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a change in one of the variables that describes a system at equilbirum produces a shift in the position of the equilibrium that counteracts the effect of the changeLe-chatlier'sdisociation constant equationK= ([B]*[H+])/[BH+]can accept or donate H+ (Property name)amphoteric (water)acidic drugs donate a proton and become?charged and unprotonatedbasic drugs accept a proton and becomecharged and protonatedthe _____ of a drug determine the protonation state in a given pHpKdefined by the pH of the environment at which 50% drug is charged (ionized) and 50% is uncharged (unionized)pK of a drugif high H+ concentration, then the ability of a drug to release H+ is _____ and more of the drug will be in the _____ formif high H+ concentration, then the ability of a drug to release H+ is *poor* and more of the drug will be in the *protonated* formwhat form of LA diffuses easily through nerveB
unprotonated, uncharged, basereflects the onset of anesthesia% of drug in base form (determined by pKa)form of LA responsible for action inside nerveBH+
protonated, charged, conjugate acidfor LAs, pK correlates to what functional property of the drugtime of onsetare LAs tertiary amines?yes, not quant ammoniumsester HC chain-CO-amide HC chain-NH-relationship b/t CO2, H2CO3 (carbonic acid), HCO3-(bicarb), pH, and pKCO2 hydration reactionCO2 hydration reaction catalyzed bycarbonic anhydrasepK of the HCO3-/H2CO3 buffer system6.1How do you estimate H2CO3PCO2*0.03examples of strong acids (SA-)keto acids, lactic acid, metabolic waste products3 categories of body buffers (broad)chemical, respiration, renalbuffer system that can return pH to near normal even in presence of pathologyrenalmost important ECF bufferHCO3-most important ICF bufferproteins (lots of (-) binding sites)what kind of disorder primarily effect PaCO2respiratorywhat kind of disorder primarily effects HCO3-renal5 important body fluid buffers1. bicarb (H2CO3/HCO3-)
2. Hgb (HHb/Hb-)
3. plasma/intracellular proteins (PrH/Pr-)
4. phosphates (H2po4-/HPO42-) (HPO42-/PO43-)
5. ammonia (NH3/NH4+)pulmonary acid-base compensation mediated by whatchemoreceptorsdoes pulmonary compensation restore pH to normal by itself?NO- Neverkidneys respond to acidemia in these 3 ways1. increased reabsorption of filtered HCO3-
2. increased excretion of titratable acids
3. increased production of ammoniamaximum renal compensation can take up to how long5 days for max responseequation for anion gapanion gap= Na - (Cl + HCO3)anion gap does not measure whatSC+, A-, SAA-
A-: proteins, PO43-
SAA-: organic acid anions, SO42-
SC+: K+, Ca2+, Mg2+defined as the concetration of ions not measuredanion gapdoes an anion gap actually exsist?no, due to requirements for electroneutrality; "gap" is in what isn't measurednormal anion gap8-16mEq/Lhgb, plasma and intracellular proteins, and phosphate are all whatweak anions (A-)anion gap is ______ proportional to the sum of the [weak acid] and the [strong acid anion]anion gap is *directly* proportional to the sum of the [weak acid] and the [strong acid anion]AG can help determine whatorigin of acidosisin metabolic/ organic acidosis _____ increases, ______ decreases, and the anion gap _______in organic acidosis *SA-* increases, *HCO3-* decreases, and the anion gap *increases*in renal dysfunction acidosis, AG _______in renal dysfunction acidosis, AG *does not change*
loss of bicarb is balanced with Cl- retention, so AG doesnt changethe ____ the IMF the greater the surface tension forcesthe *greater* the IMF the greater the surface tension forcesa soap/detergent that has polar and nonpolar regions is calledamphipathicterms used to express the concentration of gas in a liquid (2)pressure and tensioncreated at the interface b/t a liquid and a gas where the liquid molecules are pulled together by intermolecular (cohesive) forcessurface tensiondefines the pressure gradient across the wall of a sphere (or cyclinder) which are related to wall tension (surface tension) and radiuslaw of LaPlacesurfactant _____ surface tension*decreases*law of LaPlace applied to a cylinder: tension is defined as the internal force generated by a structure. What is the equation?T= P*r
tension= pressure * radius
applications:
-blood vessels (ANEURYSMS)
-L Vetricle (DILATED HEART CHAMBER)law of LaPlace applied to spherically shaped structures: tension is defined as the internal force generated by a structure. Give the equationT=(Pxr)/2 OR *P=2T/r*
*pressure is inversely related to radius
applications
1: normal alveoli (lung elastic recoil and WOB)
2: surfactant deficient alveoli (Pel and WOB)define LaPlace's law in terms for alveolar applicationP=2T/r
P= pressure inside the sphere
T= tension in wall of sphere (surface tension)
r= radius of sphere
surface tension "T" is constant for spheres of similar composition, so we can say that P is inversely related to resistance in the alveoli (without surfactant)(without surfactant)
if the radius is ____, then according to LaPlace's Law, the pressure w/n the sphere is ______if the radius is *small*, then according to LaPlace's Law, the pressure w/n the sphere is *increased*
why would this be a problem?
