain into the blood bronchial veins which bring deoxygenated blood they drain into the vessel which are bringing fully oxygenated blood from the lung this will lead to mixture of two blood fully oxygenated blood and deoxygenated blood because fully oxygenated blood is very big amount deoxygenated blood is very little so there is a little drop in oxygen pressure here again listen this blood which is coming from the alveolar side it has a partial pressure of 100 and this blood which is coming from bronchial veins that is a partial pressure of veins which is 40 millimeter of mercury so these two blood mix before they reach to the left heart and when this venous blood mixture occur thank God fully oxygenated blood is in large volume and bronchial blood is in small volume so this Tornai oxygenated blood and fully oxygenated blood when the mix the partial pressure drop from 100 millimeter of mercury to 95 millimeter of Metheny is that clear it means that when blood is moving from this side forward what is the partial pressure of oxygen here remember mosy Jian is lost on the way because there is no oxygen going to the tissues so blood when blood is moving from here forward and will cause this blood and this blood is mixed so partial pressure will drop to 95 millimeter of mercury this is the right anyone who could not understand this concept raise your hand anyone who could not understand this that why partial pressure of 100 millimeter of mercury drop to 95 millimeter of mercury within arterial system everyone is clear strange you are clear about it that's good I don't know in this hypoxic environment you can understand so well right now partial pressure of oxygen has dissolved oxygen has a draw-off from 100 to 95 due to mixture of V deoxygenated bronchial blood mixing with the pulmonary blood pulmonary venous blood this is pulmonary arterial blood this is pulmonary venous blood that is from children s blood and both of them when they mix is the term which is used as venous admixed and the book somewhere it is written if you read that there is veena due to Venus Adam admixture Atmos German mixture mixing you to Venus add minute admixture the partial pressure of oxygen dropped from 100 to 95 right now the partial pressure of oxygen will drop do you think oxygen will remain a hemoglobin will remain 100% saturated no under the pressure of 100 you keep hemoglobin 100% saturated one partial pressure of oxygen becomes little less then hemoglobin becomes a little less saturated right we say that saturation look pressure drop from partial pressure of oxygen has due to that event has dropped from hundred to 95 clear and percent saturation drop from 100 to 97 again I will tell you don't worry these are pockets of hemoglobin before pressure was how much 100 under the pressure of 100 it is 100% full it 100% loaded but when pressure become 95 it is about 97% full am i clear no problem up to this it means attention plays it means there total amount of oxygen which was supposed to be twenty point four ml that will drop down is it right we can say approximately 20 ml oxygen is carried by 100 ml blood again let me repeat it what is happening look here it was fully oxygenated this was less oxygenated for both of them mix do you think in every 100 ml of the blood a fission content will go up or down content of oxygen will go down so from twenty point four it may become 20 ml this is it right now I will sum up this thing and then I will come to that tissue let's sum up now you will tell me there is 100 ml blood which is entering this is a suppose bolus of blood right hundred ml blood from here up to this and it is going to enter into some arterial side - capillaries now you will tell me what is the partial pressure in this yes partial pressure is 95 partial pressure is 95 and what is that dissolved dissolved oxygen 0.3 ml what is the dissolved of fusion coming here 0.3 ml and what is the oxygen with hemoglobin okay what is the hemoglobin saturation percent saturation 97 and what is the amount of oxygen here content of oxygen total about 20 and look the total capacity was slightly more but it is loaded with less than its full capacity because when oxygen is 100% saturated we say it is saturated to full capacity when it is 90 percent saturated it is loaded with slightly less than full capacity you just imagine that you have a container which can hold 20 ml but if that container is not 100% 4 that is false 7% you will say there's a difference in capacity and the content this point is important let me explain let's suppose we can put 100 ml 20 ml any substance fully at 100% for 20 ml this is the capacity of this container but if you don't pull it rather you fool it up to 97% so we say content will be less than the capacity same is true about 100 ml of the blood 100 ml of the blood has more capacity but due to this mixture content is less than its full capacity this is not right when we talk about what is the capacity of 100 ml of the blood to carry oxygen capacity mean what is a maximum amount of oxygen which 100 ml of the blood can carry just remember when I say tell me the capacity of 100 ml of the blood to carry oxygen I mean that what is the maximum capability of blood to hold the oxygen and when I say tell me the content of oxygen then I'm asking okay fine whatever it is whatever is its capacity tell me how much is really there right so an arterial side of the blood capacity and content are very very near to each other because it is 97% for any question up to this there's no question now this will reach to the capillaries this isn't right what happens in Crippler is systemic Appel is that these are tissue cells now tissue cells are all the times utilizing oxygen tissue cells are all the time utilizing oxygens you know they use oxygen and burn some glucose and fats and predict convert ADP into ADP right and during this effusion is being used because tissues are metabolically using oxygen so in that tissue pressure of oxygen is going up or down down this is right in most of the resting tissue not for example if you are dancing around a different situation but you are comfortably sitting in your resting muscles the partial pressure of oxygen is around partial pressure of oxygen is around yes forty millimeter of mercury is there right I will draw that structure here there what is happening now let's suppose this is a capillary right this is the hundred ma this was the blood which were the N train now when blood enters here this is RBC is there right you are supposed to tell me what is happening here partial pressure of oxygen is 95 at entry point we'll see what is happening at entry point in the kiparis and what is happening at exit point this should be the concept now partial pressure of dissolved oxygen is this what is the amount of dissolved oxygen 0.3 ml per 100 ml of the blood point 3 ml of oxygen per 100 ml of blood no need to write it but anyway now in the hemoglobin under the pressure of 95 hemoglobin saturation percent saturation is 97 is that right so most of the hemoglobin is loaded with oxygen is that right clear to everyone and content of content of oxygen is how much 100 ml of the blood