What types of hypoxia and in what sequence developed in the patient?

3. Describe the possible causes and pathogenesis of the given types of hypoxia. Explain the typical changes in pH, P_aCO₂, S_aO₂, S_vO₂, blood oxygen capacity, the minute volume of breathing, and the minute volume of circulation during these types of hypoxia.

Why was the treatment provided by the physician ineffective?

Case 5

A 30-year-old patient K. has been treated in the intensive care unit after a surgical procedure of uterus amputation which was done under an endotracheal ether narcosis. Suddenly the patient's condition worsened sharply. She developed a choking sensation, dyspnea, chills, psychomotor retardation and apathy. Her skin turned pale; acrocyanosis became evident. Physical examination showed an increased respiration rate of 28 per minute, muffled heart sounds, no rales during auscultation of the chest; the pulse was regular 120 beats/min; blood pressure 65/30 mm Hg; concentration of Hb 100 g/L; hematocrit 0.30 (N: 0.36-0.42). The patient was administered supplemental oxygen but these measures had no effect.

Questions:

What pathologic process(es) developed in the patient after the surgery? Substantiate your answer.

2. Can the worsening of the patient's condition be associated with the postsurgery development of hypoxia of:

a) respiratory type?

b) circulatory type?

c) anemic type?

d) cytotoxic type?

What are the possible causes and mechanisms of development of each of the presumed types of hypoxia in this case?

Are there any signs of the urgent adaptive mechanisms that could compensate hypoxia in this patient? Describe them, if they are present. Why do they appear to be ineffective in this case?

Case 6

A 50-year-old patient K. has undergone a gastrectomy under narcosis with the use of mechanical ventilation. The surgery was urgently performed due to extensive stomach bleeding which developed suddenly as a result of tumor decay. During the treatment of shock and during the surgery the patient was administered various volume expanders (approximately 1 L) and received a transfusion of 2.5 L of whole donor blood which had been stored for 2 days. By the 3-d day after the surgery, despite the restoration of the normal blood values of Hb, the patient complained of weakness, headache, dizziness. On examination: the skin of the extremities was cold; severe dyspnea and renal insufficiency were observed; in the conjunctiva a tint of jaundice appeared. Eventually, mechanical ventilation was initiated to treat the patient.

Questions: