Respiratory | Types of Hypoxia: Hypoxemic | Anemic | Stagnant | Histotoxic

I ninja nerds in this video we're going to talk about the different types of hypoxia so first off what is hypoxia how would you define hypoxia hypoxia by simple definition is basically inadequate oxygen delivery to the tissue cells that's it hypoxia is defined as the inadequate oxygen delivery to the tissue cells let's write this down and what I want to talk about is how would you identify certain signs so if like you're looking at a person how would you know if they're actually in the early stages of a boxia or the late stages of hypoxia and then we'll go over the types of my box here so first thing I said I want to discuss is what is the definition of hypoxia and we already define hypoxia to keep it as simple as possible hypoxia is low oxygen delivery or inadequate so we get input low or inadequate oxygen delivery to tissues regardless of what the tissue is okay so whether it be the brain which is a very very vital organ you always want to make sure that you have an abundant supply of oxygen to the brain as well as the heart those are very vital organs even the skeletal muscles but again how would you define hypoxia it is a low inadequate we don't need to put this around this we can put it around an adequate you can put a parentheses around an adequate so low or inadequate oxygen delivery to the tissues okay so now that we have the definition of hypoxia the next thing that we want to say is how would you determine if a person is actually exhibiting hypoxia well it's hard to say because there's different stages of epoxy so within the early stages of hypoxia so let's say well how would you determine if someone's in the early stages of epoxy so in the early stages of epoxy you can remember this little mnemonic it goes rat okay so you can remember rat and what does this stand for or is specifically going to be for restlessness so you're going to exhibit restlessness and certain agitation right a is going to be for anxiety and remember key is for two things so there's two T's in this right so one is actually going to be tacky cardia someone's going to be tachycardia and the other one's going to be ticketing yeah this one's going to be to Kipp Nia how would you find ticket Nia to kidney is basically an accelerated respiration process that's all it is soda kidney is an accelerated respiration now the next thing I want you guys to understand how would you differentiate because sometimes people can be confused to Kipp Nia with hyperventilation or I purpo hyperventilation let me define this pre so that we're going to get these confused hyperventilation is an excessive increase in pulmonary ventilation that exceeds the metabolic demands of the body and it can change their blood chemistry it can lead to respiratory alkalosis hypertonia is an increase in the depth in the respiration rate but it does it's usually in the sense of like exercise or even in painful stimuli but it does not change the blood chemistry and to Kipp Nia is defined as accelerated respiration okay and then tachycardia how would you define tachycardia it's whenever their heart rate is greater than 100 beats per minute so whenever their heart rate is greater than 100 beats per minute okay so these are the early signs so you're going to remember rat okay and if you remember the two teams of four tachycardia tachypnea what about the late stage is when it's actually really bad what about the late stages of this hypoxia so some of the signs and again what are the what are we trying to say here this is the early signs of hypoxia and then these are the late signs of hypoxia and the reason why you want to be able to catch these things early if it's possible is to prevent these people from actually developing certain brain damage or damage to the heart as well okay so again what is the late signs the late signs are going to be specifically remember bed see remember bed see B is going to be four specifically so whenever you look at this one B is going to be four braddock are you ready kardia oh you might be like well what the heck their heart Lear is eventually a 100 beats per minute and then it switched to a decreased heart rate to where the heart rate is now less than 160 beats per minute okay and then e is for extreme restlessness so this is for extreme restless and this I said the D is for dis Nia okay now the last one is going to be I put C right so there's going to be C and C is specifically going to be 4 this is the bad one when you recognize this is when you make you need to make sure that you alert the patient and try to take care of the patient as quickly as possible this is cyanosis and cyanosis means that there's actually a blue cast of this skin right so it's a bluish cast of the skin that means that there's not not enough oxygen delivery to the tissues so again hypoxia how would you define it low inadequate oxygen delivery to the tissues the early science is going to be remember rat so restlessness anxiety tachycardia and tachypnea and remember the late signs of hypoxia which you want to try to make sure that you treat the issue as soon as possible it's going to be Brad acharya whenever the heart rate is less than 60 beats per minute when they have extreme restlessness they have distant what is dissing it this thing is basically shortness of breath or gasping to bring in air and the last one is cyanosis and I'll talk about whenever you see these signs how would you treat it because it depends upon what type of hypoxia they have okay so that's hypoxia now the next thing I want to go over is I want to talk about specifically the four types of Epoque so first let's list off the four types of hypoxia so the four types of hypoxia that I want to talk about in this video is going to be we're going to talk about hypoxemic hypoxemic hypoxia we're going to talk about another one