which has a hemoglobin of 15 grams and partial pressure of 95 total content of oxygen is 20 M please these are the three parameters which you have to talk about arterial side at a strange site at Venus site and Alvino site what are these three parameter number one what is the partial pressure of oxygen at any point number two what is the hey what is the capacity of blood to have the maximum hemoglobin in it number three what is the saturation of hemoglobin number four what is the true amount of oxygen really carried so we have said it from the arterial side and blood is entering into systemic capillaries partial pressure of dissolved oxygen is 95 amount of devolve dissolved oxygen is 0.3 ml per 100 ml of the blood and if person has 15 grams of hemoglobin per 100 ml of the blood and under this pressure it is about 97% saturated so it is about 19 point some 19 points was 5 or 6 ml oxygen total hemoglobin bound oxygen plus dissolved oxygen is approximately 20 ml sub content our oxygen in hundred ml of the blood is 20 ml now it come to the tissue now we come to your this beautiful muscle black muscle now this muscle is okay first it is resting right if it is resting still it needs some oxygen to run its normal basal metabolism when muscle cells are using oxygen naturally within the muscle cell let's both this is muscle cell oxygen level will be low usually oxygen level in the your body tissue is somewhere between 15 to 40 millimeter of millimeter of mercury this is the partial pressure of oxygen because tissues are is using oxygen so within the tissue of fusion level is 15 to 40 now what is the pressure here 95 what is the pressure here 40 now here pressure is high I'm writing 95 here 95 is the partial pressure here 40 is the partial pressure in the tissue naturally oxygen will move from high pressure to low pressure from the dissolved oxygen now listen don't tell anyone that oxygen from hemoglobin jump they are known first first this is the dissolved oxygen which is the even though in very small amount dissolved oxygen shift from capillary plasma to the interstitial fluid and from the interstitial fluid oxygen shift to the cells again what is happening cells are metabolically active they're constantly utilizing oxygen partial pressure of oxygen in the cells is very low so oxygen is constantly shifting from interstitial fluid to the cells so oxygen level in the interstitial fluid is also low fusion it is around 40 millimeter of mercury right when arterial blood come when oxygenated blood comes into capillary fresh blood come into capital is that is having a pressure of ninety five here the pressure of 40 so oxygen moves from dissolved state of plasma to the dissolved state of interstitial fluid from there oxygen will move to the dissolved state of cell this is it right now soon when oxygen will start shifting in this direction dissolved oxygen partial pressure of oxygen will drop here it will become equal to this partial pressure so as blood is oxygenated blood is moving through the tissue Capella's effusion is moving from dissolved state of plasma to the dissolved state of interstitial fluid and the cells during this process partial pressure of oxygen from the plasma which is ninety five drop to the partial pressure of 40 when partial pressure of dissolved oxygen become less under low partial pressure you cannot keep all the EMU oxygen sticking to the hemoglobin right so what really happens that as rep this pressure drop and the plasma right oxygen will jump out from where from hemoglobin now this concept let me make it more clear two three four four pockets were there this pocket number one oxygen two three and four now let me tell you the behavior of these pockets it's very important to understand actually if around this molecule this is a molecule of hemoglobin right now this is a molecule of hemoglobin which is D oxygenated and deoxygenated hemoglobin molecule has how many pockets open only one pocket open one pocket open other pits are closed this point is suppose um now I'm not discussing at this point I will come back to here I'm going to some very basic concepts separate than this discussion let us suppose you have a hemoglobin molecule which does not have any oxygen it will have only one pocket open other pockets will be closed it means this pocket is ready to accept oxygen so we say this pocket is having high affinity for oxygen other pockets are closed it means other pockets are not having affinity for oxygen now let's suppose the partial pressure of oxygen in this area is 0 if partial pressure is 0 no oxygen is binding here no oxygen right of course partial pressure 0 mean there is no oxygen if there's no seizure nothing binding there let us suppose that in this container we start increasing the partial pressure of oxygen if they start increasing the partial pressure of oxygen more and more oxygen will bind with these pockets is that clear it is just like that if there is no passenger no one's written the car is the more and more passenger on the road more and more will try to get into public transport our transported four-seater is there right now let's suppose you are taking the oxygen pressure up when you're taking the oxygen pressure up first of all first pocket will get loaded now listen as soon as first pocket folks first pocket is worth the heme of heme with its iron in which form ferrous for heme molecule in the first pocket with this iron in the ferrous form except one of freedom right as soon as we receive oxygen just touch the other one open your mouth there is something coming so second open second open the third and fourth are still sleeping so what has happened when one is loaded it increase the affinity for the second now if you take the pressure up second will accept the oxygen when second will have loaded it alter the pocket of the next and then next will open up its mouth and if you really increase further pressure of oxygen this will also get loaded now which has become loaded which pocket third they are very cooperative with each other but selfish although first they fill their own pocket then tell the next one be ready something is there right now next pocket will open and eventually if pressures are high enough like very high pressure all of them will be loaded so this process in wedge when one pocket is loaded right it increases the affinity of the next pocket for oxygen it means first is leading to cooperation with the second and the second get loaded it cooperate with the third side to increase the oxygen loading this is called positive cooperativity what is it called positive cooperative routine I still have to write it positive cooperate T VT so positive cooperativity is shown by the human globin molecule this is molecule is just like for friend right or you can say that in this hemoglobin car there are how many seeds for seed if one seat is full the switch automatically first seat automatically you open the second seat when second seat is loaded with passenger second seat of the button which open the third seat and when third seed become loaded automatically which seat open the last seat it means that when one site is oxygenated it