hi engineers 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 hypoxia or the late stages of hypoxia and then we'll go over the types of hypoxia so first thing I said I want to discuss is what is the definition of hypoxia and we already defined hypoxia to keep it as simple as possible hypoxia is low oxygen delivery or inadequate so we can put 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're having abundant supply of oxygen to the brain as well as the heart those are very vital organs and 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 inadequate we can put a parenthesis around inadequate so low or inadequate oxygen delivery to the tissue issues 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 hypoxia So within the early stages of hypoxia so let's say well how would you determine if someone's in the early stages of hypoxia so in the early stages of hypoxia you can remember uh this little pneumonic it goes rat okay so you can remember rat and what does this stand for R 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 T is for two things so there's two T's in this right so one is actually going to be Tachi cardia so one's going to be T cardia and the other one's going to be tpia the other one's going to be tpia how would you define tpia teyia is basically an acceler at respiration process that's all it is so dpia is an accelerated respiration now the next thing I want you guys to understand and how would you differentiate because sometimes people can um confuse Topia with hyperventilation or hyperpnea hyperventilation let me Define this for you so that way we don't 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 hyper is an increase in the depth and 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 their blood chemistry and teyia is defined as accelerated respiration okay and then Tac cardia how would you define Tac cardia 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 you're going you're going to remember rat okay and if you remember the two T's of forac cardi and Topia what about the late stages when it's actually really bad what about the late stages of this hypoxia so some of the signs and again what are 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 C remember bed c b is going to be for specifically so whenever you look at this one B is going to be for bradicardia Brad cardia oh you might be like whoa what the heck their heart rate was eventually above 100 beats per minute and then it switched to a decreased heart rate to where the heart rate is now less than what 60 beats per minute okay and then e is for extreme restlessness so this is for extreme restlessness all right so the D is for disia 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 for this is the bad one when you recognize this is when you make you need to make sure that you uh 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 The Skin right so it's a bluish cast of the skin that means that there's not enough oxygen delivery to the tissues so again hypoxia how would you define it low inadequate oxygen delivery to the tissues the early signs is going to be remember rat so restlessness anxiety tacac cardia and tnia and then remember the late signs of hypoxia which you want to try to make sure that you treat the issue as soon as possible is going to be brat cardia whenever the heart rate is less than 60 beats per minute when they have extreme restlessness they have disia what is disia disia 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 the four types of epoxy first let's list off the 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 hypoxic hypoxic hypoxia we're going to talk about another one which is called esic you know what's called esic and they even call it stagnant so they can call it es schic hypoxia or stagnant hypoxia and then there's the third one which 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 hyox Hyo actually hysto toxic hypoxia histotoxic 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 the hypoxemic hypoxia all the rest of them are generally pretty easy but we're going to start off with the hypoxic hypoxia it'll make all the rest of these a lot easier so first thing I want you guys to remember about hypoxemic hypoxia is there's three things that you're going to see in hypoxemic hypoxia three things so what are those three things that you'll actually see in hypoxemic hypoxia so in this they you know they can also call hypoxic hypoxia they call hypoxemia so we can also refer to it as high poemia 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 profusion 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 disorders and restrictive pulmonary disorders and another thing that can actually cause hypoxemia besides the ventilation profusion coupling and the pulmonary diseases any situation in which there is very little oxygen within the atmosphere and that specific situation is at high altitudes so when you're at high altitudes so again three situations that you would actually become apparent with hypoxemia that causes it is any type of situation altering the ventilation profusion coupling any situation like a pulmonary disease like 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 hypoxic hypoxia well when you're at CA level when you're at sea level generally the pressure the barometric pressure so the pressure of the atmosphere is approximately equal to about 760 millimet of mercury and out of that 760 millim of Mercury 21% of it is going to be the pressure of oxygen so whenever you do this you take 21% of this 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 ATM 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 millimet of mercury so let's just suppose um that whenever you're at high altitudes you're you're hikk in Mount 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 millim 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 100 millimet of mercury so it's about a 100 millime of mercury so it's about 104 actually 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 100 is a 60 millim curve 120 to 100 is a 20 mm curve this is going to have very little oxygen so the amount of oxygen getting down here into the alvioli 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 lower not as much oxygen is going to be coming into the alvioli and just imagine if this even drops below 100 then very little air will be coming in at all so again to recap this part here whenever the partial pressure of oxygen in the atmosphere is less than 160 millim of mercury and it drops down significantly it decreases the actual movement of oxygen from the atmosphere into the alveoli which is is eventually going to cause a decrease in the partial pressure of oxygen and this could actually lead to problems and the reason why is we'll discuss it in that diagram over there if the partial pressure of oxygen is very very low here then what's going to happen to the actual exchange process with 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 if this sucker drops really really low depending upon high how High the elevation is to where it drops below 100 millim of mercury let's just suppose 80 millim of mercury what's the partial pressure of oxygen in the aviola going to be it's going to be 80 millimeters of mercury and that's going to cause less oxygen to be delivered into the tissues and that can lead to hypoxemia okay what about uh certain pulmonary diseases so you know a chronic obstructive pulmonary disorder um you know they actually classify asthma to be one of those types and and they also there's actually chronic bronchitis and empyema so in certain situations let's say that we take the let's say that we take chronic bronchitis and so in chronic bronchitis there's an excessive amount of mucus production and look what it's doing to these actual bronchials it's decreasing the amount of air that's getting into this bronchial if you decrease the amount of air getting into these bronchials what's going to happen to the ventilation within this alveoli it's going to decrease so what happens to 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 well how would asthma cause this you know asthma is basically generalized and widespread Bronco constriction so if I constrict the bronchite if I have an excessive constriction of the bronchi what's going to happen to the air going to the alvioli 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 asthmatic attack and I have severe Broncos spasms and those bronos spasms are constricting the actual bronchi and decreasing the amount of air going to the alvioli what's going to happen to the part paral pressure of oxygen it's going to decrease okay what about uh another pulmonary disease we said inma what is empyema classified how would you classify empyema empyema is basically a situation in which you know how we have our normal alvioli here let's say that I draw a general diagram of the alvioli so let's say here's the alvioli 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 them you know that you're going to have a lot of blood vessels right here's going to be a lot of blood vessels and what happens in osma is your neutrophils start producing excessive amounts of elasti because remember there's an alpha 1 antirion deficiency and what starts happening it starts breaking up the actual sepal 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 though it's not a problem with this because you know empyema generally these people have a normal partial pressure of oxygen generally so in this situation empyema they can have a normal we shouldn't put increase we should have a normal they can have a normal partial pressure of oxygen and that partial pressure of oxygen can be about 100 millimeters of Mercury and again if you want to be specific it could 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 is this condition this is called osma and an osma 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 there'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 um one more pulmonary disease um okay let's say that for some situation you have um okay you get stabbed and there's some type of situation where the actual atmospheric pressure okay the atmosphere air is exposed into this actual plural 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 millimet of mercury what is the partial pressure in the actual plural cavity do you guys remember the partial pressure I'm sorry the pressure within the inter plural cavity was approximately 756 or we said4 if you guys remember right but in either way it's a less pressure so where's air going to want to move it's going to want to move into this actual plural cavity what do we say that would do over time look at this let's say I eras 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 equilibri with the atmosphere and if it equilibri with the atmosphere and it actually Rises up to the point of 760 or even maybe above 760 millimet Mercury what's it going to start doing it's going to start pushing on the lungs as it starts 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 alviola that I'm compressing I'm going to be decreasing the actual what am I going to do I'm going be collapsing the avoli so whenever I have an increased int plural pressure whether or be to air leaking in what does that call when air leaks into the actual plural cavity what do you call that you call this a numo thorax so in some situation in which there's actually air you can develop a num numo thorax you know there's other situations besides air if there's actually a rupture of the the blood vessels within this area and the blood accumulates within this actual in plural space what do they call that when blood's accumulating they call that a hemothorax and there's even more if you actually have uh 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 thorax 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 to the alveoli it's going to collapse the alveoli if this let's imagine here's this alveoli it was previously inflated but then because of the numo thorax or the hemothorax or the kylo thorax it collapses so now look at it look at it it collapsed the balloon popped 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's 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 this situation because of the increased pressure because of the numo thorax or hemothorax or chylothorax 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 will be no exchange if there is no exchange that's occurring between these the actual um the alveoli and the actual ponary capillary blood what is that called it's called shunting so this is an example of shunting so this is an example of shunting okay so I want you guys to understand again one more time if you have have chronic bronchitis it's going to impede the actual air flow decrease the partial pressure of oxygen also with asthma it's you're going to cause WID spread and generalized Bronco constriction which will decrease the air getting into the alvioli that'll also cause a decrease in the partial pressure of oxygen if you're at high altitudes the partial pressure of oxygen in the atmosphere is going to be a lot lower it can actually drop below 160 and if it gets really really low below 100 let's say suppose we said 80 mm 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 millim 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 an osma in osma there's a decrease in surface area due to the breaking down of the elastic fibers in 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 this also if you have pneumonia 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 osma affect the actual exchange process but what other two conditions can pulmonary edema as well as we said pneumonia and pneumonia can actually cre produce a pyothorax which is really nasty it's puss that accumulates within this cavity too which can also compress and that was the last thing 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 it 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 hypo what is this again what was this first one that we talked about mainly hypoxemic hypoxia how this is actually occurring be due to any type of ventilation profusion coupling M 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 t11 and the C3 through C5 nerve roots that are supplying the actual diaphragm the external neosales if they are damaged that can also produce this actual hypoxic 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 hypoxic hypoxia 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 esic so let's go over to this big diagram okay so now again in hypoxic hypoxia 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 uh this color here this dood 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 so there'll be a decrease in exchange of gases and this was by osma or pneumonia or even what else do we say we also said due to pulmonary Emon maybe due to congestive heart failure and this decreased partial pressure of oxygen could have been due to chronic bronchitis could have been due to asthma 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 this I'm just picking a number let's say that the partial pressure of oxygen in the alveoli equals 60 mm 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 mm Mercury and then when it's moving through the actual capillary blood what happens it should have its exchange process and whenever there's exchange process between what the actual alveoli in the blood oxygen will move down its concentration gradient until the actual partial pressure in the pulmonary capillary blood equals the partial pressure in the alvioli which is 60 so when it leaves it should leave at partial pressure of oxygen is equal to 60 mm 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 it the normal one so we can compare usually it's about 100 millim of mercury so this is normal this is abnormal okay we'll put AB all right so that's what I want you guys to get whether it be due to some decreased partial pressure of oxygen in the alv DU 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 freaked 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 ox is 100 mm of mercury they're they're rolling okay they're coming and they're 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 100 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 atherosclerotic plaques or th throm by that is accumulating in this area and he has all of this actual plaque an 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 a big Max and Quarter Pounders what's going to happen very little blood is going to get by if 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 is hemoglobin 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 is that called hypoxia so again in this uation the oxygen delivery to the tissues is actually going to decrease so there's going to be a decreased oxygen delivery okay so again one more time with this one what is this one called here so that we write this one down this one here is the second one that we talked about this is called es schic hypoxia and again what is another name for it just in case you can call it stagnant hypoxia okay so again in this situation there's a thrombus or an embolis or something like that that is 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 here very little red blood cells in the vicinity in capillary okay I'm not talking about anema anemia 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 coming to the area so it's a decrease oxygen delivery and that results in hypoxia wo all right what about what else you know there's another situation same guy you know he's been uh putting down the Big Mac like it's going out of style and the Double Quarter Pounders which chees those are so delicious but anyway we come back to this and he's he's look what 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 this is the left ventricle here right because if if this is the left ventricle this would be the right ventricle okay and this is the right atrium and this is the left atrium this is the aorta right so in congestive heart failure what happens there actual cardiac output decreases what is cardiac output cardiac output is defined as the heart rate multiplied by the stroke volume right so there if they have a decrease in cardiac output then they're not going to have a lot of vol volume of blood coming to this area so what happens to the volume of blood being distributed if there what's normal cardiac output so cardiac outputs normal is about five lers okay so 5 lers per minute their cardiac output is actually going to be less than this so they'll have less than 5 lers 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 then is it 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 that mean there's not going to be a lot of red blood cells doesn't that mean that there's not going to be a lot of oxygen delivery and doesn't that mean that they'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 aeic hypoxia and again this is due to more of a stagnant because it's going to have a very slow flow you're not going to have a lot of blood coming to this actual area very very little blood coming to this area Okay okay so again what have we talked about so far so far we've done hyp what was this one here guys this one up here that we discussed was the first one this was called hyp oxic hypoxia and then we've talked about es schic hypoxia or we've talked about we can call it stagna epoxy which due to 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 come into the area very little oxygen delivery and 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 is going to be called [Music] anemic hypoxia so an anemic hypoxia it's very simple it's honestly very simple we've already had a video on anemas 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 myoid stem cell so we'll put Ms C and if you guys remember the myoid stem cell was dividing right it was forming a lymphoid stem cell and then a myoid stem cell so we had specifically the um actually you should call this not a myoid stem cell you should call this actually a plur potent stem cell the hemocytoblast and it was actually dividing and forming lymphoid stem cells and myoid stem cells and the myoid 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 red blood cells uh certain types of anemia this could be maybe in certain situations when there's very little red blood cells being produced maybe a plastic anemia could be due to a plastic anemia another thing that could actually cause decreased red blood cells to actually be present besides a plastic anemia is actually them getting liced and if they're getting liced 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 isn't normal amount of hemoglobin inside of the red blood cells so let's say that it's not just specifically the actual low 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 um could be due to a specific situation like microtic anemia 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 even be due to phemia and it can even be due to sickle cell anemia so you guys should get the point right so it again in certain situations in which there is anemia whether it be due to very little red blood cells being produced in which there's an aplastic anemia in other words if you guys remember there's damage to the myoid 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 spherocytosis or G6 pdh 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 phemia or celmia 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 250 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 time 4 1 billion 1 billion oxygen molecules for for what for one red blood cell isn't that 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 the number of red blood cells or a decrease in the actual I'm sorry not a decrease in hemoglobin or yeah decrease in hemoglobin or abnormal hemoglobin it could significantly affect the amount of oxygen molecules that 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'm going to 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 decrease 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 eske hypoxia and then we talked about this third one which was anemic hypoxia which could be due to a decrease in the 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 dysemia and CLE cell so in Thal and CLE 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 that we need to talk about and I want to 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 is called histotoxic hypoxia so again the last one is called hsto toxic hypoxia so this one is re it's really interesting you could have a normal partial pressure of oxygen all day you could have greater than 100 press pressure of oxygen 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 you know 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 CN negative is cyanide for whatever reason they they have they get poisoned with cyanide cyanide affects a 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 chain if you guys remember from our uh electron transport chain video it's C 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 isn't utilized can you produce ATP in this cell no and the ATP levels plummet same thing with this one ATP levels plummet and same thing with this one ATP levels will plumm it okay so even though you have abundant you could have abundant amounts of oxygen but it would not matter because their cytochrome oxidases being inhibited by the cyanide it's binding to it very strongly and preventing the electrons from being added onto oxygen so it's not being utilized and 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 are the what I told you two main tissues 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 a esia 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 neurons are amitotic if they're damaged they AR coming back heart 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 would be able to treat these patients because it's not all the same you could probably just say oh give them supplemental oxygen it's not going to work for all of them one last thing I wanted to mention I forgot to talk about was the shunting thing right I talked about it here whenever there's complete lung collapse there's one more thing and it's it's it's unfortunate it's in a condition called um tardive cyanosis okay they call it tardive cyanosis okay and in of cyanosis what happens is the it's it's a con heart disease and in the congenital heart disease the the ventricles the sepal 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 ventricle 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 oxygen and blood very high 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 uh Atrium to which actually going to be oxygen delivered 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 right side of the heart's going to have to pump a lot harder so it pumps a lot harder and actually what happens is eventually it hypertrophies and whenever a muscle like this hypertrophies so if this muscle right here has consistent contractions it will hypertrophy hypertrophy and whenever this muscle hypertrophy is eventually actually 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 happened to the normal let's pretend that here inside of this actual left ventricle the partial pressure of oxygen is 100 millimeters of mercury and some of this deoxygenated blood comes over here and over time when it leaves and goes out to the systemic circulation it actually drops down let's suppose to about um 80 mm of so again in this situation in which the partial pressure of oxygen is actually decreased ining 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 then the partial pressure of oxygen is actually going to decrease and what's it called 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 spend a lot of time on it it's whenever you have carbon monoxide poisoning carbon monoxide poisoning is actually a situation very deadly happens a lot when there's fires um but in situations like that carbon oxide poisoning is actually specifically considered to be a unique type of hypoxic hypoxia and what it does is is if I had the hemoglobin right here here's my hemoglobin and you know 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 carbon oxide poisoning you could actually have this bind onto 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 to bind and hemoglobin is delivering this carbon monoxide and it can actually produce a very dangerous hypox because you wouldn't even know that you're actually having carbon monoxide poisoning okay you would just develop some type of U you turn cherry red you'd have like a disorientation be a little bit confused but 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 give them exceedingly amounts of oxygen it can competitively outbeat the carbon oxide and whenever it actually competitively out beats the carbon oxide it can then rebind okay okay how do you treat people with hypoxemic hypoxia well in 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 chemo receptors um es schic or stagnant hypoxia well if they have this condition over here let's come over here really quickly if they have es schic hypoxia what are you going to want to do give them some type of uh uh basically a a clot busting drug so give them tissue plasminogen activate or give them warin or give them um 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 warin or whether it even be surgery to remove the clot what about congestive heart failure in 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 dioxin and dioxin is going to try to stimulate the actual inotropic agent increase the contractility of the heart 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 it can be the the difference between life and death in these patients okay what about histotoxic hypoxia whenever you have cide poisoning 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 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 thos sulfate 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 and these individuals in anemic hypoxia they could have normal partial pressure of oxygen um but again you have to treat the anemia so in this type of situation you might have to do blood transfusions depending upon what type of anemia 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 it 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 all right engineer so in this video we talked talked about the different types of hypoxia 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 I you 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 in the comment section as always Ninja nerds until next time