which is called ischemic this what's called ischemic and they even call it stagnant they call it a scheme and hypoxia or stagnant hypoxia and then there's the third ones we're going to talk about which is going to be anemic hypoxia and the last one that we'll talk about is going to be his stock SiC histo actually histo toxic hypoxia histo toxic hypoxia okay so let's start off with the first one which is usually the hardest one because it's the most in-depth one this is going to be v hypoxemic epoxy all the rest of them are generally pretty easy but we're going to start off with a hypoxemic epoxy it'll make all the rest of these a lot easier so first thing i want you guys to remember hypoxemic epoxy is there's three things that you're going to see in hypoxemic up boxes three things so what are those three things that you're actually seeing hypoxemic hypoxia so in this new commodity console called hypoxemic hypoxia they called hypoxemia so we can also refer to it as high poxy mia which again is hypoxemic hypoxia there's three things that are going to be able to cause this hypoxemia one thing that can cause this is actually going to be a alteration in the ventilation for fusion coupling so any type of alteration in the ventilation perfusion coupling mechanisms and we'll talk about that another one is going to be certain types of pulmonary diseases so certain types of pulmonary diseases specifically chronic obstructive pulmonary disorder and restrictive pulmonary disorders and another thing that can actually cause hypoxia besides the ventilation/perfusion coupling and the pulmonary disease is any situation in which there is very little oxygen within the atmosphere in that specific situation is that high altitudes so when you're at high altitudes so again three situations that you would actually become a parent with hypoxemia that causes it is into any type of situation altering the ventilation perfusion coupling any situation like a pulmonary disease like clinic chronic obstructive or even restrictive pulmonary diseases or high altitudes so let's start off with the easy one high altitudes how can this cause hypoxemic hypoxia well when you're at sea level when you're at sea level generally the pressure the barometric pressure so the pressure the atmosphere is approximately equal to about 760 millimeters of mercury and out of that 760 millimeters of mercury 21 percent of it is going to be the pressure of oxygen so whenever you do this you take 21 percent of the 760 this gives you about 160 millimeters of mercury of oxygen within the atmosphere okay that is usually the partial pressure of oxygen in the atmosphere so let's put here a TM now as you go to higher altitudes higher elevation the percentage of oxygen decreases so then look at this the percentage of oxygen is actually going to decrease so if the percentage of oxygen is going to decrease it's going to become less than 21% what's going to happen to the partial pressure of oxygen it's going to be less than 160 so now the new partial pressure at high altitudes of the atmosphere is going to be less than 160 millimeters of mercury let's just suppose then whenever you're at high altitudes your your hiking mountain McKinley whatever you're doing let's say it drops significantly let's say it drops from 160 to about let's say it actually drops down to about 120 millimeters of mercury so let's say it drops down really low okay so now out here if the actual partial pressure of oxygen in the atmosphere is about 120 millimeters of mercury and the partial pressure of oxygen in the lungs what's the normal partial pressure of oxygen within the lungs the normal partial pressure of oxygen in the lungs is generally about what a hundred millimeters of mercury so it's about a hundred millimeters of mercury so it's about 104 actual if you want to be specific it's about 104 so if you look at the difference here 160 all the way down to 120 160 to 160 millimeter curve 120 to 100 is a 20 millimeter curve this is going to have very little oxygen so the amount of oxygen getting down here into the alveoli is going to be a lot less so what happens to the partial pressure of oxygen inside of this alveoli if the atmospheric oxygen is lower it's going to be a lot or not as much oxygen is going to be coming into the alveoli and just imagine if this even drops below a hundred then very little air will be coming in at all so again recap this part here whenever the partial pressure of oxygen in the atmosphere is less than 160 millimeters of mercury and it drops down significantly it decreases the actual movement of oxygen from the atmosphere into the alveoli which is eventually going to cause a decrease in the partial pressure of oxygen and this can actually lead to problems and the reason why is we'll discuss it in that diagram of there if the partial pressure of oxygen is very very low here then what's going to happen to the actual exchange process within the actual blood it's actually going to decrease within the blood and that's going to be important we'll talk about how that happens so again I used 120 as an example but I want you to understand that if this sucker drops really really low depending upon how high the elevation is to where it drops below 100 millimeters Merkel let's just suppose 80 millimeters of mercury what's the partial pressure of oxygen in the alveoli again if it's going to be eating millimeters of mercury and that's going to cause less oxygen to be delivered into the tissues and that can lead to hypoxia okay what about certain pulmonary diseases soon a chronic obstructive pulmonary disorder you know they actually classify asthma to be one of those types and and also and there's actually chronic bronchitis and emphysema so in certain situations let's say that we take the let's hear duplicate chronic bronchitis and so in chronic bronchitis there's an excessive amount