AP Study Guide - Ch. 6-13 - PDF

### Ch.6 Heart Pulmonary arteries= carries deoxygenated blood Pulmonary veins = carry oxygenated blood Bronchi Bronchial arteries= carry oxygenated blood Bronchial veins= carry deoxygenated blood Pulmonary veins and bronchial veins mixing create the anatomical shunt. And 1-2% of cardiac outpu...

### Ch.6 Heart Pulmonary arteries= carries deoxygenated blood Pulmonary veins = carry oxygenated blood Bronchi Bronchial arteries= carry oxygenated blood Bronchial veins= carry deoxygenated blood Pulmonary veins and bronchial veins mixing create the anatomical shunt. And 1-2% of cardiac output comes from this Difference between pulmonary circulation and systemic circulation. Pressure decreases and resistance decreases in pulmonary circulation and rhythm is more pulsatile. For bronchial circulation pressure and resistance increases and the flow is more continuous. Pulmonary circulation gives 9% of blood at any given time which is about 450ml PVR= the resistance the right ventricle has to pump against An increase in PVR causes an increase in right ventricle work Formula for PVR= mean PAP-mean PCWP/cardiac output. Second step is multiple your answer by 80 Chemical factor that causes vasoconstriction is alveolar hypoxia Less than 60-70 mmhg causes HPV Alveolar hypoxia causes pulmonary edema in high altitudes Alveolar hypoxia causes vasodilation in the system circulation HPV exaggerates the shunt affect Zone 1( dead space) this is ventilation without perfusion PA\>Pa\>Pv Zone 2 (transitional): ventilation and perfusion are equal. Pa\>PA\>Pv Zone 3( gravity dependent) perfusion with little ventilation, Pa\>Pv\>PA Exercise causes PAP to increase and may convert zones 1 and 2 to zone 3. Ch 7: Gas diffusion is the net movement of molecules from high concentration and pressure to low concentration and pressure. Pio2 (room air)= 760 x 0.21= 159 mmhg Pio2 ( humidified) (760-47) x 0.21=149 mmhg Respiratory exchange ratio value is 0.8 R=vco2/vo2 Alveolar equation when patient is breathing fio2 of 0.60 or less PAo2= Pio2-(paco2)1.2 or PAo2= fio2(760-47)-(Pao2 x 1.2) depending on if given pio2 value or fio2 only. When patient is breathing fio2 greater than 0.60 pAo2= Pio2-Paco2 ### Ficks law: vgas is greater with an increase in surface area, solubility coefficient, and pressure gradient. With an increase in thickened alveolar membrane the slower the diffusion Henry\'s law: gas diffusion is directly proportional to partial pressure ( greater pressure= greater diffusion) Graham\'s law: focuses on weight ( lighter gas equals diffuses faster) What causes diffusion and persuasion limitations in o2 transfer 1. 2. Ch 8: Oxygen is transported in the blood two ways in the plasma formula for it is po2 x 0.003 and bound to hemoglobin 1 g of hb =1.34ml of o2 Pao2 is 5-10 mmhg \< pAo2 due to the shunt Male hb levels are 16-18g/dl Female hb levels are 12-15 g/dl Normal amount o2 carried on the hemoglobin is 20.1 vol%o2 but hb is only 97% saturated so it is actually 19.5% Total o2 content formula is Cao2=(hb x 1.34 x Sao2)+ (pao2 x 0.003) cvo2=( hb x 1.34 x Svo2) + (pVo2 x 0.003) oxyhemoglobin= hb bound to oxygen Deoxyhemoglobin= hb not bound to oxygen Oxyhemoglobin curve us a s sigmoid shape and compares po2 to hb saturation Flat portion of curve=an increase in po2 does not cause much change in so2 levels Steep portion of curve= hb saturation drops greatly with a slight drop of po2 from 60 and lower p50= is when hb is saturated to 50% and is reached at 27 mmhg of o2 Right shift( decreased affinity) Ph decrease Co2 