[usmlear] you start with any q
[malak93] what mean by hypoxia?
[usmlear] low oxygen in tissue..its a general term
[erum] dec oxygen
[malak93] Rt
[malak93] and hypoxemia?
[usmlear] types?
[usmlear] dec O2 in plasma
[malak93] mean
[erum] dec oxy in plasma
[malak93] yes]
[usmlear] may be bec of venti,perfusion,diffusion defects
[erum] what is o2 saturation
[usmlear] decPao2
[malak93] O2 attached to HB
[erum] rt malak
[usmlear] what is 100% O2 saturation?
[erum] all four sites on hb has o2
[usmlear] yes
[usmlear] what cond can't recover after o2 admin.?
[erum] what dec o2 saturation
[erum] methbnimia
[usmlear] methHb
[usmlear] how about anemia?
sanfer has left the chat.
luckyal has left the chat.
[erum] dec hb
[malak93] fe+3
[usmlear] right..so O2 saturation is normal here
[sanfer] hi
[usmlear] but PaO2 dec?
[usmlear] hi sanfer
[erum] as well as partialpressure of o2 is normal
[malak93] hi
[usmlear] we r discussing 1 topic/day...as u said
[usmlear] today is cell injury..
[erum] hi
[sanfer] sorry I'm late
[usmlear] will go in order now..
[sanfer] thks
[malak93] not much
[usmlear] yes..just started
[sanfer] what values make up oxygen content?
[malak93] resp acidosis-----dec P02
[usmlear] pt with hypoxemia..u give 100% O2..no improvement
[usmlear] what causes?
[malak93] vent. defect
[sanfer] ventilation defect
[erum] met hb
[sanfer] RDS
[usmlear] intrapulm shunts
[usmlear] ARDS
[malak93] ARDS
[usmlear] yes
[erum] and vent
[usmlear] whats your Q sanfer?
[usmlear] O2 content?
[sanfer] i saw you were talking about oxygen content...
[an_bo_al] ventilation defects (rds, ards) and methb
[usmlear] ok
[erum] :cl an
[malak93] 1,34 HB 02 sat p02= 02 content
[usmlear] O2 content...total ammount of O2 in blood
[usmlear] it depends on mainly Hb
[usmlear] other factors..PaO2,SaO2
[sanfer] yes its make up of Hb, SaO2 and PaO2
[malak93] yes
[erum] includes o2 saturation pao2
[malak93] 'rt
[usmlear] yes
[sanfer] main cause of tissue hypoxia?
[malak93] :cl
[an_bo_al] ischemia
[malak93] ischemia
[sanfer] ok, example
[erum] thrombotic obstruction
[malak93] MI
[an_bo_al] trombosis...mi
[erum] of vessel
[usmlear] causes of cyanosis?
[malak93] co poising
[erum] dec o2
[sanfer] rt, mcc is a thrombus of any muscular artery, classic
[erum] no co dont have cyanosis
[malak93] coronary
[an_bo_al] decre SaO2
[usmlear] rt an
[usmlear] main cause..Hb dec
[usmlear] yes mala
[erum] co has chery red color no cyanosis
[usmlear] no cyanosis in CO
[malak93] co there is cyanosis
[malak93] but mask by cherry red
[an_bo_al] there is cyanosis but is not visible
[an_bo_al] rt malak
[malak93] thanx
[erum] cyanosis is visible blue coloration
[sanfer] in ventilation defect we lost ventilation but we still got perfussion, how is that call?
[usmlear] but cyanosis is word...meaning blue discoloration of skin
[malak93] dead space
[erum] co dec o2 but no blue color
[an_bo_al] dead space
[usmlear] even Goljan says..no cyanosis in CO
[sanfer] SHUNT
[usmlear] off course SaO2 dec
[malak93] yes shunt
[an_bo_al] lets do the cyanosis thing 1st
[erum] pulmonary shunt
[malak93] intrapulmonary shunt
[erum] ok
[sanfer] rt
[sanfer] mcc of perfussion defect?
[usmlear] its ok..but NO CYANOSIS in CO poisoning..
[malak93] pul embolism
[erum] cyanosis means blue colored skin
[usmlear] rt erum
[erum] not present in co poisioning
[usmlear] yes
[erum] the color is red
[erum] plethora is the name
[malak93] but there is cyanosis
[usmlear] yes...bec of CO ..mole. r red
[an_bo_al] in goljan notes it says that masks cyanosis
[malak93] either clear or not
[usmlear] mala..cyanosis is term..just to describe skin color
[sanfer] yes pulmonary embolism, common in prolonged flights, stasis
[usmlear] but,Goljan audio...no cyanosis in CO
[usmlear] ok,lets move on..
[erum] thats what makes it diff to diagnose ......hypoxemia withut cyanosis [w/out blue color]
[malak93] ok no problem
[sanfer] we have ventilation but no perfussion, how do you call it?
[an_bo_al] agree w/ erum
[erum] intrapul shunt
[usmlear] me too
[sanfer] no
[sanfer] DEAD SPACE
[erum] oh sorry
[malak93] shunt
[erum] usmlear an_bo_al tx
[malak93] dead space
[sanfer] perfussion defect produces "dead space"
[usmlear] thanks to u 2
[erum] dead space
[sanfer] ventilation defect produces intrapulm shunt
[usmlear] yes sanfer
[an_bo_al] rt
[sanfer] what happen if we give them O2, if pt has perfuss defect?
[usmlear] like..pul embolus..give 100% O2-->pO2 inc
[sanfer] rt
[usmlear] ok
[erum] it will improve po2
[an_bo_al] will correct
[sanfer] because not every single vessel in the lung is clogged
[an_bo_al] rt
[erum] +compensation
[usmlear] but it will not happen in venti defects..
[malak93] rt
[usmlear] bec no O2 delivary to alveoli
[erum] inc vessels
[sanfer] what happen with the vessel around the bronchi when there is ventilation defect?
[sanfer] dilate or constrict?
[malak93] vasoconstrict
[sanfer] rt
[an_bo_al] constrict
[erum] they contract
[erum] constrict
[sanfer] how do you differentiate ventilat def from perfuss defect?
[usmlear] produce intrapulm shunt
[usmlear] venti
[malak93] give O2
[sanfer] yes
[an_bo_al] where is ventilation and perfusion best in lung?
[malak93] base
[sanfer] what's wrong in Diffusion defect?
[erum] vent doent get better w/ 100 % o2
[usmlear] yes
[an_bo_al] rt
[erum] 1st an
[erum] vent =apex perfusion = base
[sanfer] in apex an-bo?
[erum] sanfer inc thickness of alveolar wall
[malak93] base
[sanfer] vent is in apex and perf in bases
[sanfer] rt
[usmlear] rt
[sanfer] example?
[sanfer] of diffusion def...
[erum] sarcoidosis pul edema
[usmlear] fibrosis
[erum] fibrosis
[sanfer] somebody remember the J reflex that goljan talks in the audio?
[erum] dyspnea on exertion
[erum] in chf pt
[kyounus] u mean J receptor
[erum] bcuz of pul edema
hosdurga has left the chat.
[erum] j receptor activation
[malak93] pul edema-stimulate j receptor-dypnea
[sanfer] goljan tells about J reflex
[sanfer] compromise X nerve
[malak93] rt
[an_bo_al] irritation of pleura uses X nerve to produce reflex
[usmlear] yes
[malak93] lead to dyspnea
[kyounus] yes
[erum] via 10th nervw
[sanfer] yes, in heart failure, the excess fluid will produce the dyspnea in the pt because activ of J receptors
[malak93] irritation by edema
[sanfer] it's the fluid in the interphase in lungs that exerts this action
[sanfer] rt
[malak93] yes
[usmlear] thanks
[sanfer] what happen with O2 content compounds in Anemia?
[usmlear] good pt
[malak93] dec
[usmlear] dec,bec Hb dec
[malak93] Hb dec-O2 content dec
[sanfer] paO2?
[sanfer] SaO2?
[malak93] normal
[sanfer] in anemia?
[erum] normal
[usmlear] but PaO2 & SaO2 normal
[usmlear] right
[malak93] sat normal
[kyounus] normal Sao2 and pao2
[sanfer] why O2 content is decrease then?
[erum] only hb is dec
[usmlear] bec Hb dec
[malak93] Hb dec
[sanfer] rt
[sanfer] and O2content means=
[usmlear] what r superoxides?
[erum] pao2 +o2 sat
[sanfer] the relation of those 3 factors rt?
[erum] yep
[malak93] Hb ,O2 sat and PO2
[usmlear] O2 contents means ..total amount of O2 in blood
[sanfer] what happen with PaO2 in CO poisoning?
[sanfer] rt
[usmlear] PaO2=O2 dissolved in plasma
[usmlear] SaO2...O2 bound with Hb
[erum] pao2 normal
[malak93] po2 in co poising normal
[erum] in co
[sanfer] ?
[erum] po2 normal
[usmlear] Dec SaO2
[malak93] dec only in O2 sat
[sanfer] PO2 in CO poisoning?
[erum] sat o2 dec
[usmlear] no effect on PaO2
[malak93] normal
[erum] normal
[sanfer] yes
[erum] o2 sat dec
[usmlear] bec PaO2 is in plasma...CO is on Hb
[sanfer] it's just that PCO increases and CO will be sitting in the chair of O2
[usmlear] affecting SaO2
[sanfer] so SaO2 decr
[sanfer] good
[malak93] same for met Hb
[sanfer] CO has 210 greater afinity for Hb than O2
[malak93] yes
[usmlear] in MethHb...Fe+++..rathet than Fe++
[sanfer] CO poisoning Rx?
[usmlear] so..dec SaO2
[malak93] dec O2 sat
[usmlear] no effect on PaO2
[malak93] Po2 normal
[usmlear] yes
[sanfer] you were talking before about the chocolate color in CO poisoning, color in blood called?
[usmlear] ok..great..hope we will not forget these tiny but imp. points now
[sanfer] treatment for CO poisoning?
[usmlear] color in blood?
[usmlear] blue=cyanosis
[sanfer] Cherry Red Pigment or Mask cyanosis
[malak93] 100% O2
[sanfer] why malak?
[usmlear] 100%O2
[usmlear] cherry red..bec of CO mole
[malak93] displace co
[usmlear] CO has dark red color
[usmlear] so when in access..causes this color
[sanfer] yes, because increasing PO2 will kick out CO from Hb
[usmlear] ok
[an_bo_al] tx for methb?
[sanfer] RX for methemoglobinemia?
[sanfer]
[an_bo_al] wow conected!
[usmlear] methy. blue
[malak93] i v methylene blue
[usmlear] ascorbic acid
[an_bo_al] 2ndary tx?
[malak93] vit c
[an_bo_al] rt
[sanfer] wait, chocolate color blood is in methemoglobinemia
[sanfer] Fe+3 cant bind O2, so SaO2 decreases
[malak93] rt
[an_bo_al] agree
[sanfer] the RBC has an enzyme for this Fe+3?
[malak93] nitrat or dapson
[malak93] reductase
[sanfer] rt methemoglobin reductase
[usmlear] Vit C reduces Fe+++ to Fe++
[sanfer] which convert Fe+3 to +2 = reduction
[erum] rt
[usmlear] methylene blue activates metHb reductase
[sanfer] a pt coming from rockie mountains, cyanotic, diagnosis most likely?
[sanfer] you give him O2 100% and nothing...
[erum] met hb
[sanfer] why
[erum] from water
[sanfer] Rt, Rockie mountains have water full of nitrates yes
[usmlear] methhemoglobenemia is common in HIV pt..why?
[erum] tmp/sm rx
[sanfer] nitrates oxidize fe+2 to +3
[sanfer] Rx?
[usmlear] Rx for what sanfer?
[sanfer] methem
[usmlear] oh..we did that..methy. blue +vit C?
[erum] we did that
[usmlear] my Q..why in HIV?
[sanfer] yes and why pat with HIV get methemoglobinemia?
[usmlear] meth. is common?
[usmlear] bec of sulfa drugs
[erum] told y tmp /sm
[sanfer] yes
[usmlear] right
[sanfer] TMP/SMX used wide to treat pneumocystis carinii
[usmlear] rt
[an_bo_al] what else?
