HYPOXIAS &

ASPHYXIA

By
Dr. M. Anthony David MD,
Professor of Physiology

NomadPARA:Respi:Hypoxiasphyxia 1
 HYPOXIA
 A condition where there is
decreased Oxygen supply
to the tissues is called as
“hypoxia”

NomadPARA:Respi:Hypoxiasphyxia 2
HYPOXIA: CLASSIFICATION

1. Hypoxic Hypoxia:
 Arterial P O2 is less.
2. Anemic Hypoxia:
 Decreased Hemoglobin causing O2
carriage
3. Stagnant Hypoxia:
 Due to slow & low blood flow.
4. Histotoxic Hypoxia:
 Tissue toxins deny O2 to the cells.
NomadPARA:Respi:Hypoxiasphyxia 3
TYPES OF HYPOXIA
1. HYPOXIC HYPOXIA
2. ANEMIC HYPOXIA
3. STAGNANT HYPOXIA
4. HISTOTOXIC HYPOXIA

NomadPARA:Respi:Hypoxiasphyxia 4
 HYPOXIC HYPOXIA
 The arterial PO2
is decreased.
 This may be
due to:
1. Decreased
Atmospheric
PO2:
 High Altitude
 Closed room

NomadPARA:Respi:Hypoxiasphyxia 5
 Arterial PO2 decreased due to:
2. Decreased Ventilation:
 Respiratory Paralysis.
 Bronchial Asthma

 Emphysema

3. Defective Gas exchange:

 Pulmonary Edema
 Pneumoconiosis

 All these cause a decreased partial

pressure of Oxygen and so Hypoxic
Hypoxia.
NomadPARA:Respi:Hypoxiasphyxia 6
 HYPOXIC HYPOXIA
 Commonest type.
 CAUSES: PHYSIOLOGICAL:
• High altitudes.
• > 3000 Mts above MSL: Alv. PO2: 60mm
Hg.
• Causes irritability

NomadPARA:Respi:Hypoxiasphyxia 7
 HYPOXIC HYPOXIA:
PATHOLOGICAL CAUSES
 Lung Failure due to:
• Pulmonary Fibrosis.
• Ventilation/Perfusion imbalance.
 Ventilatory Pump Failure:
• Fatigue
• Mechanical defects
• Depression of respiratory centers.
 Shunts.
NomadPARA:Respi:Hypoxiasphyxia 8
TYPES OF HYPOXIA
1. HYPOXIC HYPOXIA
2. ANEMIC HYPOXIA
3. STAGNANT HYPOXIA
4. HISTOTOXIC HYPOXIA

NomadPARA:Respi:Hypoxiasphyxia 9
 ANEMIC HYPOXIA
 A decrease in hemoglobin or RBC
count causes decreased Oxygen
carriage and so hypoxia.
 Can also be due to CO Poisoning.

• CO combines irreversibly with Hb.

 Abnormal Hemoglobins such as
Sickle Hb can also cause Anemic
Hypoxia.
NomadPARA:Respi:Hypoxiasphyxia 10
TYPES OF HYPOXIA
1. HYPOXIC HYPOXIA
2. ANEMIC HYPOXIA
3. STAGNANT HYPOXIA
4. HISTOTOXIC HYPOXIA

NomadPARA:Respi:Hypoxiasphyxia 11
STAGNANT HYPOXIA
 Also called “Ischemic” or “Hypo-perfusion
Hypoxia”.
 Blood flow to tissues is slow or low.
 The Oxygen reaching the tissues per unit
time is less.
 This situation is seen in:
• Heart failure
• Venous obstruction
 May lead to Adult Respiratory Distress
Syndrome if it occurs in the lungs.
NomadPARA:Respi:Hypoxiasphyxia 12
TYPES OF HYPOXIA
1. HYPOXIC HYPOXIA
2. ANEMIC HYPOXIA
3. STAGNANT HYPOXIA
4. HISTOTOXIC HYPOXIA

NomadPARA:Respi:Hypoxiasphyxia 13
HISTOTOXIC HYPOXIA
 Oxygen is available at tissue
levels
 But the cells cannot use it due to

a toxic agent.
 Seen in Cyanide poisoning.