of tubb mucus production and look what it's doing to these actual bronchioles it's decreasing the amount of air that's getting into this bronchial if you decrease the amount of air getting into these bronchioles what's going to happen to the event elation within this alveoli it's going to decrease so what happens with the partial pressure of oxygen within the alveoli it decreases so there's going to be a decrease in the partial pressure of oxygen so and that could be in chronic bronchitis we'll how would asthma cause this you know asthma is basically generalized a widespread bronchoconstriction so if I constrict the bronchi if I have an excessive constriction of the bronchi what's going to happen to the air going to the alveoli so let's say that for example I actually start trying to constrict this bronchi I'm having some type of allergic reaction or something like that I'm having matic attack and I have severe bronchospasms and those bronchospasms are constricting the actual bronchi and decreasing the amount of air going to the alveoli what's going to happen to the partial pressure of oxygen it's going to decrease okay what about another pulmonary disease we said emphysema what is the emphysema classify how would you classify emphysema emphysema is basically a situation in which you know how we have our normal alveoli here let's say that I draw a general diagram of the alveoli so let's say here's the alveoli you know they have a large surface area right so there's my diagram there and again what's coming around these guys what do you have around you know that you're going to have a lot of blood vessels right there's going to be a lot of blood vessels and what happens in emphysema is your neutrophils start producing excessive amounts of elastase because remember there's an alpha 1-antitrypsin deficiency and what starts happening it starts breaking up the actual septal walls that are consisting of the nice elastic tissue and then what does it eventually do to the actual alveoli it makes it one big alveolar chamber and then when you have a one just one big alveolar chamber with not very many septa what happens to the actual surface area it decreases if the surface area decreases what happens to the gas exchange process that also decreases so but specifically remember this stuff it's not a problem with this because you know emphysema generally these people have a normal partial pressure of oxygen generally so in this situation in emphysema they can have a normal we shouldn't put increase we should have a normal they can have a normal partial pressure of oxygen that partial pressure of oxygen can be about 100 millimeters of mercury and again if you want to be specific to be 104 but they're not having a problem with getting air in they're having a problem with the exchange process because again what's happening they have a lot less what does this condition this is called emphysema and an info Zena what happens to their surface area what's the overall result what happens to the surface area there is a decrease in the surface area what does that mean that means there's going to be a decrease in the exchange process so it's not going to be as much what there's not going to be as much co2 moving over here and not as much oxygen moving into the blood and so if there's not as much oxygen moving into the blood what happens to the partial pressure of oxygen within the blood it decreases that's hypoxemia okay and then we'll talk about one more pulmonary disease okay let's say that for some situation you have okay you get stabbed and there's some type of situation where the actual atmospheric pressure okay the atmosphere air is exposing to this actual pleural cavity what can happen you know air can actually flow right in because the pressure in the atmosphere is what the atmospheric pressure is approximately 760 millimeters of mercury what is the partial pressure in the actual pleural cavity you guys remember the partial pressure I'm sorry the pressure within an Tripoli cavity was approximately 756 we said negative 4 if you guys remember right but either way it's a less pressure so we're going to want to move it's going to want to move into this actual pleural cavity what did we say that would do over time look at this let's say I erase this partial pressure of oxygen here look at this as this pressure starts increasing so it goes from 756 eventually to what if you guys remember it eventually can equilibria with the atmospheric and it's equilibria it's with the atmosphere and it actually rises up to the point of 760 or even maybe above 760 millimeters mercury what's it going to start doing is going to start pushing on me lungs and start pushing on the lungs look what happens here let's say I actually depress in these lungs here look at this if I have this little cavity here now if I have this little cavity here what am I going to do to all the small alveoli that I'm compressing I'm going to be decreasing the actual what I'm going to be collapsing the alveoli so whenever I have an increased intrapleural pressure whether it be - air leaking what does that call when air leaks into the actual pleural cavity what do you call that you call this a pneumothorax so in some situation in which there's actually air you can develop a pneumo full racks in other situations besides air if there's actually a rupture of the ball of the blood vessels within this area and the blood accumulates within his actual intrapleural space what do they call that one Bloods accumulating the call that a hemothorax and there's even more if you actually have lymphoma there can be a blockage of the actual lymphatic vessels and it can lead to a lot of the lymph draining into this area and they call that kylo 4x either way the whole important point here is that as this fluid starts accumulating what does it start doing it starts pushing on the lungs as it starts pushing on the lungs what is it going to do the alveoli it's going to collapse the alveoli if this let's imagine here is this alveoli it was previously inflated but then because of the pneumothorax or the hemothorax or the kyla thorax it collapses so now look at it look at it to collapse the balloon pops right so it collapsed if that sucker collapsed what's going to happen to the ventilation within that there's going to be no ventilation if there is no ventilation to this area and there's blood vessels passing by this area so let's say here is a blood vessel coming past this area here's a blood vessel and it's looking to pick up some oxygen if this sucker right here pops right or collapses in the situation because of the increased pressure because of the pneumothorax or hemothorax or kyla thorax it's pushing on it is there going to be any ventilation no so if there is extremely low ventilation or almost no ventilation there'll be no exchange if there is no exchange that's occurring between these products well the alveoli and the actual pulmonary capillary blood what is that called called shunting so this is an example of shunting so this is an example of shunting ok so I want you guys to understand again one more time if you have chronic bronchitis it's going to impede the actual air flow decrease the partial pressure of oxygen also with asthma it sanics you're going to cause widespread and generalized bronchoconstriction which will decrease to air getting into the alveoli that'll also cause a decrease in the partial pressure of oxygen if you're at high altitudes the partial pressure of oxygen the atmosphere is going to be a lot lower you can actually drop below 116 if it gets really really low below 100 let's say that suppose we said 80 millimeters of mercury then the partial pressure in the atmosphere when it actually exchanges with the alveoli it's going to drop significantly and it can drop all the way down right inside the alveoli and let's just say that it drops down to like 70 or 80 millimeter mercury in the alveoli that can actually impede the exchange process and cause a decreased partial pressure of oxygen within the blood then we also said in emphysema and emphysema there's a decrease in surface area due to the breaking down of the elastic fibers and the walls and that decreases the exchange process but remember they have a normal alveolar partial pressure of oxygen it's the diffusion process that's actually affected there's another situation that can affect us all so if you have pneumonia now or you have pulmonary edema due to the heart failure right what happens to the fluid that accumulates in between these spaces these interstitial spaces it spreads out the actual respiratory membrane the thicker that respiratory membrane what's it going to do to the actual exchange process it's going to decrease the exchange process so again not only can emphysema affect the actual exchange process but what other two conditions can pulmonary oedema as well as we said pneumonia and the moaning can actually produce a pile oryx which is really nasty it's pus that accumulates within this cavity too which can also compress and that was lasting whenever there's air blood lymph or even pus that accumulates within this area it compresses on the lungs and actually does what it collapses the alveoli if these alveoli are receiving no air they're going to be not ventilated and whenever there is no so look at this I'm going to represent like this if there is no movement of co2 in here or there's no movement of oxygen there so now look if there's none of this this action is inhibited there is no ventilation there is no actual exchange process that is called shunting all of these things are trying to do what what is the overall result of hypoxemia it's trying to decrease the arterial partial pressure of oxygen okay so now that we've covered that we honestly should understand now for the most part right how this whole thing is actually this hypothesis event was this first one that we talked about mainly hypoxemic hypoxia how this is actually occurring be due to any type of ventilation perfusion coupling mismatch or high altitudes or pulmonary diseases that we covered if you really honestly want to know if the diaphragm is damaged the external intercostals are damaged or even the nerves that are supplying them that we talked about remember the t1 through TN and the c3 c5 nerve roots that are supplying the actual diaphragm the external Coastal's if they are damaged that can also produce this actual hypoxemic epoxy but that's that's really bad or even if there's damage to the respiratory centers within the medulla like the vrg or the DRG right anyway that covers that concept okay so now we covered hypoxemic epoxy oh now let's go into the next one because these two are going to kind of link together it's going to help us to really understand hypoxemic and ischemic let's go over this big diagram okay so now again and hypoxemic epoxy what were the two issues it was either one issue was that there was a decrease partial pressure of oxygen within the alveoli or the exchange membrane was thickened let's do that in a nice this color here that's doing a brown color here this actual exchange membrane is thickened if the exchange membrane is thickened what does that do to the actual gas exchange process this will actually impede the gas exchange will there be a decrease in exchange of gases and this was by emphysema or pneumonia or even what else do we say we also said due to pulmonary edema it may be due to congestive heart failure and this decreased partial pressure of oxygen content into chronic bronchitis could have been due to asthma it could be due to being at high altitudes we already get the point now all right and again what's the whole purpose here we said the two things if the partial pressure of oxygen decreases let's