increases the affinity of the next site for the oxygen am i clear no problem after this relic now look in the beginning when oxygen was when hemoglobin was totally deoxygenated now this is the very sad mo globin you can say no oxygen so only the first one pocket is open at this moment out of this four pocket of foresight only one site has high affinity for oxygen other sites don't have affinity but when one get loaded it increases the affinity of the second site for the Ephesian then first and second both get loaded they activate the third side when three get loaded they activate the four side now you have to use your brain and tell me the answer therefore friends together standing when first get stimulated his stimulate the second one when first and second both are stimulated both of them together stimulate the third one and third also become stimulated don't think of wrong things all three of them stimulate the fourth one who is most stimulated fourth one so the end result is that one oxygen becomes fully loaded on all four side maximum affinity is shown by the fourth side but in the beginning process maximum affinity was shown was shown by the first one again let me repeat it when there's deoxygenated hemoglobin only first situs having the full affinity to bind oxygen as more and more molecules bind and occupy the sides the sites which are loaded which activate the next and eventually the last site becomes the most highly offended heavy affinity for binding oxygen am i clear there's no problem another relationship I will draw here and then I will come back to this point let's suppose I make a simple graph here I'm going to draw it hypothetically right let's suppose that you have a beaker here and in it there is lot of hemoglobin right and you're putting pressure and with pressure you are adding oxygen there with the piston you are adding pressure now here you are progressively increasing partial pressure and more and more pressure will add to oxy saturation of hemoglobin percent saturation again blessin you are having emo globin some amount of hemoglobin in a container and you are exposing that hemoglobin to progressively increasing pressure of oxygen oxygen as you keep on increasing the pressure of oxygen the saturation of hemoglobin will become progressively more is the right and what really happens at the pressure of 100 let's suppose this is the pressure of 100 and at the pressure of 100 this is the point at the pressure of 100 it is 100% saturated no globin is 100% loaded with oxygen this concept is clear no problem up to this if you know globin was a simple molecule and it is not but if hemoglobin was a simple molecule it will behave like this you keep on increasing the pressure you keep on getting more saturation so actually if hemoglobin was a simple molecule it will go like this what is this in your relationship that as you keep on increasing the pressure there is proportionate increase in hemoglobin saturation when you study from point 1 up to points both rendered when you study in this direction you are studying that how pressure is leading to Association right and if you keep on decreasing the pressure saturation will keep on decreasing and it will move like this those are right hemoglobin is not so simple it does not follow this rule this graph is wrong but why I draw it because I have to tell you what is the special thing about this graph of program first you think if it was a simple molecule at pressure of 100 100 percent saturation a pressure of 50 there should be 50% saturation at pressure of 25 there should be 25% situation it is not like this it is really not like this right actually hemoglobin behave in a different way have you seen some people who are philanthropist what is the definition of a good friend request he should be a person who should grab where he finds the money he should grab as much chicken gram he should become greedy and when he goes to the poor people he should give as much he can give hemoglobin molecule is like this let me tell you first for example I'm a hemoglobin molecule but I'm not interested in oxygen I'm interested in money just pose this is the lung area this is a tissue area along areas the rich people area and tissue is the poor people area I'm going to the rich people area here do you think I should give oxygen or take oxygen so my behavior should be snatch as much money as much I can so I should become greedy greedy or I will not rob I'll not go by your advice that is left up to you now listen and we I have a tendency to associate money with me I have a tendency to associate money with myself so when I go to their money rich area I will show a strong behavior of association with money I will take more and more money from there now I'm going to visit poor people there right there my behavior should turn into dissociation when I see the poor people I'd associate more and more but when I turn back I should again become a strong associate a strong holder of the money and here I should become a loose holder and more distributor hemoglobin molecule is like this it behaves in the lung in a different way it behaves in the tissue in a different way that is why the curve is not linear right the cause in the lung it molecule has more affinity to hold the Ephesian right when hemoglobin is exposed to high pressure of oxygen its affinity to hold the oxygen is very very high and when it moves hemoglobin moves to the tissues which have look low pressure of oxygen there is a dramatic out of proportion fallen affinity of human globin to hold oxygen and it loses oxygen that is the how it work like a good oxygen transporter it will take from the oxygen-rich area and give it to the poorest I will draw the curve and I will show you what does it mean explain now this is the law what does it mean let's study point by point at the pressure of 100 it is saturated 100% is easy to understand at pressure of 90 that pressure of 90 it should be saturated how much 90 percent no it's still 99 percent now listen carefully if it was a linear molecule at pressure of 100 saturation should be 100 and if it was a linear and pressure of 90 saturation should be 90 and pressure of 80 saturation should be 80 but it is not like that here it is operating in the lungs because lung has high pressure so in the lungs at pressure of 100 it is saturation of 100 a pressure of 90 test saturation of 99 pressure of 88 a saturation of 95 so it means it is not very willing to release oxygen it is keeping itself very well saturated it is not willing to be de saturated this is a right actually on this curve if you look at that if you drop the pressure from 100 to 50 you are dropping pressure 100 to 50 right and when you drop pressure from 100 to 50 this drop is what is the 50 point this drop actually here is draw up only 85 what does it mean that you have dropped the pressure from 100 to 50 but saturation has dropped from 100 to 85 it means how much of citchen is released only how much hemoglobin is d saturated 15% it means in spite of a big fall in the pressure it did not release much oxygen these are right now you come to this part of the curve if there's further drop of pressure