-small alveoli would dump into large
this equation doesnt factor in surfactant!_____ equalizes the pressure inside the alveoli of different sizes, thereby stabilizing them*surfactant* equalizes the pressure inside the alveoli of different sizes, thereby stabilizing them
-surfactant changes the surface tension proportional to the radius thereby reducing surface tension more in small alveoli than large alveolisurfactant reduces WOB by ____ the compliance of the lung and _____ alveolar collapsesurfactant reduces WOB by *increasing* the compliance of the lung and *preventing* alveolar collapsesurfactant reduces surface tension more in what size alveoli (due to density)smaller alveoli (at baseline are higher resistance, so need more reduction in surface tension)
-this equalizes the pressure w/n small and large alveoli
-surfactant has the ability to reduce surface tension based on surface area1% lidocaine is how many mg10mg/mL (move decimal right 1)2mg/mL tetracaine is what % concentration0.2% tetracaine
(move decimal L one place)
% concentration is g/100mLepi 1:1000 means?1,000,000mcg epi in 1000mL
-so divide desired epi concentration into 1,000,000index that quantifies the metabolic acidosis; defined as the amount of strong acid (in mmol/L) that needs to be added in vitro to 1L of fully oxygenated blod in order to return the sample to standard conditions (pH 7.4, PCO2 40, and T 37C)base excess
-can be used to predict severity of hypovolemic shock and consequent metabolic acidosisbase excess equationcalculated [HCO3-]- 24mEq (normal bicarb)
-sum of weak acid (buffer) anions in plasma: includes hgb, plasma proteins, phosphate, and bicabnormal base excess range-2 to +2 mmol/LIf base excess is -2 that means...there is a decrease of base or accumulation of acid found in blood
(need more base)when recording electrodes are perpendicular to the direction depolarization (or MEA), what will the potential difference be?0: no deflectionthe most parallel recording electrode to the MEA will show what?greatest maximal upward deflectionmagnitude of the de/repolarization vector depends on the ________ depolarizingmagnitude of the de/repolarization vector depends on the *proportion of tissue* depolarizingthe direction of the de/repolarization vector depends on what two things1: orientation of the tissue in the body
2: direction of depolarization
these two combined with the position of the recording electrodes determine the height of the voltage on the EKGAVR stands foraugmented voltage rightAnterior chest leads
& coronary supplyV1-V4
supplied by LADLateral leads & coronary supplyI, aVL, V5, V6
supplied by L circumflexInferior leads & coronary supplyII, III, aVF
supplied by RCANormal axis degrees & what QRS looks like in leads I and II (or aVF)-30 to +90
I and II positive deflectionLeft axis deviation degrees & what QRS looks like in leads I and II (or aVF); and causes-30 to -90
I: positive deflection
II: negative deflection
causes: normal variant (diaphragm elevation), L ventricular enlargement, Inferior MI, R side tension PneumoRight axis deviation degrees & what QRS looks like in leads I and II (or aVF); and causes+90 to +180
I: negative
II: positive
causes: children (normal), RV enlargement, Lateral MI, L sided pneumoExtreme Axis Deviation degrees & what QRS looks like in leads I and II+180- (-90)
lead I: negative
II: negativeend products of CO2 scrubbercarbonates, H2O (exothermic rxn)chemical reactions of soda lime (3)CO2+H2O--> H2CO3 (carbonic acid)
H2CO3+NaOH--> Na2CO3+H2O+heat
-carbonic acid neutralized by NaOH
Na2CO3+ Ca(OH)2--> CaCO3+NaOH
end products: Ca Carbonate (chalk)and sodium hydroxideIndicator dye for soda lime works howEthyl violet
-physical indicator of absorbent function
-turns PURPLE when pH<10.3Calcium hydroxide container reaction and color indicatorCa(OH)2+ CO2--> CaCO3+H2O
Color indicator turns violet in response to HYDRATION, AND acid/base change (same as soda lime)each CO2 scrubbing canister has a total volume of _____, with ______kg of granules, and can absorb _____L of CO2, and last about _____hourseach CO2 scrubbing canister has a total volume of *1500mL*, with *1-1.3kg* of granules, and can absorb *150L* of CO2, and last about *8-10* hours