increases Acidosis Increase in temp Increase in 2-3 dpg levels Left shift( increased affinity) Increase in ph Decrease co2 Alkalosis Decrease in temp Decrease in 2-3 dpg levels carboxyhemoglobin= hb has a 210x more affinity for hb so there is competitive bidding. Hyperbaric o2 therapy is needed methaemoglobin= cannot bind to o2 caused by nitrate poisoning Increased affinity there is a decrease in p50 but greater so2 for po2 A decreased affinity there is an increase in p50 but decreased s02 for given po2 Cao2 (20) -cvo2(15)=c(a-v)o2 normally is 4-6 ml/dl ### ### ### Ch 9 study guide #### **1. CO₂ as a Byproduct of Cellular Metabolism** - ### Carbon dioxide (CO₂) is produced as a byproduct during cellular metabolism when cells use oxygen for energy. - ### CO₂ needs to be removed from the body to maintain proper pH and avoid acidosis. #### 2. **How CO₂ is Transported in the Blood** ### **CO₂ is carried in the blood in three main ways:** 1. ### Dissolved in Plasma (8%): A small amount of CO₂ is transported directly in the blood plasma. 2. ### Bound to Proteins, including Hemoglobin (12%): CO₂ binds to proteins, particularly hemoglobin, to be transported in the blood. 3. ### Ionized as Bicarbonate (HCO₃⁻) (80%): The majority of CO₂ is converted into bicarbonate ions, which is the primary method of CO₂ transport in the blood. #### 3. **Formula for Dissolved CO₂** - ### To calculate the amount of CO₂ dissolved in plasma, the formula is: ### Dissolved CO₂ (mmol/L)=PCO2×0.03 ### This shows that the dissolved CO₂ concentration in blood is proportional to the partial pressure of CO₂ (PₐCO₂). #### 4. **The Bohr Effect** - ### The Bohr effect explains how CO₂ and H⁺ ions affect hemoglobin's affinity for oxygen. - ### When CO₂ levels increase, it leads to a rightward shift in the oxyhemoglobin dissociation curve, reducing hemoglobin's affinity for oxygen. - ### This shift helps release oxygen from hemoglobin, allowing more oxygen to be delivered to the tissues where CO₂ levels are higher. #### 5**. The Haldane Effect** - ### The Haldane effect explains how oxygen levels affect hemoglobin's ability to carry CO₂. - ### When O₂ levels increase, it causes CO₂ to detach from hemoglobin. This is important in the lungs, where oxygenation occurs, allowing CO₂ to be released and exhaled. - ### Essentially, oxygen determines hemoglobin's affinity for CO₂. The more oxygen there is, the less CO₂ is bound to hemoglobin, and vice versa. #### 6. **Clinical Relevance: CO₂ Curve vs O₂ Curve** - ### The CO₂ dissociation curve is relatively more linear than the O₂ dissociation curve. - ### This means that changes in ventilation can easily manipulate CO₂ levels, making it more responsive to ventilatory adjustments compared to oxygen levels. - ### This is why CO₂ levels are often targeted in ventilatory therapy to maintain pH balance. #### 7. **CO₂ Reaction in the Lungs and Tissues** - ### CO₂ is converted into carbonic acid (H₂CO₃) in tissues: ### CO2+H2O→H2CO3 ### In the lungs, this reaction is reversed, allowing CO₂ to be released and exhaled. #### 8. **Relationship Between CO₂ and pH** - ### CO₂ and pH are inversely proportional: - ### Increased CO₂ leads to an increase in hydrogen ions (H⁺), which lowers the pH (making the blood more acidic). - ### Decreased CO₂ leads to a decrease in H⁺, which raises the pH (making the blood more alkaline). #### 9. **Regulation of CO₂ Through Ventilation** - ### The body regulates CO₂ levels through ventilation: - ### Increased ventilation (hyperventilation): Causes CO₂ to be blown off, leading to decreased CO₂ levels in the blood, which increases pH (more alkaline). - ### Decreased ventilation (hypoventilation): Causes CO₂ to accumulate, leading to increased CO₂ levels in the blood, which lowers pH (more acidic). - ### Ventilatory control is crucial for maintaining proper acid-base balance in the body. ### ### **Key Concepts to Remember** - ### **CO₂ transport: Mostly as bicarbonate (80%), some in plasma (8%) and bound to proteins (12%).