Pulmonowski Cases: High Altitude, Premature Birth, Upper Respiratory Infection
Explore three intriguing medical cases involving high altitude effects, premature birth complications, and upper respiratory infections. Dive into the physiological responses and treatments for each scenario, from respiratory alkalosis to surfactant deficiency and bronchoconstriction. Discover the impact on vital signs, oxygen saturation, and more in these detailed case studies.
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Presentation Transcript
Case 1: Paul Pulmonowski The Case of the Climbing Expedition High Altitude Decreased Atmospheric Pressure Decreased Hemoglobin Saturation Decreased Atmospheric PO2 Increased production of 2,3-BPG in RBCs Shift in O2-hemoglobin dissociation curve to the right Increased P50 Decreased Alveolar PO2 Decreased O2 to vascular smooth muscle Hypoxic vasoconstriction Decreased Arterial PO2 Increased pulmonary vascular resistance Increased mean pulmonary arterial pressure Stimulation of peripheral chemoreceptors in carotid and aortic bodies Increased synthesis of EPO by kidneys Increased hematocrit Increased synthesis of RBCs by bone marrow Increased viscosity of blood Stimulation of medullary inspiratory center Hyperventilation (tachypnea) Increased expiration of CO2 Decreased Arterial PCO2 Shift from H+ and Bicarbonate to CO2 Increased blood pH Respiratory Alkalosis Fun Fact: Leadville, Colorado is the tallest city in the US at 10,200 ft above sea level
Case 2: Penelope Pulmonowski The Case of the Premature Birth Premature birth Lack of surfactant by type II alveolar cells Increased alveolar surface tension Increased collapsing pressure Crackling sounds can be heard during inspiration Collapse of alveoli (atelectasis) Inward pull of intercostal muscles Decreased air pressure in lung Mild intercostal retraction Decreased V/Q ratio (due to right-to-left shunt) Decreased Alveolar PO2 Decreased Arterial PO2 Decreased Oxygen saturation Stimulation of peripheral chemoreceptors in carotid and aortic bodies Penelope s Vital Signs: Pulse: 130 (0m); 140 (60m) RR: 50 (0m); 75 (60m) SBP: 55 (0m); 64 (60m) DBP: 30 (0m); 42 (60m) Normal Vital Signs for Newborns: Pulse: 120-160 RR: 40-60 SBP: 60-85 DBP: 45-55 Stimulation of medullary inspiratory center Hyperventilation (tachypnea) Sad Fact: JFK had a son (Patrick Kennedy) who died from Respiratory Distress Syndrome
Case 3: Patrick Pulmonowski The Case of The Upper Respiratory Infection Asthma Inflammation Upper respiratory infection Fever Increased mucus secretion Inflammation Bronchoconstriction Increased mucus secretion Inspiratory and expiratory wheezes Increased air velocity and turbulence Increased airway resistance Bronchoconstriction Decreased air flow Decreased FEV1/FVC ratio Low V/Q ratio (V/Q mismatch) Albuterol = B2 adrenergic agonist Decreased Oxygen saturation Bronchodilation Decreased Arterial PO2 Decreased airway resistance Decreased peripheral perfusion Stimulation of peripheral chemoreceptors in carotid and aortic bodies Increased air flow Sympathetic response Increased FEV1/FVC ratio Stimulation of medullary inspiratory center Increased heart rate (tachycardia) Some bronchodilation that can t compensate Hyperventilation (tachypnea) Increased expiration of CO2 Decreased Arterial PCO2 Shift from H+ and Bicarbonate to CO2 Increased blood pH Respiratory Alkalosis Sad Fact: Theodore Roosevelt suffered from debilitating asthma in his youth
Case 4: Preston Pulmonowski The Case of the Gas-Powered Generator Generator pumping out carbon monoxide Increased carbon monoxide in apartment Inhalation of carbon monoxide Mistakenly high oxygen saturation Binding of carbon monoxide to hemoglobin Increased carboxyhemoglobin Cherry red skin Bright red blood color Decreased binding of oxygen to hemoglobin Shift of oxygen-hemoglobin dissociation curve to the left Decreased P50 Decreased release of hemoglobin to tissues Lack of cerebral perfusion Hypoxemia Altered Mental State Hypoxia Increased respiratory rate (tachypnea) Treatment with 100% oxygen Increased arterial pressure of oxygen Fun Fact #1: Carbon monoxide is used to color meat in order to keep meat looking red and fresh Fun Fact #2: The process is banned in Japan, Singapore, and the European Union