note: each 100g of granules absorbs 15L CO2 (15L*1000g granules=150L)
average adult CO2 production ~15L/hrissues with channeling in CO2 scrubber-channel becomes path of least resistance, gas will direct there
-gas will get scrubbed less as it encounters less surface area
-would reflect in pt's ETCO2canister air space types-inter-granule air space: 50% total air space
(in between granules)
-intra-granule space: 8-10%
(through granules themselves)Sevo breaks down best in what cannistersoda lime (4x as much broken down)Sevoflurane breaks down to what and how do we avoid associated issues?compound A: causes renal toxicity
-use at least 2L/min FGFanesthetic with highest CO accumuation in scrubber; prevent how?desflurane
-use low gas flow, change absorbent weekly, shut off flow meters when not in use (maintians hydration and minimizes CO production)measures the CO2 in respiratory gascapnometry
mainstream: in-line measurement/no gas removed
sidestream: aspiration of gas/disposalCO2 measurement techniques (2)infrared light absorption(CO2 absorbs infrared light strongly- 4300nm)
mass spectrometry: does NOT use light, uses characteristics of CO2 moleculeswhat does PaCO2-PETCO2max tell us about?
what should the difference be?ventilation and perfusion
differene should be b/t 3-5mmHg
-in lung disease can be as large as 10mmHg differentan elevated baseline end tidal pleth means whatleaky expiratory valve in the circuit; it won't ever read 0prolonged ETCO2 wave duration means whatleaky inspiratory valvewhat would expiratory resistance look like on an ETCO2 plethmore gradual slope up before maximal CO2 expiration (takes longer to expire alveolar air)we see colors that are reflected or absorbed?reflectedmaterial that reflects all colors of light will be what colorwhitethe law that states: the amount of energy absorbed or transmitted by a solution is proportional to the solution's molar absorptivity and the concentration of solute; can measure how much light is transmitted which is inversely proportional to how much has been absorbedBeer Lambert lawmethod to measure how much a chemical substance absorbs light by measuring the intensity of light passing through a samplespectophotometrymeasure of the quantity of light absorbed by a sampleabsorbancedeoxy hgb absorbs light at what wavelength660nm
red light spectrum (620-750nm); so deoxygenated hgb reflects less red (why venous blood appears blue)factors that impact beer lamberts law-length of tube
-volume of solution/ concentration of substance
-light sourceoxygenated hgb absorbs what wavelength of light940 (infrared)relies on the differences of oxygenated and deoxygenated hgb in absorption of red and infrared wavelengthspulse oximetry
-sense the minute changes in absorption of pulsating blood, and calculates the proportion of oxy to deoxy hgb
-estimates the arteial O2 sat based on ratio of o2hgb to total hgbon the pulse ox pleth, why do peaks occur?-each heart beat increases blood flow to the area- increased blod flow= *increased length* of "tube" and *increased concentration* of solute
which means- MORE light is getting absorbed and this is reflected in the peaksIron in ferric (Fe3+) state, not ferrous (Fe2+) state, cannot carry oxygenmethemoglobinemiaSpO2 of 85%, refractory to treatmentmethemoglobinemiaSpO2 reading in CO poisoningnormal; hgb saturated with CO still absorbs same wavelength of light as oxyhgb, just cant use O2causes of falsely low SpO2 (5)-hypoperfusion
-vasoconstriction
-calloused skkin
-excess movement
-incorrect sensor applicationcauses of falsely high SpO2-CO poisoning
-methemoglobinemia
-hypothermia, sensor movement, bright ambient light
-dark skin3 components of cerebral oximtery1: light source (NIR light)
2: light detector
3: computerfor cerebral oximetry, why do we need a scalp and a brain sensorywe substract the reading of the scalp measurement from the brain sensory measurement to isolate brain oxygenation statusif the scalp sensor is 30mn away from the brain sensor, how deep into the brain is the reading assessing?10mm deep (1/3 of the distance between the two)cerebral oximetry light travels howelliptical pathsin cerebral oximetry if there is no change in baseline is the brain for sure okay?no: not certain there isn't a deeper issue