** - ### **Bohr Effect: More CO₂ promotes oxygen release from hemoglobin to tissues.** - ### **Haldane Effect: More O₂ promotes CO₂ release from hemoglobin in the lungs.** - ### **CO₂ curve is linear: Making CO₂ easier to regulate via ventilation compared to oxygen.** - ### **CO₂ and pH: Inversely related---more CO₂ means lower pH (acidosis), and less CO₂ means higher pH (alkalosis).** - ### **Ventilation is how the body adjusts CO₂ levels to maintain pH balance.** ### ### ### ### ### **Ch 10 : Study Guide: Acid-Base Balance and Buffer Systems** #### **1. Basic Concepts of Acids and Bases** - - - - - - - #### **2. pH and Hydrogen Ions** - - - - - #### **3. Buffer Systems** - - - - - - - - #### **4. Hydrogen Ion Formation** - - - #### **5. Henderson-Hasselbalch (H-H) Equation** - pH=6.1+log⁡(\[HCO3−\](PaCO2×0.003) It shows the balance between: - - #### **6. Roles of the Lungs and Kidneys in Acid-Base Balance** - - - - - - - - - #### **7. Respiratory and Metabolic Acid-Base Disorders** - - - - ### **Summary** - - - ### **Ch 11: Study Guide: Control of Breathing and Respiratory Centers** #### **1. Medulla and Pons: Control of Breathing** - - - - #### **2. Dorsal Respiratory Group (DRG)** - - - - #### **3. Ventral Respiratory Group (VRG)** - - - - - - #### **4. Inspiratory Ramp Signals** - - #### **5. Pons Respiratory Centers** - - - - - #### **6. Hering-Breuer Reflex** - - - #### **7. Central Chemoreceptors** - - - - - #### **8. Peripheral Chemoreceptors** - - - #### **9. Control of Breathing in Severe COPD** - - #### **10. Oxygen-Induced Hypercapnia** - #### **11. Abnormal Breathing Patterns** - - - - - - ### **Key Terms to Remember:** - - - - - - - - - - ### **Ch 12: Gas Exchange and the V/Q Ratio Study Guide** ### **1. Importance of the V/Q Ratio for Gas Exchange** - - - - ### **2. Hypothetical Extremes in V/Q Ratio** - - - - ### **3. Shunts and Dead Space** - - - - - - ### **4. V/Q Distribution in the Lungs** - - - - - ### **5. Hypoventilation Effects on PaO₂ and PaCO₂** - - - - ### **6. Normal Gas Exchange Values** - - - - - ### **7. Types of Shunts in Gas Exchange** - - - - ### **8. Common Cause of V/Q Mismatch: Hypoxemia** - - ### **9. Dead Space Due to Excessive Ventilation** - - - - ### **10. Increased V/Q Ratio and Its Impact on Gas Exchange** - - - Ch 13 study guide:3 ways to calculate ABG interpretations : classification, calculation and confirmation The systematic classification consist of 3 steps 1: classify ph is it alkalotic or acidotic 2: analyze pco2 35-35 mmhg is normal Greater than 45 hypercapnia acidosis Less than 35 hypocapnia which mena alkalotic 3: look at bicarb 22-26 is normal Greater 26 is a high bicarb which means alkalotic Less than 22 is a low bicarb which means acidotic 4: asess for compensation Fully compensated means ph is normal but both pco2 and hco3 is abnormal Partially compensated means ph, Paco2, HCO3 are all abnormal Uncompensated means pH is abnormal and 1 of the other values is also abnormal. ### **Types of Acid-Base Disturbances** 1. - - - 2. - - - - 3. - - - 4. - - - ### **Study Guide for Acid-Base Balance** 1. - 2. - 3. - 4. - - - - -