just pick a number I'm not saying it will be the I'm just taking a number let's say that the partial pressure of oxygen in the alveoli equals 60 millimeters of mercury right what is the partial pressure of oxygen going to the lungs in the actual pulmonary artery blood it should be approximately if you guys remember 40 millimeters of mercury and then when it's moving through the actual capillary blood what happens it should have this exchange process and whenever there's the exchange process between what the actual alveoli in the blood oxygen will move down the concentration gradient until the actual partial pressure and the pulmonary capillary blood equals the partial pressure in the alveoli which is 60 so when it leaves it should leave at partial pressure of oxygen is equal to 60 millimeter mercury and again what did we say is the normal partial pressure of oxygen within the arterial blood so we'll put here right below at the normal one so we can compare usually it's about a hundred millimeters of mercury so this is normal this is abnormal okay we'll put AV all right so I want you guys to get whether it be due to some decreased partial pressure of oxygen in the alveoli do-it-all reason all the reasons we discussed or because the exchange membrane is so thick or the surface area is decreasing that the exchanges of gases isn't occurring efficiently and that's also decreasing the arterial partial pressure of oxygen all right we beat the dead horse with that one let's move on okay so let's say now your arterial partial pressure of oxygen let's assume that it's perfect so let's assume that you're coming down here we're taking a whole new person that person was someone else all right he was all the way fricked up but now we're going to say let's say that someone has a good partial pressure of oxygen so their partial pressure of oxygen is a hundred millimeters of mercury there they're roling okay they're coming in they're different delivering this blood to their capillary beds right so the blood is coming through here okay and it's coming in at what it's coming in at a partial pressure of oxygen one hundred millimeters of mercury good oxygen supply oh boy but look what happens to this guy this poor guy he's been eating too many Big Macs and he has a lot of ethereal erotic plaques or thrown by that is accumulating in this area and he has all of this actual plaque and occlusion to this actual blood vessel what's going to happen to the amount of blood getting through this area because of him pounding down Big Macs and quarter pounders what's going to happen very little blood is going to get by is very little blood is going to get by what's going to happen what is the structures that are carrying the actual oxygen hemoglobin what a team of Oban carried in red blood cells so if you guys remember here look here's my actual red blood cell here and again who is the actual structure inside of my red blood cell that's holding on to that oxygen hemoglobin right and if you remember hemoglobin can actually bind on to four oxygen molecules now if there is very few red blood cells coming to this area because there's an occlusion what happens to the oxygen delivery to the tissues it decreases what does that cause hypoxia so again in this situation the oxygen delivery to the tissues that are actually going to decrease so there's going to be a decreased oxygen delivery okay so again one more time with this one what does this one call here so that we write this one down this one here is the second one that we talked about this is called ischemic hypoxia and again what is another name for just in case you can call it stagnant hypoxia okay so again in this situation there's a thrombus or an embolus or something like that that including a blood vessel and decreasing the amount of blood going to the capillaries if you decrease the amount of blood going to the capillaries you decrease the actual amount of red blood cells going to this area if you decrease the amount of red blood cells that decreases the actual oxygen delivery okay so again in this situation there is very little red blood cells in this area that is not anemia do not confuse this I am NOT writing this here let me actually write this a very little red blood cells in the vicinity in capillary okay I'm not talking about a NEMA NEMA that is a different type of hypoxia I'm just saying that there's not a lot of red blood cells in this area because there is a thrombus impeding the amount of red blood cells come to the area so the decrease oxygen delivery and that results in hypoxia whew all right what about what else you know there's another situation same guy you know he's been putting down the Big Macs like it's going out of style on the double quarter pounders with cheese those are so delicious but anyway we come back to this and he's liquidy look what's happening here he has congestive heart failure and his heart muscle has become very weak and so in congestive heart failure what's the whole problem their heart is not strong enough to be able to pump blood from the left ventricle here right because this is left ventricle this would be the right ventricle okay this is the right atrium and this is the left atrium this is the aorta right so in congestive heart failure what happens their actual cardiac output decreases what is cardiac output cardiac output is defined as the heart rate multiplied by the stroke volume right so they're if they have a decrease in cardiac output then they're not going to have a lot of volume of blood coming to this area so what happens to the volume of blood being distributed if they're what's normal cardiac output so cardiac outputs normal is about five liters okay so five liters per minute their cardiac output is actually going to be less than this so they'll have less than five liters per minute now if you think about that if they have very little blood coming to this actual same capillary bed very little blood if they don't have a lot of blood coming to this capillary bed what is it going to mean that isn't going to mimic the same thing that there's not going to be a lot of blood coming to this area if there's not a lot of blood coming to this area doesn't I mean there's not going to be a lot of red blood cells doesn't mean that there's not going to be a lot of oxygen delivery I mean that'll produce hypoxia yes okay so in this situation in congestive heart failure due to a decrease in cardiac output this is due to a decreased blood volume delivery or supply to tissues okay so we can mimic this actual ischemic hypoxia and again this is due to more of a stagnate because it can have this very slow flow you're not gonna have a lot of blood coming to this actual area very very little blood coming to this area okay okay so again what do we talked about so far so far we've done hai for one here guys just one up here that we discussed was the first one this was called hypoxemic hypoxia and then we've talked about a schema type ox here we've talked about we call it stagnant foxy which is a congestive heart failure or due to some type of thrombus or maybe even a vascular tumor of some form it's basically impeding the blood flow and the blood flow through this area is very very very slow very little red blood cells coming to the area very little oxygen delivery in the hypoxia okay now let's do the third one the third one is anemic hypoxia okay so the third one that we're going to talk about here is going to be called anemic hypoxia so an anemic hypoxia it's very simple it's honestly very simple we've already had a video on an emu if you guys have already watched it and if you guys remember inside of the actual bone marrow what do you have you have the myeloid skin cell so we'll put M s C and if you guys remember the myeloid stem cell was dividing right it was forming a lymphoid stem cell and then a myeloid stem cell so we had specifically the actually should call this not on my list M so you should call this actually a pluripotent stem cell the hemocytoblast and it was actually dividing and forming lymphoid stem cells and myeloid stem cells and the myeloid stem cells were actually looking to form the red blood cells when some situation and whether there is actually a decreased number of red blood cells what could cause a decreased number of of blood cells certain types of anemia this could be maybe in certain situations when there's very little red blood cells being produced maybe aplastic anemia could be due to a plastic anemia another thing that could actually cause decrease red blood cells to actually be present besides aplastic anemia is actually then getting lysed and that they're getting lice consistently that can decrease the amount of them present so maybe even in hemolytic anemias okay what about a situation where it's not about the number of red blood cells what if the hemoglobin isn't appropriate or is it normal amount of hemoglobin inside of the red blood cells so it's not just specifically the actual little red blood cells let's say it's another issue and let's say that you have abnormal hemoglobin why is that important because hemoglobin is responsible for carrying oxygen so if there's an abnormal hemoglobin that's going to affect the oxygen carrying capacity right so in certain situations like this what could this be due to this could be due to could be due to a specific situation like microcytic anemias like iron deficiency so it could be due to iron deficiency it could be due to b12 deficiencies it could be due to many different things it'll even be due to Salas emia and it can even be due to sickle-cell anemia so you guys should get the point right so again in certain situations in which there is an emu whether it be due to very little red blood cells being produced in which there's an a plastic anemia in other words if you guys remember there's damage to the myeloid stem cell in this case it won't be able to produce enough red blood cells or if there's hemolytic anemias to where there's fear of psychosis or g6pd age deficiencies or whatever the situation might be and it gets stuck in the capillaries and they get destroyed that can decrease the number of red blood cells or if their hemoglobin is actually abnormal like an iron deficiency b12 deficiency folic acid deficiency thalassemia or sickle-cell anemia you guys get the point why am i stressing this I want to make a quick point of how how crazy this is okay in one red blood cell this is insane in one red blood cell you have two hundred and the million hemoglobin molecules and one hemoglobin molecule can actually bind four oxygen molecules that means in one red blood cell that consists of 250 hemoglobin molecules what is 250 million times 4 1 billion 1 billion oxygen molecules for what for 1 red blood cell is not insane so because of that I just want you guys to get the point that if there is any situation in which there's what a decrease in number of red blood cells or a decrease in the actual I'm sorry not a decrease in hemoglobin or a decrease in hemoglobin or abnormal hemoglobin it could significantly affect the amount of oxygen molecules are bound and if this red blood cell for example let's say that I have this red blood cell I'm going to expand this capillary a little bit let me expand this capillary a little bit so you guys can see here so let me grab my blue marker here and I expand this capillary just a little bit more here and I want you guys to understand here let's say that now I don't have a lot of red blood cells so I have a decreased number of red blood cells or the red blood cells that I do have are actually having abnormal or deficient hemoglobin what does that mean that means very little oxygen delivery and if there is very little oxygen delivery what does that produce