Download Treatment of hypoxia

HYPOXIA
SMART DOCTORS
DR.KHIDIR A.A.GALIL
INTRODUCTION of HYPOXIA :
Literally Means :
DEFICIENT IN OXYGEN ”
It can refer to a shortage of oxygen due to some of the
conditions like high altitude.
Definition of hypoxia:
IS A PATHOLOGICAL CONDITION
in which the body as a whole or region of the body is
deprived of adequate oxygen supply and failure to
adequately provide oxygen to cells of the body and to
remove excess carbon dioxide from them.
Different between hypoxia and anoxia:
Hypoxia and Anoxia are related conditions that are the
result of the blood not carrying enough oxygen to
support the brain and organs , While hypoxia describes a
partial lack of oxygen in the blood .
anoxia :
is complete lack of oxygen, though blood flow is still
adequate.
Traditionally it has been classified into 4 category
1- hypoxic hypoxi :
is a condition of reduced arterial Po2 .
This problem can be seen in normal individual At high
altitudes.
Causes of Hypoxic Hypoxia :

Altitude sickness - The FAA recommends supplemental
oxygen for flights over 10,000 feet and over 6,000 feet
at night (because a pilot's vision is very sensitive to low
oxygen)

Lung conditions - Inadequate air exchange in the lungs
due to illnesses such as COPD, asthma, lung cancer,
pneumonia, rheumatoid lung disease, and pulmonary
hypertension.

Hypoventilation – Hypoventilation simply means “not
breathing enough.” This can be “central” if the brain
doesn’t tell the lungs to breathe, such as when under
anesthesia, due to a stroke or head injury, as a side
effect of medications for pain, or as a reaction to illegal
drugs.
It can also be “peripheral” due to an airway obstruction
that interferes with breathing, such as choking (when a
foreign body lodges in the trachea or large airways of
the lungs), drowning, suffocation, or in a cardiac arrest
when breathing stops and may be occurs due to low o2
in atmosphere.
2-anemic hypoxia ( hypoxemia ) :
is due to anemia , ( PO2 is normal but total o2 content is
reduced due to decreased ability of HB to carry O2 ) ,
thus anemic patient face difficulty during exercise
because of limited ability to increase O2 delivery to the
active tissue ( muscle tissue ) .
Causes of Anemic Hypoxia:

Anemia of any cause – This can include iron deficiency
anemia, pernicious anemia, and chemotherapy induced
anemia.

Hemorrhage

Methemoglobinemia - Methemoglobinemia, also known
as affinity hypoxia, is an abnormal hemoglobin that
doesn't bind oxygen very well.

Carbon monoxide poisoning - With Carbon monoxide
poisoning, hemoglobin is unable to bind oxygen.
3-Stagnant hypoxia :
is due to slow circulation ( decreased in blood flow ) .
Causes of Stagnant Hypoxia
A-Edema - Edema, a swelling in the tissues (like from
heart failure), can limit the ability of oxygen present in
the blood to adequately reach the tissues.
B-Ischemic hypoxia – Obstruction to the flow of blood
carrying oxygen, like from a clot in a coronary artery (a
heart attack), can prevent the tissues from receiving
oxygen.
4-Histotoxic ( histologic ) hypoxia :
Is due to inhibition of tissue oxidative process
(
phosphorylation ) , in this case the o2 reaching the cells
normally , But the cells are unable to use o2 effectively.
Cause of histotoxichypoxia :
It’s common cause is cyanide poisoning.
Stages of Hypoxia:
1. Indifferent
At the beginning, the person may not know there is a
problem.
The first effect is the depression of the function of the
eye to adapt to dark and color. This can happen at an
altitude as low as 5,000 feet.
2. Compensatory
The respiration rate, heart rate, blood pressure, and
cardiac output can rise.
3. Disturbance
It’s Obvious symptoms begin.
These are different for each person
(i.e :numbness, tingling, ….etc).
4. Critical
Loss of consciousness.
What are the symptoms of Hypoxia?
You may not even recognize the symptoms of hypoxia
, because It depend on its severity and acceleration of
onset.
- In the case of altitude sickness :
where hypoxia develops gradually, the symptoms
include: headaches, fatigue, shortness of breath, feeling
of euphoria and nausea.
- In severe hypoxia :
changes in levels of consciousness, seizures ,coma
priapism and death occur.
Severe hypoxia induces a blue discoloration of the skin,
called cyanosis.
The signs and symptoms can be different for every
person and may not occur in the same progression
therefore, it is important to be aware of all the signs and
symptoms as listed below.
Signs:

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Rapid Breathing
Cyanosis (Because hemoglobin is a darker red when it is
not bound to oxygen (deoxyhaemoglobin), as opposed
to the rich red color that it has when bound to oxygen
(oxyhaemoglobin), when seen through the skin it has an
increased tendency to reflect blue light back to the eye)
Poor Coordination
Lethargy/Lassitude
Executing Poor Judgment
Symptoms:

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Air Hunger
Dizziness
Headache
Mental and Muscle Fatigue
Nausea
Hot and Cold Flashes

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
Tingling
Visual Impairment
Euphoria
What do you think the appropriate action that
taken before you start in treatment ?
mesurment of hypoxia :
If someone is suffering from this condition, it is very
important to"
1-assist breathing
2- monitor the blood pressure + heart rate
3- put cold blanket to slow down activity of the brain
and decrease need of o2
Test"Workup :
A history and physical exam will be performed. Tests will
be done to determine the cause of the low oxygen level
and its severity.
For example, a chest x-ray, oxygen saturation level
and/or an arterial blood gas may be measured.
Tests:
Complete blood count (CBC), Comprehensive metabolic
panel (CMP), X-ray.
Additional tests that may be required :
Blood cultures, urine culture if the type is histotoxic
hypoxia.
Treatment :
The treatment of hypoxia will depend upon the
underlying cause. While you and your doctor are
working together to determine the cause, The most
immediate priorities are to reverse the cause of hypoxia
and to administer enough oxygen to increase blood
levels out of a dangerous range. Oxygen may be
provided with a nasal cannula, face mask, or a ventilator
if severe.
Treatment of hypoxia :
1- oxygen therapy
if you are short of breath or having other symptoms
suggestive of moderate or severe hypoxia
2-mechanical ventilation
If your symptoms are severe
3- invasive ventilation
1-oxygen therapy
benefits :
1-an increase in survival rates in patients who use
oxygen more than 15 hours a day
2-supplemental oxygen improves sleep, mood, mental
alertness and stamina and allows individuals to carry out
normal, everyday functions.
2- mechanical ventilation
Mechanical ventilation is life-supporting ventilation that
involves the use of a machine called a ventilator, or
respirator.
Goal :
support breathing when a COPD patient is no longer
able to do so effectively on their own. Mechanical
ventilation is generally the last resort when a patient is
having difficulty breathing and cannot maintain
adequate oxygenation.
Procedure:
When a patient requires mechanical ventilation, a tube
is inserted into the throat by a process
called intubation. The tube extends down the trachea
and into the lungs and is connected to outside plastic
tubing that hooks up to the ventilator.
If you are having difficulty breathing, and medications or
other treatment options aren't working, your doctor
may initially try non-invasive ventilation to help you
breathe better. If this fails, then mechanical ventilation
may be necessary to sustain your life.
3- invasive ventilator
Noninvasive ventilation, such as CPAP or BiPAP, is an
alternative to invasive, mechanical ventilation for
patients who have chronic respiratory insufficiency
or respiratory failure and can no longer breathe
adequately on their own.
benefits :
1- It enhances the breathing process by giving the
patient a mixture of air and oxygen from a flow
generator through a tightly fitted facial or nasal mask
2- It enhances the breathing process by giving the
patient a mixture of air and oxygen from a flow
generator through a tightly fitted facial or nasal mask
3-Also known as Noninvasive Positive Pressure
Ventilation (NIPPV), noninvasive ventilation assists the
patient in taking a full breath and helps to maintain an
adequate oxygen supply to the body.
N.B: Noninvasive ventilation is not appropriate for every
patient and is not always successful. Only your doctor
can determine if you are a candidate for noninvasive
ventilation.
Treatment according to type :
1- ischemic hypoxia:
Following initial resuscitation and stabilization,
treatment of hypoxic-ischemic encephalopathy (HIE) is
largely supportive and should focus on adequate
ventilation and perfusion, careful fluid management,
avoidance of hypoglycemia and hyperglycemia and
treatment of seizures.
Treatment depends on the underlying cause of the condition, as well as the
severity of the damage to the brain. Treatment options include:

Life-sustaining treatment-If brain function has stopped but damage is not yet
extensive, life-sustaining treatment is administered.

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Mechanical ventilation-This may be needed to sustain breathing.
Treatments for the circulatory system-Treatments are administered to maintain
heart function and control blood pressure.
Seizure control-Medicine and general anesthesia may be administered to control
seizures.
Cooling-Hypoxic brain damage is often caused by heat. Cooling blankets or other
means of cooling may be applied to reduce the body's temperature.
Hyperbaric oxygen treatment-This treatment is used in cases of carbon
monoxide poisoning.
2-histotoxic hypoxia:
Hyperbaric oxygen (HBO2) significantly increases the
oxygen diffusion driving force, thus increasing oxygen
availability to tissues. This helps to correct negative
effects of histotoxic hypoxia and restore normal tissue
oxygenation.
Hyperbaric oxygen is 100% pure oxygen used as a drug
under increased atmospheric pressure maintained
inside a sealed Hyperbaric Chamber.
3-animic hypoxia
When a patient demonstrates signs of anemic hypoxia,
or any form of oxygen deprivation, medical providers
may administer oxygen and take other measures to
immediately stabilize the patient. They also collect a
medical history and conduct tests to find out why the
patient isn’t getting enough oxygen. This information
can help them determine on the best course
oftreatment.
For example, if the patient has a bone marrow disease
that is destroying red blood cells and limiting the
oxygen-carrying capacity of the blood, that disease
needs to be treated or controlled to resolve
the anemic hypoxia.
Patients may need transfusions as well as
othertreatment to address the underlying cause of the
anemia
. A simple, inexpensive, disposable plastic mask for controlled lowconcentration oxygen inhalation has been developed. An inspired oxygen
concentration of about 24% is obtained with an oxygen flow rate of 1.5 to
2 liter/min through a Venturi device, with negligible rebreathing of
carbon dioxide (mean FICO2, 0.7%) under the mask. In 68 patients the
mask raised the arterial oxygen tension by a mean of 34 mm Hg,
whatever the clinical diagnosis or initial Pao2. The mean rise in Paco2, in
patients with hypercapnia, eucapnia, or hypocapnia did not exceed 3 mm
Hg during low oxygen inhalation with the new mask. The mask is an
economical and well-tolerated method of short- or long-term low oxygen
therapy in patients with hypoxemia of varied causes.
References
http://www.authorstream.com/Presentation/
randhawakiran23-1122518-hypoxia/
http://www.authorstream.com/Presentation/randhawakiran23
-1122518-hypoxia/
http://en.wikipedia.org/wiki/Hypoxia_(medical)
http://advancingthescience.mayo.edu/hypobaric-hypoxia/
http://www.avweb.com/news/aeromed/181893-1.html
http://www.normalbreathing.com/d/hypoxemia.php#.UTOGgz
Aty9E
http://www.youtube.com/watch?v=9DsOaMEICgg&playnext=1
&list=PLBE00088BA35D192F&feature=results_video
http://www.youtube.com/watch?v=4wQGNMGdvzs
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