1. Is the amount of oxygen in the alveolar space high, low or normal? __________

Question

1. Is the amount of oxygen in the alveolar space high, low or normal? ____________________

2. Is the amount of arterial oxygen (in the blood) high, low or normal? _____________________

3. Given the alveolar oxygen level, is Mark’s arterial oxygen to be expected? ______________

4. Explain what is causing Mark’s observed level of arterial oxygen.

5.How could Mark’s blood have a lower than normal pH given his low CO2 levels?

PLEASE EXPLAIN IN DETAIL!

Part III- Airlifft Mark deteriorated rapidly and lost consciousness by the time the group reached the lower camp. The urgency of the situation strengthened the tired legs of the climbers, as Tom, John, and Pete carried Mark the final yards towards camp. Emily had run ahead to call for support help, and the group was told an airlift was on its way and would be there within the hour. The camp's medical tent had some basic supplies and a resident paramedic, and he and Emily went to work stabilizing Mark with oxygen. 90 Minutes Later, Denali Valley Hospital "We have a 28-year-old white male, unresponsive, no prior history of pulmonary disease, who became unconscious around 15,000 feet after hiking to 17,000 feet earlier today. His friends say he was having severe breathing difficulty prior to losing consciousness...." The following tables summarize the findings of the Denali Valley Hospital Medical Team: PULMONARY FUNCTION TESTS Mark's Normal 147 Torr Inspired Oxygen Tension Vapor Pressure Alveolar Oxygen RQ Tidal Volume 150 Torr 47 Torr 98-104 Torr 0.78-0.82 Torr 0.5 L 45 Torr 110 Torr 0.66 0.4 L

Explanation / Answer

This is a case of acute mountain sickness as the team ascended to 17000 ft ( without acclimatization)

Normally acute mountain sickness presents with nausea, dizziness, irritability, fatigue, shortness of breath, confusion.

In severe cases it can cause severe dyspnoea, loss of consciouness, respiratory failure as happened in this case.

Mark is presently having Type 1(Hypoxic) respiratory failure(Possible reason Pulmonary edema that occcured from altitude sickness/HAPE)

However in the mean time as he was supplemented with oxygen both at the camp and during airlift certain parameters have changed.

1. Alveiolar Oxygen is 110 Torr at present which is HIGHER,it is due to supplemental O 2 ,

however its Not reflecting on arterial O2 as diffusion across Alveolo capillary membrane is impaired due disease process itself.(explained below)

2. arterial O2 is MUCH LOWER, as there is a severe diffusion defect due to damage to membrane,

a huge A-a gradient has been created

3. The normal A a gradient in a non smoker in room air should be less than 10 mm hg(=10 torr)

Merk should have an arterial PO2 >100 torr, whereas present value is much less

4. This decreased PaO2 is due to ventilation perfusion mismatch

It is caused by pulmonary edema or accumulation of fluid in and around alveoli affecting the diffusion capacity of alveolocapillary membrane.

Due to O2 supplementation Merk is NOT having hypoventilation, Hoever

this O2 is not being diffused properly to capillaries --> low O2 level in arterial blood

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