NomadPARA:Respi:Hypoxiasphyxia 14
 HISTOTOXIC HYPOXIA
 Cyanide inhibits the intracellular
enzyme, “Cytochrome oxidase”
 This problem can be treated with
Methylene Blue.
• Methylene blue converts Cyan Hb into
CyanmetHb which is nontoxic.

NomadPARA:Respi:Hypoxiasphyxia 15
 EFFECTS
EFFECTSOF
OF HYPOXIA
HYPOXIA
 Severe Hypoxia < 20mm Hg
• In 10 – 20 seconds: Loss of
consciousness.
• In 4 – 5 minutes: DEATH
 Mild Hypoxia:
• Symptoms are similar to alcoholism
• Impaired Judgment.
• Drowsiness.
• Dulled sensitivity to pain.
NomadPARA:Respi:Hypoxiasphyxia 16
EFFECTS OF MILD HYPOXIA
 Headache.
 Nausea &
Vomitting.
 Tachycardia.
 Anorexia
 Disorientation.
 Excitement.

NomadPARA:Respi:Hypoxiasphyxia 17
 CYANOSIS
 Bluish discoloration of the skin &
mucous membranes.
 Cause: the presence of Reduced
Hemoglobin in the blood.
 Seen only when the absolute amount
of Reduced Hb is > 5 Grams/dLt.
 Is more common therefore in
Polycythemias.
NomadPARA:Respi:Hypoxiasphyxia 18
 OXYGEN THERAPY
 Given to patients of Hypoxic
hypoxia
 Can be given through:
• A Nasal catheter.
• Venturi mask.
 Pure Oxygen is not given
 A mixture of Air & Oxygen is given.
 Useful in all cases of Hypoxic
Hypoxia.
NomadPARA:Respi:Hypoxiasphyxia 19
 ASPHYXIA
 “Improper aeration of blood
continued for sometime produces
two pathological changes:
• Hypoxia : O2
• Hypercapnia :  CO2

NomadPARA:Respi:Hypoxiasphyxia 20
 TYPES OF ASPHYXIA
 LOCAL: Due to obstruction of blood
supply:
• Too tight tourniquet, for too long.
• Blue painful, swollen congested limb.
 GENERAL:
• ACUTE:
 Strangulation: Occlusion of trachea
 Airtight room: suffocation.

NomadPARA:Respi:Hypoxiasphyxia 21
 GENERAL ASPYXIA: CHRONIC
 Chronic Lung Disease.
 Chronic Bronchiectasis.
 Emphysema
• Decreased Alveolar Ventilation
  CO2 content
 O2 content

NomadPARA:Respi:Hypoxiasphyxia 22
 ASPHYXIA: STAGES
 I STAGE:
• Violent Respiratory Efforts
• Tachypnea & Hyperpnea.
• Hypoxia
• Loss of consciousnesss.
 II STAGE:
 Sympathetic discharge
• Hypertension & Tachycardia
• Ventricular fibrillations
• Convulsions

NomadPARA:Respi:Hypoxiasphyxia 23
 ASPHYXIA : STAGE III
 Gasping :
• Slow deep inspiration
 Hyporeflexia
 Pupillary Dilatation
 Hypotension
 Bradycardia
 Cardiac Arrest
 Death.
NomadPARA:Respi:Hypoxiasphyxia 24
 FAILURE OF ONE, IS
FAILURE OF ALL!
CARDIAC
FAILURE

BRAIN
FAILURE

RESPIRATORY
FAILURE

NomadPARA:Respi:Hypoxiasphyxia 25
NomadPARA:Respi:Hypoxiasphyxia 26