   Chapter 6, Problem 11RQ

Chapter
Section
Textbook Problem

Case Study: Automobile Collision VictimA 37-year-old woman is on a volume-cycled mechanical ventilator on a day when the barometric pressure is 745 mm Hg. The patient is receiving an Fl o 2 of 0.50. The following clinical data are obtained: Hb:    11g/dL ( Pa o 2 )   60 mm Hg  ( Sa o 2  = 90% ) P V ¯ o 2   35 mm Hg  ( S V ¯ o 2  = 65% ) Pa c o 2   38 mm Hg Cardiac output: 6 L/minBased on this information, calculate the patient'sA. Total oxygen deliveryB. Arterial-venous oxygen content differenceC. Intrapulmonary shuntingD. Oxygen consumptionE. Oxygen extraction ratio

Summary Introduction

Case summary: A 37-year-old woman met with an accident and is on a volume-cycled mechanical ventilator.

Characters in the case: A 37-year-old woman met with an accident.

Adequate information: The barometric pressure is 745 mm Hg. She was receiving FlO2 of 0.50.

To determine: The total oxygen delivery, the arterial venous content difference, the intrapulmonary shunting, oxygen consumption, and the oxygen extraction ratio.

Explanation

Given information:

Cardiac output: 6 L/min

Hb: 11g/dL

PaO2: 60 mm Hg

Pv¯O2: 35 mm Hg

PaCO2: 38 mm Hg

With this information,

PAO2=(BP-PH2O) FlO2-PaCO2(1.25)=(745-47) 0.5 - 38(1.25)=(698)0.5 - 47.5=349 - 47.5=301.5

CcO2=(Hb×1.34)+(PAO2×0.003)=(11×1.34)+(301.5×0.003)=14.74+0.90=15.64

CaO2=(Hb×1.34×SaO2)+(PaO2×0.003)=(11×1.34×0.90)+(60×0.003)=13.266+0.18=13.44

Cv¯O2=(Hb×1.34×Sv¯O2)+(Pv¯O2×0.003)=(11×1.34×0.65)+(35×0.003)=9.581+0.105=9.686

A)

Totaloxygen delivery=QT×CaO2×10=6×13446×10=806

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