from 50 to 0 from 85 to 0 it means between the 100 250 it loves to remain saturated and between the pressure of 50 to zero it loves to be d saturated again let me explain if you have a hemoglobin in a container and you are applying the pressure of 100 all of the hemoglobin will be fully saturated if you keep on reducing the pressure you reduce the pressure from 100 to 50 only 15 percent hemoglobin will bubble out not 50 percent but if you remove the last 50 percent of the pressure 85 percent or remaining of see general bubble out you to mean that higher pressure it will it desaturate a little at lower pressure it desaturate very rapidly so it means and higher money pressure is like that man and higher money pressure of the rich area it loves to remain saturated and at lower money pressure it loves to desaturate and deliver I am a really clear no problem up to this right now let's truly study this graph actually in this graph first of all you should understand that pressure is 100 on arterial side or lung side pressure is 100 at arterial side or lung side so this is the curve at lung when hemoglobin come to the what is this tissue Capella's pressure drop where 40 when pressure drop 40 it means from 100 pressure will go 50 and then 40 here add the pressure of faulty yes curve is moving only this this much here it was 100% saturated and here it is still 75 percent saturated what does it mean you could not understand this stranded surprise of the year now what we're really talking that in the lungs under the pressure of 100 it was 100% saturated when it came to the tissue pressure has dropped to 40 it only released how much 25 percent oxygen because pressure drop from 100 to faulty but saturation drop from 100 to 75 it means now we put another parameter here content of oxygen how much was the content of oxygen here 20 ml is that right 10 ml 5 ml 0 ever now correlate all this in the lung pressure is 100 saturation is 100 content is 20 ml all of them correlated in the tissue pressure drop from hundred to 40 40 a saturation drop from hundred to 75 and content drop from hundred twenty to fifty what does it really mean apply here pressure has dropped from 95 to 40 this is class under that saturation will drop to 75 so three pocket will remain full and oxygen from one pocket will come out so how much percentage of oxygen will be delivered 25 percent will be delivered because 75 percent is still saturated is that right 75 percent is still saturated this is there right now how much attention attention how much amount is delivered to the tissue listen you came with 20 ml we came with 20 ml oxygen in hundred ml of blood 25 percent is d saturated 25 percent desaturation mean release of 5 ml because originally when it came how much of sisian was carried 20 mm and when we say when it is 100% saturated oxygen is how much loaded one DML when it is 75% saturated how much of CL is still loaded 15 ml so how much is D loaded 5 ml we don't need Sherlock home to answer it it's very easy right that when saturation is 100% content is 20 ml when saturation is 75% content remain 15 and how much is lost 5 ml so how much tissue receive oxygen 5 m is it right now we take this thing back now remember you know in normal person when you are not working hard comfortably sitting actually this curve is operating lung and tissue 100 to 75 percent saturation and again going back to here this part of the curve is left for emergency next we are exercise right because we will talk about that later now let's come back now you have to tell me here what is happening just as a ravine this is the hemoglobin molecule yes partial pressure at entry 1 how much 95 400 approximately at exit what is the partial pressure 40 what is the saturation in the beginning about about 100 percent approximately truly 97 percent and what is the saturation on the way out 75 percent what is the content in the beginning 20 ml what is the content in the end 15 ml so we can say out of 4 pocket 1 2 3 or 4 one has come out out of 20 ml how much is delivered to the tissue 5 member now you take this blood - what is this venous side now will put 100 ml blood going back now you will tell me characteristics of this bad blood this is a venous blood going to the right heart if you tell all the characteristics of this I'll be proud of you right and you should be proud of yourself as well this blood going back what is the partial pressure here now partial pressure of oxygen forty millimeter of mercury what is the dissolved oxygen I have not told you so you will make a mistake but anyway dissolved oxygen here was point three here it become point one two and what is the percent saturation of hemoglobin yes seventy-five percent and what is the content 15m of oxygen that's right so now I will repeat all this in one going and you have to see did you understand it or not if you don't understand don't worry stop me immediately right this start from here and you have to see do you really understand this medical terminology and language and concept or not when blood comes from right heart to the lungs this deoxygenated blood which is coming so called deoxygenated blood is not fully deoxygenated so mixed venous blood from the right heart coming to the pulmonary capillaries it has a partial pressure of oxygen 40 it has a under the partial pressure of 40 millimeter of mercury it is he having hemoglobin which is saturated up to 75% and it's content of hemoglobin if a if he mo globin is 15 grams per 100 ml then content of oxygen total is 15 ml right pressure is faulty saturation is 75% content is 15 amber when it is passing from here what are the changes pressure from 40 goes to hundred saturation from 75 go to approximately 100 and content from 15 ml per hundred you are going too fast on slow young brains you know content from 15 ml oxygen per 100 ml is going to approximately 20 ml per 100 ml is that right as it is going forward there is a little naughty thing here what is that noticing that some bronchial venous blood mix there and drop the pressure a little head drops raishin a little don't mess much there come back when arterial blood is coming to the capillaries what is the pressures about 95 what is the saturation 97 what is the content 20 ml right here when it come into tissue what is the pressure of oxygen in tissue 14 so what is the pressure of the dissolved because of such an shift so pressure of dissolve diffusion drop from 95 to 40 and saturation which was originally 97 drop to 75 and content which was 20 drop to 15 and how much amount of oxygen is delivered by AMA oh my god you're so good okay why don't we talk about that in a person who is resting comfortably how much oxygen is delivered to tissue every minute all tissues of the body listen it's very easy to understand 100 ml blood has delivered how much oxygen to the tissues 5 Emma are you understanding hundred ml blood when it passes supercouple is it delivers how much oxygen 5 ml under resting circumstance now 1000 ml will transfer how much 50 ml thank you mathematics is good and 5000 ml blood per minute will deliver how much oxygen 250 what is the cardiac output every minute 5000 10 so right now your left ventricle is pumping how much oxygenated blood to your tissue speak 5 liter per minute right now your left ventricle is pumping how much blood to the tissues 5 letters you know cardiac output a five-letter so if you cardiac output is 5 letter then every 100 ml of the blood gives 5 ml then 5 litre of blood gives how much oxygen to tissue 250 ml so this is the oxygen consumption when you are rested out of this most of the oxygen is bound with hemoglobin very little going as dissolved oxygen am i clear there is no question up to this is their right another thing which is very important now during exercise what really happens when you're doing too much exercise strenuous exercise you should need less of serum or oxygen more so how more oxygen is supplied to the tissues we'll talk about that tomorrow let's make the break now now I will explain in detail the hemoglobin oxygen saturation or hemoglobin oxygen Association dissociation curve right in detail properly let's pose that here we've put partial pressure of oxygen and here we put percentage of hemoglobin which is oxygenated that is percentage in Oh globin saturation now let's suppose that we do an experiment that in a container we have put oxygen here in the solution form right and here is oxygen and with a piston we are progressively now with this piston if we change the pressure then loading of oxygen on the hemoglobin molecule changes for example if you increase the pressure here more oxygen will be bound to hemoglobin and if you decrease the pressure here less oxygen will be bound with the hemoglobin it means that when you increase the pressure saturation saturated hemoglobin increases when you decrease the pressure desaturation occur those are right or another term is when you increase the pressure association develop association between hemoglobin and oxygen and when you decrease the pressure dissociation develops between the hemoglobin and oxygen right now let's pose we study it step by step as I told you previously that this is a sigmoid curve it is not a straight linear curve right what does it mean that I had pressure of 100 the saturation is approximately 100 right but when you keep on decreasing the pressure as the right saturation keep on decreasing but in early part you can see we are decreasing the pressure but saturation is decreasing very little for example when you decrease the pressure from 100 to 50 right it means that from this point of the curve at pressure of 50 it is here now you can see that originally saturation was 100 at the pressure of hundred and at the pressure of 50 still saturation is 85% does that clear then you further drop it let's pose to 40 right it is 50% saturation here and here it is suppose 75 percent saturation at the pressure of 40 there is 75 percent saturation now what we really see that an upper part curve has to part the upper part of the curve and lower part of the curve at high pressure curve is flat relatively flat and at lower pressure it is relatively steep again this curve is at higher pressure it is somewhat flat and at lower pressure it is steep right when curve is flat it means that when you drop from 100 to 50 when you drop the one hundred two fifty only fifteen percent hemoglobin is dissociated and eighty five percent remains associated or saturated but pressure from 50 is further dropped up to zero then saturation drop from eighty five to zero it means that when pressure operating at high level hemoglobin loves to hold oxygen and when pressures are operating at lower level hemoglobin loves true deliver oxygen is that right now in our body what are the normal functioning normal functioning is between 140 because pressure in the longest partial pressure in the lungs is hundred and partial pressure in the tissues is when tissues are resting is 40 and add the forty saturation is 75 it means that when curve is operating like this physiologically that as blood moves from the lungs to the tissue this part of the curve is utilized the right and when we go back from the tissue to blood goes back from the tissues to the lungs curve is working like this right and if you draw the content here it was 20 ml content if mo globin was 15 gram under the pressure of 100 right and when pressure was 40 okay remove this 50 because 40 s physiologically more important point when pressure was 40 then saturation was 75 and content was 50 number so first point which a good student should know what is normal physiological part of the curve which is right now happening in a resting student right there from the lungs up to the tissue right pressure drop from 100 to 40 saturation dropped from hundred to 75 content drop from 20 ml to 15 mm when blood goes back to the lungs pressure raise from 40 to 100 saturation increase from 75 to 100 content of oxygen in 100 ml of blood move from 15 ml to 20 this is the normal I will talk about someone who is doing swear exercise what really happens actually when you are doing exercise number one your cardiac output increases and under severe exercise if you are a healthy person the cardiac output can increase six to seven times what is normal your cardiac output five liter per minute if your cardiac output increase six time if your cardiovascular system is healthy heart can't take cardiac output up to six times more so your cardiac output increase from five liter per minute to thirty liter per minute it means in a one minute every tissue is getting blood supply how many times more six time Wars and then exercising tissue specially dilated arterioles so they're out of proportion there is increase in blood supply so during exercise one way to provide extra region to the tissue is simply by increasing the cardiac output there when cardiac output is more more blood is going to the tissue then there is another thing that when you are doing severe exercise extremeness exercise the utilization of oxygen is very rapid in their tissues and within the tissue oxygen partial pressure dramatically fall we have been discussing than resting to show you the partial pressure of 40 but when you are doing very severe exercise partial pressure of oxygen within the tissue due to rapid utilization of oxygen in the tissue partial pressure of oxygen within the tissue will drop from 40 maybe up to 15 and now you look at it pressure of oxygen and extremely exercising muscle is 15 then oxygen saturation remains maybe 10 what does it mean that 90% of oxygen is delivered to the tissues so it means this part of the curve now in exercising person this will further go down and a large amount of oxygen will be released to the tissues so this part of the curve operates when there is excessive extra need of oxygen right in normal situation saturation drop from 100 to 75 right so it means 25% of vision is labored but in exercising person arterial blood bring 100% saturation but a drop of to 10 percent it means 90 percent of the oxygen may be delivered to the tissue 90 percent of the oxygen mean that content which was 20 ml may be 18 ml is delivered and only two MLS left so this is one another way how we increase the oxygen supply to the exercising muscles so exercise your muscles get