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13-10-2010 wed
^ the last lecture we discussed the
elasticity of the lungs, and
compliance(how much effort is required to
stretch or distend the lung) and we said
the more lung compliance the easier we
breathe (less energy), and this compliance
could be increased in abnormalities like
lung diseases, in such diseases the
elasticity of the lungs will not be normal
it's not easy to flat that lung so the
breathing will be difficult and we need
more energy to do the simple respiratory
cycle, and we said that when you breath
you take the normal amount of air you need
under quiet conditions, and it's called
tidal volume. So you should remember when
you look at the respiratory system as a
system it's divided into two parts:
1-c xhe 1st part is the ¦

 
¦ which has nothing to do

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with gas exchange, just to conduct

the air inside the lung.
2-c xhe good one for physiology is
the ¦ , so if you look back to
the structure of the respiratory
system, {the lungs the alveolar
part and the air conducting
channels on top}.
When you breathe you do the inspiration
you will take the fresh air from
atmosphere inside your chest, if it's
quiet breathing you will take about 500mls
of air these 500 will go down through the
air conducting channels until they reach
the alveolar compartment by the end of
inspiration " follow that procedure" I
took half a liter of air inside my lung by
the end of inspiration there is small
amount of air still in the air conducting
channels .. Right « because they are
opened and they are full of this air « so
the 500ml will never reach the alveoli as
a total 500 some of it will remain in the
air conducting channels this amount of air
{a volume} inside the air conducting
channels we call it
¦
¦ why this
term ? «. Because this amount of air even

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if it is full or rich of O2 its not used

for gas exchange, there is no property of
the tissues in the air conducting channels
to cause the O2 to go to blood and the co2
to go to the channels so the amount of
oxygen in that area "air" will remain
constant, it will not decrease by oxygen
consumption, but the air inside the
alveoli in the part that reaches the
alveoli will be exposed to the alveolar
"what we call respiratory membrane" oxygen
will leave and carbon dioxide will be
gained; if we take that air way channels
and we measure the volume of that channels
in the adult person it is equal to 1500ml
so the dead space in normal physiological
condition equals 1500ml now if you breathe
500ml 150 of them will be in the dead
space and the rest 350 will go down to the
alveolar system, so this is the amount of
air we use for oxygen exchange this is the
amount of air we increase by the CO2
percent in the 350, in other words if we
asked a question: " if a person breathes
12 times per minute this is the normal
<< el 9bayah ele 3al looj ya be6la3o
ya be23odo 2odam :P >>

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now 500mls it¶s the tidal volume it

will get in and out in each respiratory
cycle, if the person breathes 12 times per
minute so how many mil will be getting
inside the chest and outside the chest in
that minute? « It will be [500 X 12]
because each time I take 500 and it's 12
times, so it will equal about 6 liter of
air we get them inside our chest and
outside this amount of air you get it
inside and about side per minute is called
pulmonary ventilation rate the rate of
pulmonary ventilation now consider that
fact «. When we breathe those 500 about
150 remains in the air conducting channels
and they are not useable so the only
useable amount is 350 so we can calculate
another term in physiology which is called
¦¦
  ¦  
 the amount of
air which gets inside the lungs and
exposed to the gas exchange it's called
alveolar ventilation rate how much per
minute? If we are talking about 12 times
per minute 500 tidal volume but each time
I take the inspiration 150 will be lost so
the amount getting inside the alveoli is
350 each respiratory cycle, so the

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alveolar ventilation rate = {350X12} , how

we did that ?! By taking the tidal volume
subtracting from it the dead space, then
the result times the respiratory rate "is
that clear?!", now for the exam if I ask
you to calculate any of these terminology
if the number is not in the stem of the
question don't put it yourself in other
words if I want you to use a number it
should be in my question not memorizing
the text book numbers if the dead space
not there don't use the 150 because it is
the average and when I want you to
calculate something it's about a patient
or a person which could be not 150 it
might be this or more "is that clear for
the exam ?!" .
Now the second objective of this lecture
«. xo give you an idea of the gas mixture
in the atmospheric region, in the alveolar
region, in the capillaries of the lung, in
the systemic circulation, and in the cell,
before giving these numbers to you I think
you remember from biology that there is
something called 
c of the
gas, and it is inversely proportional to
the volume, in other words if you take a

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volume of air in a container and you

measure the partial pressure of that gas
let's say X now if you push that volume by
decreasing the volume by half the partial
pressure of the gas will be doubled, and
if u expand that volume more the partial
pressure will be less. So if we take the
atmospheric pressure "the normal is 760ml
hg" on the sea level "this is our
reference", and we are talking about a dry
weather day, the content of atmosphere is
Nitrogen about 80%, and Oxygen about 20%,
zero carbon dioxide "almost", and no water
vapor {a dry day}, but in winter time when
we have vapor in the atmosphere that vapor
gas will replace amount of pressure for
itself, now if we measure the
concentration of O2 and N2 we said 80:20
so the 760ml hg was divided between oxygen
and nitrogen but not equally, nitrogen
will take 80% of the partial pressure, and
oxygen will take 20% of that pressure, so
{760X20} it will give you the partial
pressure of oxygen, normally it's about
160ml hg and the remaining will be for
nitrogen, in some text books you will find
very tiny small amount of partial pressure