hypoxia okay so that should be clear now okay so so far we covered hypoxemic hypoxia we covered a schema type ox yet and then we talked about this third one which was I mean Makai pasta which could be due to a decrease in number of red blood cells like aplastic anemia or hemolytic anemias or it could be due to deficient or abnormal hemoglobin such as an iron deficiency b12 deficiency thalassemia and sickle cell so enthusiam and sickle cell would be abnormal hemoglobin and iron and b12 would be more of a deficiency in the actual functional hemoglobin okay now that we've done that I have one more than we talk about and I will talk about how you would actually be able to treat these situations very efficiently to make sure that the patient doesn't die okay so the last one it's called histo toxic hypoxia so again the last one is called histo toxic hypoxia so this one is rich it's really interesting you can have a normal partial pressure of oxygen all day you could have greater than hundred partial pressure bakken wouldn't matter inside of your actual cells you have a specialized structure look at this structure here you guys should already know this structure this is called your mitochondria and your mitochondria are responsible for what your mitochondria are specifically responsible for being able to take oxygen and you know they basically accept the electrons they put the electrons onto the oxygen to form water to make ATP in a certain situation in which someone for whatever reason has cyanide you know see a negative is cyanide for whatever reason they had to get poisoned with cyanide cyanide affects the specific component of the electron transport chain you know there's what's called complex 4 or cytochrome oxidase it inhibits this enzyme and this enzyme is responsible for doing what it's responsible for taking the electrons from the electron transport chains you guys remember from our electron transport chain video at CU cytochrome a plus a3 who drops the actual electrons onto oxygen so it takes the electrons and it adds it on to oxygen to form water well if there's very little oxygen there's going to be very little actually electron accepting and if that's the case what's going to happen then even though oxygen is an abundant amount this enzyme is inhibited and if this enzyme is inhibited it cannot pass the electrons onto oxygen so what happens oxygen does not get utilized if oxygen is in utilized can you produce ATP in this cell no in the ATP levels of plummet same thing with this one ATP levels plummet and same thing with this one ATP levels will plummet okay so even though you have abundant you could have abundant amounts of oxygen but it would not matter because their cytochrome oxidase is being inhibited by the cyanide it's binding to it very strongly and preventing the electrons from being added on to oxygen so it's not being utilized in ATP is not being made why is it so bad to have hypoxia for such a long period of time because if a tissue goes for a while what I told you to maintain I want you guys to please remember brain and the heart at least if these tissues go for a long period of time without oxygen what can happen they can become hypoxic we already know that but then it can lead to ischemia decreased oxygen supply very very significant and then it can lead to unfortunately necrosis which is reversible cell death right and if that cell dies if you have a neuron or a mitotic so if they're damaged their day and coming back hard muscle same thing so it's very very important it's very vital that we get as much oxygen to the important vital tissues as possible okay so now that we talked about this I want to talk about one more thing I want to talk about specifically how you'll be able to treat these patients cuz it's not all the same you guys just say I'll give them supplemental oxygen it's not going to work for all of them one thing I want to mention I forgot to talk about was this shunting thing right I talked about it here whenever there's complete lung collapse there's one more thing and it's it's unfortunate it's in a condition called tardive cyanosis okay they call it tardive cyanosis okay and in Cardiff cyanosis what happens is the it's a congenital heart disease and in the congenital heart disease the vent the ventricles the septal part does not form completely and it actually develops a septal defect so they develop specifically a ventricular septal defect what happens is this is your left central this is your right ventricle usually the left ventricle is more powerful pump so it contracts harder right and what it does is over time it'll push some of this blood what kind of blood is over here in the left ventricle high amounts of oxygen achtung your blood very high what about the actual blood over here in the actual right ventricle low oxygen that's why it has to go to the lungs it has to go to the lungs to get oxygenated and come back to the left atrium to which you're actually going to be oxygen delivery to the tissues what happens is when the baby is actually having this condition a lot of the blood is being shunted from the left ventricle to the right ventricle but then what happens to the amount of blood that's being pumped from the right ventricle to the lungs it increases the actual blood volume what does that mean this size the heart's gonna have to pump a lot harder so it pumps a lot harder and actually what happens is eventually a typographies and whenever a muscle like this hypertrophy so if this muscle right here has consistent contractions it will hypertrophy hyper tricky and whenever this muscle hypertrophy is eventually action is going to become very strong and when it becomes very strong guess what happens the Blood starts flowing in the opposite direction and then when it starts flowing into the opposite direction blood is flowing from the right ventricle into the left ventricle and what blood is coming over here low oxygen and what would happen to the normal let's pretend that here inside of this actual less ventricle the partial pressure of oxygen is a hundred millimeters of mercury and some of this deoxygenated blood comes over here and over time when it leaves and goes onto the systemic circulation it actually drops down let's up supposed to about 80 millimeters of so again in this situation in which the partial pressure of oxygen is actually decreasing because some of the blood the deoxygenated blood from the right ventricle is being pumped over here into the left ventricle and it's leaving out with a little bit deoxygenated blood what's going to happen that the partial pressure of oxygen is actually going to decrease and what's a call when the reduction of partial pressure of oxygen is on the arterial side it's called hypoxemic hypoxia there is one last one I'm not going to send a lot of time when it's whenever you have carbon monoxide poisoning carbon dioxide poisoning is actually situation very deadly herb happens a lot when there's fires but in situations like that carbon monoxide poisoning is actually specifically considered to be a unique type of hypoxia hypoxia and what it does is is if I had the hemoglobin right here here's my hemoglobin and how oxygen wants to bind to the actual hemoglobin what happens is and people who have carbon monoxide poisoning carbon monoxide actually binds to that site because it has 200 times more affinity than the oxygen and if that's the case then if you have carb monoxide poisoning you could actually have this binding on to oxygen it doesn't matter how much oxygen you have it's actually going to be specifically blocking that oxygen and then when it blocks the oxygen it prevents the oxygen from being able bind and hemoglobin is delivering this carb monoxide and it can actually produce a very dangerous eye pockit because you wouldn't even know that you're actually having carbon dioxide poisoning okay you would just develop some type of you turn cherry red you'd have like a disorientation be a little bit confused look again very deadly how would you treat this one you give them a lot of oxygen as much oxygen as you possibly can put them in a hyperbaric oxygen chamber and give them high pressure oxygen and the reason why is if you get an exceedingly amount of oxygen it can competitively out beat the carbon dioxide and whenever it actually competitively out beats the carbon dioxide it can then rebind okay okay how do you treat people with hypoxemic epoxy a-- when all those situations usually you're going to want to be able to give them supplemental oxygen so give them supplemental oxygen so in treating hypoxemic hypoxia one of the best things to do is give them supplemental oxygen be very careful when you're giving supplemental oxygen to people with chronic obstructive pulmonary diseases because if you give them too much it can actually put them into respiratory arrest okay we'll talk about that when we talk about chemoreceptors ischemic or stagnate pacquiao well if they have this condition over here come over here really quickly if they have a schema cap box yet what do you want to do give them some type of basically a clot busting drug so give them tissue plasminogen activator or give them warfarin or give them aspirin or give them some type of drug that's actually going to rid the clot or do a surgery so whether it be TPA whether it be warfarin or whether it even be surgery to remove the clot what about congestive heart failure and congestive heart failure you have to be able to take care of the issue so in this case you're going to want to give them digoxin and dioxin is going to try to stimulate the actual inotrope again going to increase get the contractility part but with people who do have congestive heart failure you can help them a little bit if you do give them supplemental oxygen it can make a small difference in the actual congestive heart failure can be the difference between life and death in these patients okay what about histo toxic hypoxia whenever you have cyanide poisoning now if you give them supplemental oxygen it's not going to do anything because it doesn't matter how much oxygen you have it's because the actual cyanide is actually inhibiting the cytochromes so you have to give them some type of drug so usually they give them a derivative of vitamin b12 they call it hydroxocobalamin you can give them that or you can give them what's called sodium thiosulfate with um nitrites and that can also get rid of this actual cyanide poisoning okay and if they have anemic hypoxia obviously you have to treat the anemia because in these individuals in anemic EPOXI they could have a normal partial pressure of oxygen but again you have to treat the anemia so in this type of situation we have to do blood transfusions depending upon what type of mimi it is it all depends right but in general you could give them supplemental oxygen so if you give them supplemental oxygen it actually can make a small difference because they can actually increase the amount of dissolved oxygen within the blood that can give them just a little bit more oxygen that they need to be able to get through that issue all right I'm Israel so in this video we talked about the different types of epoxy and different types of clinical correlations and signs that you would see in these individuals I hope all of it made sense I really do a hippy I thank you guys for sticking in there with me throughout this video if you guys enjoyed this video please hit the like button subscribe comment down the comment section as always engineers until next time

Channel: Ninja Nerd

Views: 197,509

Keywords: hypoxemic hypoxia, anemic hypoxia, stagnant hypoxia, histotoxic hypoxia, types of hypoxia

Id: RlpBOOb8KkU

Length: 48min 12sec (2892 seconds)

Published: Mon Jul 10 2017