extra oxygen number one by increased cardiac output the total blood flow is increase secondly due to drop the oxygen pressure in exercising muscle they extract out of proportion extra season out of hemoglobin am i clear then there is one more phenomenon what is that let me explain that thing that a phenomenon explained later first you understand one thing there is the concept we say there's a right shift of the curve when there is left shift of the curve what is the meaning of right shift of the curve or left shift of the ders first of all we should make a concept of p50 who will tell me what is p50 50 is the pressure partial pressure of oxygen write it down P 50 is the partial pressure of oxygen at which 50% of hemoglobin s saturated and 50% is d saturated this is a right what is P 50 P 50 is the partial pressure of oxygen at which half of the hemoglobin is saturated and half of it is d saturated now listen in the normal curve so this is the normal curve normal curve if this is the 50% saturation now take this line this is the 50% saturation here 50 percent saturation occur and pressure of 25 millimeter of mercury now this is a little bit tricky concept so use your all layers of the cortex I mean cerebral cortex listen what really happens that when hemoglobin is operating with normal affinities affinity mean its tendency to stick the oxygen when hemoglobin is operating with the normal affinity then when partial pressure partial pressure of oxygen is 25 or 26 half of the hemoglobin will be saturated and half of it will be they saturated now again listen another way to state this thing is that to get the oxygen out of half of the hemoglobin we have to drop the pressure from hundred to 25 I'm restating the same fact that if you want to get half of the oxygen out of fully saturated hemoglobin you have to drop the pressure from 100 to 25 because at the pressure of 25 1/2 of 1/2 hemoglobin s loaded and half is d loaded is that right now if I say that there is another hemoglobin okay I put three hemoglobin here this is one container put a normal container first first container this is right container and this is left container and all of them are having hemoglobin all of them are having hemoglobin first so far we are talking about this standard mo globin under standard circumstances and standard mo globin we say if partial pressure is how much 25 is it right how much it is saturated 50 percent and how much is D saturated 50 percent it means when you bring the pressure at 25 half of oxygen will be delivered to the tissues well now you imagine another hemoglobin there's hemoglobin here we do something naughty you know hemoglobin is at transport or oxygen this is a public transport on which oxygen travel but if you put some other represented car so oxygen has to jump out it's very natural for example if we have a special transport public transport for the ladies for sweeter and if some of these naughty boys try to push in so what will happen to ladies most probably some of them will at least jump out this is that right it means affinity of car for the ladies will become less imagine hemoglobin is a transporter of ladies ladies mean oxygen if we bring some nasty other intruder those intruder if they try to enter into hemoglobin maybe ladies will jump out so delivery to the tissue will become better oh my god you don't know about lady is my friend look hemoglobin is having the ladies right there sitting for ladies sitting comfortably and when pressure drop up to 75 only one lady jump out do you understand it if we put some snake in maybe two will jump out maybe three it means affinity of the hemoglobin decreases for the oxygen is that right that is good for two sure bad photo shoot good for tissues now look at tissues how clever they are they want ladies oxygen so when the hemoglobin come if tissues are exercising now listen very carefully they are so clever to show when their exercises they start producing some snails and those snakes jump into hemoglobin pockets and oxygen out of proportion comes out why the cars now affinity of hemoglobin become less is that right listen now carefully exercising muscle this is exercising muscle and this is a hemoglobin which is passing through exercising muscle what are those nasty snakes or boys actually exercising tissue produces carbon dioxide that produces protons did you know that that produces high temperature and if exercise lasts more than one hour then RBC produce a special type of snake - 3 D P G what is that - 3 D P G die phosphor wristlet now - 3 d PG now listen carefully what really happens attention please first you have to imagine that car coming with 4 ladies usually you drop the pressure from 100 to 75 only one lady jumps out if you provide some different insects and snake in the car more ladies will jump out this is it right now you imagine not a car you imagine hemoglobin coming with 4 molecules of oxygen normally one oxygen molecule come out now if you put an some carbon dioxide it tried to push its way into hemoglobin you know emo globin also transport carbon dioxide so carbon decks I tried to push it way to hemoglobin or exercising muscle not only produce carbon dioxide but the carbon dioxide which is produced that mixes with the water and produces carbonic acid and that produces protons those protons bind with hemoglobin and try to stick like an insect not only this exercising muscle produced lactic acid pyruvic acid and some other acid those acid also release proton they also like insect jump into hemoglobin modify hemoglobin so what really happens that when tissues are exercising to produce more don't tell me in sex they produced more carbon dioxide they produce more protons they produce high temperature if Carl temperature is higher would you like to jump or said ladies no they will get out so even muscles when they are exercising they are taking the temperature of the blood high or hemoglobin temperature high they are adding to the hemoglobin more protons more carbon dioxide are these factors modify the hemoglobin and make the pockets of hemoglobin little bit narrow oxygen cannot stay and so more there's more tendency to jump out into tissue it means under these circumstances when there is more temperature high temperature when there is more a sadducees protons or when there is more carbon dioxide or when s more than one hour exercise may produce more to three DPG all these substances you have to tell me increase the affinity of hemoglobin for oxygen or decrease the affinity of hemoglobin for oxygen they decrease the affinity it means when tendency of oxygen binding with hemoglobin is reduced then at every given pressure hemoglobin will release less oxygen or more oxygen right is that right so what really happens when your blood is passing through exercising tissue the product which are produced during exercise they make the affinity of oxygen to the hem unless so hemoglobin releases the oxygen more readily for every given pressure hemoglobin is less saturated for every human pressure now hemoglobin will be less saturated let's talk about pressure look for every given pressure these are the pressures if hemoglobin has