[an_bo_al] profilaxis for?
[erum] name other drugs causing met
[usmlear] how acetaminophen causes liv inj?
[sanfer] Nitrates in general?
[usmlear] rt
[sanfer] forms FR in liver
[usmlear] Rx?
[sanfer] tylenol, 1st cause of hepatitis fulminant due to a drug
[sanfer] Acetylcysteine therapy
[an_bo_al] acetaminophen
[usmlear] anacetylcysteine( mucomyst)..which replenish gluta...so, it can keep up neutralizing FR
[an_bo_al] dont like comercial names
[usmlear] MCC of FR?
[erum] why do we have cellular sweling in hypoxemia
[usmlear] Goljan says...Leukemia..anybody can expl. more?
[erum] reperfusion usmlear
[erum] fr = free radicals...rt?
[usmlear] reperfusion is not the most comm.
[usmlear] yes
[usmlear] MC cancer bec of FR...Leukemia?
[usmlear] How?
[an_bo_al] xray teraphy
[erum] bone marow supresion
[sanfer] goljan says mc cancer caused because radiation: leukemia
[usmlear] radiation causes FR?
[an_bo_al] yes
[erum] yes
[usmlear] ok..got it..thanks
[sanfer] that's what he say
[sanfer] in radiation produces Hydroxyl FR
[an_bo_al] OH-
[usmlear] yes sanfer
[usmlear] rt
[sanfer] what free radical produce damage to the retina in the baby with RX for RDS?
[erum] so what smc fr injury usmlear
[sanfer] retinal premature injury is called
[an_bo_al] O-
[usmlear] retrolental fibroplasia
[sanfer] rt
[usmlear] thats Ca erum...leukemia
[an_bo_al] complication of RDS?
[sanfer] Superoxide O*
[usmlear] it can lead to blindness in NB
[an_bo_al] and?
[sanfer] also damages lungs as pulmonary dysplasia
[an_bo_al] bronchopulmonary dysplasia
[sanfer] treatment for superoxide fr?
[sanfer] superoxide dismutase
[usmlear] liver cell necrosis in dry cleaning worker..how?
[sanfer] can anybody explain the pathway of lipofucsine? how it is produced?
[sanfer] CCl3
[usmlear] lipofuscin is product of normal wear & tear..accumulated in cells which r damaged by FR
[usmlear] rt sanfer
[usmlear] these r in form of indigestible lipid
[usmlear] give tissue a brown appearence
[sanfer] because they are damaged by FR cant be digested?
[usmlear] rt
[sanfer] ok thks
[usmlear] bec of lipid peroxidation
[usmlear] it is actually a normal aging process
[an_bo_al] correction: Superoxide dismutase in its pharmaceutical form " Orgotein " is a potent antiinflammatory agent uner the trade name "Palosein". In the US, you can only get it if you are a dog or a horse, but it is an approved drug in most of the rest of the world.
[erum] i wa sthinking that too
[erum] sod is not the rx
[an_bo_al] is the ez but not the tx
[erum] sod inactivates the superoxide free r
[usmlear] what is MPO system..present where & how it works?
[erum] but its not the rx
[an_bo_al] rt
[an_bo_al] monos and neutros
[usmlear] bactericidal..present in neutro & mono.
[usmlear] yes
[sanfer] ok back
[erum] in neutrophils
[sanfer] oops yes I meant what is the antioxidant
[usmlear] causes of fatty liver?
[erum] ccl3 injury
[usmlear] is that fatty liver?
[usmlear] I thought its most common in alcoholics?
[usmlear] bec they generate NADH
[usmlear] which converts Pyruvate into lactate
[erum] yep alcoholics t
[erum] oo
[usmlear] ok..why alcoholics have fasting hypoglycemia?
[usmlear] same expl..no pyruvate available for gluconeogenesis in fasting stage..so no glucose
[erum] they dont have enuf atp
[usmlear] Thanks everybody..it was really a v. good & effective discussions today
[erum] so cant make up to whole cycle
[usmlear] rt erum
[erum] instead makes lactate
[usmlear] we will finish 2nd lecture tomorrow..with detailed info.
[erum] ok
[an_bo_al] ok txs