1) Hypoxemia --> low blood O2 levels.
Hypoxia --> low tissue oxygenation wrt demand

Types of hypoxia

1. Hypoxemic
2. Stagnant
3. Histotoxic
4. Anemic
5. O2 affinity hypoxia

Thanks to @kcolenaj Image
2) The problem arises if you define O2 content of blood purely as PaO2 or as PaO2+ oxyHb saturation --> for this is the total O2 content of blood.

If we eliminate oxyHb, O2 content of blood becomes less meaningful since the lion's share of O2 is carried by hemoglobin!
3) If you consider oxyHb + PaO2 in total the anemic and O2 affinity forms of hypoxia must necessarily be a cause of hypoxemic hypoxia --> since anemia (reduced Hb) or increased O2 affinity --> cause HYPOXEMIA!
4) If not, anemic and O2 affinity hypoxia may be classified separately.

Mechanisms of hypoxemic hypoxia
1. Low FiO2
2. Alveolar hypoventilation
3. V/Q mismatch
4. Shunts --> severe V/Q mismatch
5. Diffusion limitation aka alveolocapillary membrane problems
5) Any of the 5 classical mechanisms of hypoxic hypoxemia --> less O2 delivery to blood --> less O2 delivery to tissues.

If the surrounding lung parenchyma can provide compensatory CO2 elimination --> there is only hypoxemia/hypoxia --> type 1 respiratory failure.
6) If there is extensive lung damage with no lung reserve for compensatory CO2 elimination --> hypoxemia/hypoxia with hypercarbia --> type 2 respiratory failure.

In practice, hypercarbia is caused by extensive lung damage or low alveolar hypoventilation.
7) Thus type RF is due to

1. Any extensive lung ds

2. Alveolar hypoventilation
8) Alveolar hypoventilation is due to

1. CNS -> head injury, intoxication

2. AHC +/- PN -> GBS, ALS, phrenic neuropathies

3. NMJ -> myasthenic crisis

4. Muscle --> diaphragamtic myopathy, structural abn like hernias

5. Chest wall -> Ank spond, kyphoscoliosis
I hope you find this tweet helpful!

Please retweet if you do!

#MedTwitter
#hypoxia
#hypoxemia
#hypercarbia
#respiratoryfailure
#CriticalCare

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More from @AdiG1993

Nov 30
What is the best physiology book for 1st year?

It this one in my humble opinion.

Crisp, sufficiently detailed with good diagrams and explanations for various phenomena --> this is my Grade A recommendation. Image
I have gone through Ganong, Guyton, Taylor and Boron & Boulpaep ---> those are NOT for beginners.

The Indian textbooks are okayish but the diagrams are pretty terrible.

That is where Lippincott wins hands down.
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Nov 30
Middle aged patient presents with insidous onset, progressively worsening SOB.

Chest is full of wheezing and creps.

What is this?

#MedTwitter Image
This is the HRCT thorax. Image
This is a biopsy proven adenocarcinoma.

No GGO
No air bronchograms
Multiple coalescing nodules of various sizes --> s/o cannonball metastases.

#MedTwitter
#pulmtwitter
#oncology
#TB
#tuberculosis Image
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Nov 28
I am a big fan of @baxirahul sir and his Tweetorials.

Short, crisp and chockful of useful data --> highly recommended for physicians and patients --> for diabetes is all pervasive.

#MedTwitter
#endotwitter
#diabetes
#prediabetes
What is my personal regime?

1. Weekly BP and weight measurements.

2. Brisk walking to cover at least 7k steps/day. I also have my own exercise regimen.
3) I follow a diet prescribed by my dietitian.

I am gradually phasing out all junk food and simple carbs.

The Bengali diet is delicious.

But the carb load in the bhaat and NOT THE MISHTI is killing us.
Read 4 tweets
Nov 27
1) Why is biochemistry so commonly disliked by medical students?

Because they are made to memorize metabolic pathways without rhyme or reason.
2) They spend hours memorizing the structures of amino acids and the Krebs cycle.

Its a classic case of missing the forest for the trees.

They never learn integrated metabolism as a whole and with proper clinical correlation.
3) I started MBBS in 2012 and I have checked out several biochem texts over the years.

Harper is the worst --> for 1st year.

The Indian textbooks don't do much better either.
Read 11 tweets
Nov 27
1) I am presently working on curating the best free resources for medical professionals.

I will focus on the medical subspecialties.

I will also post some of my own work.
2) Why am I doing this?

Because FOAMed is the future.

Because we have some amazing work on Twitter and other SM that does not get the visibility it deserves.
3) All creators will be credited.

If by any chance, it is not --> please bring it to my attention.
Read 4 tweets
Nov 26
I follow a lot of educational podcasts.

This is a recent addition to my list that I am finding extremely useful both as a refresher and for first time reading.

I would recomment it for gen med residents without hesitation.
Pros

1. Crisp and clear explanations.

2. Short duration

3. Deals with common topics that are dealt with everyday in the wards.

4. The website has additional material that can be perused for further reading.
Read 6 tweets

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