to be less saturated so curve has to move downward and rightward so curve will be drawn like this let me explain exactly how look before carbon dioxide before carbon dioxide are increasing carbon dioxide increase proton of course decreased pH or increased temperature or there's increased to three DPG let me tell you what is the mechanism of DPG you know there were tails alpha chains and Vita chains DPG to three DPG hold if I'm two to three DPG I will hold two chains of beta chains and cross length so what is the function of two three DPG it binds with the beta chains of hemoglobin beta globin of the immigrant and cross-linked so pockets become wide or narrow now when pockets are narrow remove oxygen will stay or jump out jump out is their right Claire and here's another important thing you know fetal hemoglobin does not have beta chain it as gamma chain so it means their pockets remain wide or narrow wide because fetal hemoglobin does not have beta chain answer to three DPG cannot cross link their chains sophie tichina's deep and wide pockets so fetal hemoglobin has more affinity to bind oxygen an advantage is when Hugh fetal hemoglobin passes through placenta it has more affinity for oxygen it snatches a way of switching from maternal circulation that is the advantage of Futurama globin that is why fetus produces not a delta mu globin this isn't right anyway let's come back so what really happens look when curve is shifted to the right Y it is shifted to the right because now has less affinity for oxygen so it more readily delivers oxygen for every given pressure it has less saturation for example let's come to the pressure of 40 you know at the pressure of 40 normally there were saturation up to what 75 now there's saturation of maybe what is this 50 or even saturation at the pressure of fault it will go like this this is the faulty normally when this is a normal curve this is right shifted curve is the right normal curve at the pressure of faulty saturation is about 75 so how much is delivered 25 percent of season but when curve shift to the right then pressure of the 40 saturation is 50 percent it means how much it will deliver yeah 50 percent it means which this curve shift to the right then add the partial pressure of 40 rather than releasing 5 ml it will release 10 ml so it become better dissociated and better delivered to the tissues am i clear to you you are understanding that good opposite to that if we another thing this was P 50 you remember for normal be 50 was 25 millimeter of mercury at 25 millimeter of mercury half a saturated Hafez these saturated now P 50 is 40 that right shifted curve has 50 percent saturation at what pressure 40 it means right shifted curve delivers 50% oxygen at higher pressure it means it to the better dissociate er better donor this is the right a McClure now we come to another thing let's suppose if carbon takes less protons become less less than normal temperature is cold - 3 d PG is very less or there's fetal hemoglobin hemoglobin right when all these things are less it means hemoglobin is not having other disturbances carbon dioxide note is not disturbing the mo globin protons are not disturbing the mo globin temperature is not disturbing NEMA globin ladies will remain sitting or they will jump out yeah will remain sitting they don't want to dissociate so we say car has more affinity for the ladies so that will be good delivery or bad delivery bad delivery right bad delivery mean therefore every given pressure there will be more saturation and less desaturation for every given pressure there will be less oxygen released it means there will be less less D saturated hemoglobin in that case curve will behave like this look now you imagine here in this case what is happening to get the 50% desaturation you have to drop the pressure 100 to maybe 5 imagine a normal baking normal case this is a normal case is 50 percent saturation is the right normal here is 50% these saturation or saturation is at what pressures 25 it means normal hemoglobin you have to drop the pressure from 100 to 25 to get 50% of sisian delivered in right shifted case you drop just from 100 to 40 and you get 50% of seizure but in left shifted case you do have to drop from hundred to 5 to get it 50% delivery it means right shift its curve s better donor and left shifted curve is better retainer for donor this is a right now next time when you remember that when the curve should shift to the right when there is should be better donor when the we better donor when you are doing exercise so exercise you produce temperature it will shift it to the right you produce protons acidic shift to the right you produce carbon dioxide shift to the right and exercise more than one hour or a hypoxia long-term as you go to high altitude right that produces two three DPG that cross links the pockets and again it produces more delivery a mcclure now what are the things we shift the curve to the left of course all things opposite to that low carbon dioxide low protons lower temperature no.23 DPG for example is stored blood when you store the blood in blood bank to three DPG may be disintegrated then stored blood when you give it to some person the hemoglobin and store blood may bind oxygen well but may release oxygen slightly poorly just that right and fetal hemoglobin also now you tell me that cactus which I shift into left side yes low temperature no proton that is alkalosis low carbon dioxide very good to load to three D P G and fetal globin which is filtered and stored blood which has low to 3 DB now another thing here we just talked about shift to the right and shift to the left in one sentence you can save and shift to the right is there then there is reduced affinity and when shift to the left is there there is increased affinity of course for the tissue of hemoglobin with less affinity is better because that will release better am i clear another way to compare these scindia's P 15 what is P 50 P 50 is the pressure at which 50% of hemoglobin is desaturated normally P 50 s normal hemoglobin is operating p 50 and 25 so it means a normal hemoglobin pressure has to be dropped from hundred to 25 to get the oxygen out of 50% of hemoglobin when there's shift to the right P 50s more and when at higher pressure and when shift curve shift to the left P 50 become less am i clear now we'll also see what happens to this curve when there's anemia or polycythemia look this for the person with normal hemoglobin what about this immigration 15 gram per diem is that right let us suppose due to some reasons your hemoglobin level become 18 grams if your removable levels become more your capacity to hold oxygen is less or more more so it means curve move now upward so actually in polycythemia a condition in which there is poli-sci tamiya polycythemia mean increased hemoglobin right when you have polycythemia upper end of the curve will move upward moving upward shows that capacity total capacity to hold oxygen is in increase opposite to that if someone has mo globin only 10 gram can you hold 20 ma official no so his total capability to hold right let me draw it separately suppose this is the normal curve right and pulley settimia this curve will move upward no more capacity on the arterial blood to hold efficient and in anemia it will move downward is that right how you make this concept because here you put the content of oxygen normally content of oxygen is 20 ml when hemoglobin is 15 grams 100% saturated if hemoglobin is less than of course total it can never achieve the normal content and if you move globin amount is more then it can achieve more another way to discuss is that in a container you have blood with hundred ml blood with 15 gram of hemoglobin if you add more hemoglobin it will go up and out of 15 gram if you remove 5 gram no globin under the same pressure it will hold less oxygen no problem here there were three containers this container was central normal curve and curve shift to the this side you have added these things right and it will release more oxygen if you remove these things it will release less oxygen this was shifted to the and this is shifted to the left I'm just doing some acrobatics with your mind now we come to the last thing where Thrones are usually lost what happens when carbon monoxide poisoning is there is that right right that is very simple to understand yes no right p50 remain the same because look d50 is normally where 25 it will remain the same right because this has to be at 25 it will be half saturated D saturated and half saturated at 25 this will be half saturated desaturate it at 25 it will be half saturated D saturated actually this curve should go like this those are right so all of them will be still in line P 50 does not change listen if you have a container with 20 milligrams of hemoglobin right if other carbon dioxide and protons and temperature and 2 3 d PG level does not change then if you increase the Mogul open or decrease immigration 50 percent saturation remain at the same pressure this is it right ok let's come back what we were talking about what happens on carbon monoxide poisoning one thing you remember carbon monoxide has 250 times more affinity to bind with the hemoglobin as compared to oxygen so it means carbon monoxide is very very sticky to hemoglobin it is very very sticky to hemoglobin does it right now what happens let's suppose these are the four pockets let's pose oxygen-oxygen two pockets up for an attack of carbon monoxide come here is now carbon monoxide sitting this is carbon monoxide sitting here and here two pockets are loaded with carbon monoxide can oxygen come here this is problem number one the some pockets are occupied by carbon dioxide and oxygen cannot come there it means for oxygen transport purpose these sites are wasted so it means total capability of blood after the square to carbon monoxide the total capacity of blood to hold oxygen is increased or decreased it is degrees secondly when carbon monoxide come here it makes these pockets altered these pockets become like this so the don't allow the oxygen to go out so it is just like this that there four pockets two pockets are loaded by carbon monoxide and effusion cannot come there a remaining two pocket where of fridges is there they are altered in such a way that of fusion cannot go out it means four empty pocket oxygen cannot come in in full pocket effusion cannot go out it is just like that a rascal or some rascal straining and the main gate of your house it does not allow the people to come in it does not allow you to go out that is what is carbon monoxide so what will be the effect on this curve normal curve is like this number one whatever oxygen is there can it go out no it means you know globin that part of the hemoglobin which is loaded with the fission its affinity for a fission is less or more listen attention we can divide the hemoglobin in two part one emo globin one part of the envelope in which is loaded by carbon dioxide other part of the hemoglobin which is loaded with oxygen but it is not willing to is oxygen it is dysfunctional pockets is there right so in the presence of carbon dioxide oxygen loaded pockets become more sticky to oxygen now do you think affinity of this part of hemoglobin is more for oxygen or less for oxygen more for oxygen so curve will shift to the left or right to the left so what really happens with carbon monoxide poisoning number one problem is that curve shifted ah this left number two can it ever receive the fully-loaded no so it will never go this was not full loading is a half loading so what really happens there are two changes in the curve that when hemoglobin is exposed to carbon monoxide number one curve shift to the left it means whatever oxygen could be delivered is difficult to deliver right secondly the pocket where carbon monoxide is loaded they can never be filled now with of oxygen even if you increase the pressure of oxygen you cannot get enough what enough content so after carbon mono oxide poisoning hemoglobin is chained number one some sites are not willing to take the oxygen and transport oxygen so total capacity of the blood to transport oxygen is reduced and content of oxygen is also reduced number two whatever some oxygen is present with the hemoglobin that is difficult to deliver right so in a way there is a major problem that blood cannot transport oxygen enough and whatever oxygen is really with the Invo globin that cannot be released to the tissue is it right so curve is shifted to the left because it cannot release the oxygen whatever it has and it turned downward because it can never get fully saturated these two pocket which are altered after carbon monoxide poisoning they are having increased the affinity for oxygen responsible - shifting the curve to the left and these two pockets which are loaded with carbon monoxide and oxygen cannot bind here they are responsible for moving it down how do you treat carbon monoxide poisoning first of all you should stop the source of carbon monoxide and remove the patient right secondly if possible you have to give high concentration of oxygen under very high concentration of oxygen some of the carbon monoxide may be displaced but it is very difficult because carbon monoxide is very very very sticky number two way give 5% carbon dioxide what carbon dioxide will do to the patient who is poisoned with carbon monoxide and still alive carbon dioxide will stimulate respiratory center so patient will hyperventilate and when he will hyperventilate a lot he will rapidly bring out the carbon dioxide wash out of his lung I am i clear any question up to this class Christmas

Channel: Dr. Najeeb Lectures

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Keywords: respiration in humans, respiratory system, respiration anatomy and physiology, respiration cycle, respiration explanation, respiration gas exchange, respiration human, respiration lecture, respiratory system anatomy and physiology, physiology lecture, physiology of respiratory system, respiratory physiology, respiration, dr najeeb lectures, what is respiration, breathing, anatomy, physiology, lungs, carbon dioxide, biology, trachea, bronchioles, pharynx, larynx, bronchi, alveoli, dr najib

Id: qI0ZJNl-2KE

Length: 122min 7sec (7327 seconds)

Published: Sun Jun 14 2020