if there is a change we know for sure there is an issuehow do we calculate the cerebral oxygen saturationcompare SaO2 to SjO2
use arterial: venous ratio 30:70%
result is your SavO2- compare to you SctO2 (cerebral oximeter reading)rSO2 (cerebral/tissue)
pulsatility:
wavelength:
measured component:pulsatility: *NON-pulsatile*
wavelength: *varied # of wavelengths, similar range as pulse ox*
measured component: *arterial, venous, and capillary supply AND demand*Pulse SpO2
pulsatility:
wavelength:
measured component:pulsatility: *pulsatile*
wavelength: *660/940nm*
measured component: *100% arterial supply*when oxygen demand exceeds supply in brain, what happens to rSO2decreases (brain not getting enough O2)
ex: fever, increased CMRO2does cerebral oximetry measure global oxygenation?no just focal, cant assess whole brainnormal SctO2 range60-80%pressure exerted by any fluid at equilbrium due to force of gravityhydrostatic pressureamount of solutes per unit volume of solventconcentration
concentration=amount of solute/amount of solventrelated to the #of ionic charges in solution (moles of ions) and considers that valence charge of each ionequivalentsrefers to the chemical activity of an electrolytemilliequivalenthow to convert mEq/L to mgmEq/L= (mg/dlX10xVALENCE)/ atomic weightcreates a situation where slightly more Na+ and less Cl- exists in plasma than ISFdonnan effect
-proteins are multi-valent, can attract multiple cationsnet diffusion of water across a membraneosmosispressure that must be applied to a solution to prevent net flow of water into itosmotic pressureone mole (GMW) of solute particles dissolved in a solution. Indicator of osmotic activityosmollarge and small particles exert the same osmotic pressure (T/F)trueosmoles/kg solvent =
osmoles/L solventosmolality
normal for adult: 285-295
per L: osmolarityexpression of solute concentration; amount/volumeosmole
#of osmotically active particles(osmoles)/L# moles of solute per L solutionmolar solutionbody is __% water, which is ~___Lbody is *60*% water, which is ~*42L*can use van Hoff's law for whatcalculating osmotic pressure (pi) of a solution1mOsmolar is 1mOsm/L solution, which exerts a pressure of?19.3mmHg
for each 1mOsm concentration gradient of impermeable solute, about 19.3mmHg of osmotic P is generated across the cell membranecells shrinks in this solution:
cells swell in this solution:cells shrinks in this solution: *hypertonic*
cells swell in this solution: *hypotonic*results in the colloid osmotic pressure in the plasma to be about 50% greater than produced by proteins alonedonnan equilibrium effect
*increased colloid P in the blood decreases the loss of fluid from the capillaries4 pressure that determine whether fluid moves in or out of the plams/ISF1: capillary hydrostatic P
2: ISF hydrostatic pressure
3: osmotic force due to ISF protein concentration
4: osmotic force due to plasma protein concentration (this is the only force tending to keep fluid in)plasma volume:
ISF volume:
Intracellular volume:plasma volume: 3L
ISF volume: 11L
Intracellular volume: 28Lwhat compartments will isotonic crystalloids go to, and what are some examples?will go into plasma and into the ISF; ~20% will stay in plasma (3/14)
examples: LR, NS
-mild palsma volume expandershypotonic crystalloids will go to what compartments and exampleswill distribute throughout plasma, ISF, and ICF (all 42L)
example: D5W/ dextrose- cells have glucose transporters so in can go everywhere
-only ~7% stays in plasma: causes cells to swellwhen would I absolutely not give D5Wincreased ICP, will cause brain to swell moreisotonic colloid gos to what compartments and an examplestays in plasma: BIG proteins
-wont pull in fluid because it is isotonic
ex: albumin
-good plasma volume expander- expands only as much as you give since it is isotonichypertonic crystalloid distributes where, and examplegoes to plasma and ISF
-since its hypertonic, it will PULL fluid from ICF to the ECF, bring fluid out of cells
ex: hypertonic salinein an ABG, what values are directly measured and which does the analyzer calculatpH and PCO2 actually measured
-[HCO3-] and BE are calculatedcalled the transverse lead view systemchest/ "V" leads
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