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of CO2, now when you breath this dry air

inside your lung, when the air gets inside
the air way channels, your air way
channels are wet they always have vapor
water in, so the mixture will be changed
the oxygen will not be 20% but less the
nitrogen will not be 80% but less depends
on how much water vapor there this is one
factor « the other factor when air gets
inside your lungs there is amount of
carbon dioxide which gets there from your
body after metabolism this CO2 will leave
your body by the respiratory system so
when the atmospheric air gets inside your
lungs now we are talking about different
partial pressures of these compounds, and
you should remember it you should read it
in your book « those partial pressures the
important one for me for my lecture is
100ml hg of O2 and 40ml hg of CO2 remember
outside your body the O2 partial pressure
was 160ml hg inside the lung it is 100ml
hg why it is less?! Because we have vapor
water and CO2.
If you go down a little bit and reach the
capillaries which surround the alveoli «
what are these capillaries? xhese coming

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from the pulmonary artery ... they come to

the lungs they are not rich with oxygen
they lack it, they came to the lung just
to get more oxygen so if you measure the
partial pressure of oxygen in the
capillaries of the lungs which are
approaching the alveoli « the partial
pressure of oxygen in that blood under
normal conditions is 40ml hg and if you
measure CO2 partial pressure it's about
46ml hg « "the doctor summarizes what he
said in drawing" «
ËSo when you do inspiration... xhe O2
inside the lungs is 100ml hg, the CO2 is
40ml hg « for the coming blood the O2 is
40ml hg and CO2 46ml hg « this is the
normal condition quiet no exercise, the
metabolism is the basic we need in our
day, this is the normal condition. If you
are exercising then that blood will carry
less oxygen, at the same time the same
blood will carry more CO2, you know why «
because exercising utilize so the O2 will
be reduced, exercising will produce more
CO2, which goes with blood to the lungs,
at the same time if you look to the
alveolar compartment « if you are

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breathing normally most of that time you

will get CO2 from capillaries to out and
O2 from outside in « if you hyperventilate
{instead of 12 times per minute you do it
20 times or 30 times « unfortunately the
Dr. will not explain more about it because
there is no time} , hyperventilation is
good and bad, we will go in details of the
good part of it « so you will increase the
amount of oxygen getting inside your lungs
"common sense" « under normal condition
when I breath normally 160 available but
when they get inside I get only 100 « now
if I do hyperventilation this 100 will be
more what could be the max?! What is the
max O2 partial pressure inside alveoli if
I hyperventilate?! «. 160 because the max
I have out is 160, unless I breathe pure
oxygen in the hospital, now at the same
time when you hyperventilate you get more
oxygen, but at the same time you deplete
more what ?! More CO2, so the CO2 there
will be less than 40 «
Now we go down when the blood goes through
the distance beside the alveoli « {look at
the wisdom of Allah in this}, through the
capillaries in the lungs the reason that

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blood comes there is to take O2 and

deplete CO2, the gas exchange which occurs
from alveoli to capillaries « it will get
fully saturated by 1\3 of the distance of
the blood flow,
} ϥϮϜ ΕϼμϳϮͨ ϝϼΧ Ý3 ϲθ͸ Ρέ ϡΪ 
 ͔ό͛
ϛϷ  ϪΘϳΎϔϛ άΧΎ ϝϭϷ Ý ϝϼΧ {
You might ask why?! « Because Allah knows
during exercise and heavy duties the blood
flow will be increased not only 3 times
maybe 5 times, if you increase the blood
flow more "and god made the saturation by
this point "by the end of the alveoli" ",
so most of the blood when I need more
oxygen will leave the lung without being
saturated, so 1\3 is more than enough to
get full saturation of oxygen and get rid
of CO2 « (this is one important
physiological point) « the other one when
I said fully saturated it means full
equilibrium with the alveolar compartment,
so when I say equilibrium I'm talking
about passive transport of gas 'O2 and
CO2', and when you get to the equilibrium
by this point I will have O2 not 40 but «
"8adeeh ?!?!! Let's just take some extra
time to explain this « o.O ma bedko ?! :P
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the Dr. ma beshra7 mshan el exam 3shan

e7na net3alam «.. al mohem " «.. if we are
talking about normal equilibrium you
remember if we have a membrane and we have
a 100 partial pressure of O2 and 40 on the
other side «. What would be the
equilibrium?! 70:70 In lungs equilibrium
doesn't mean that because when I reach 70
on both sides I'm still breathing « I'm
still doing expiration so 70 will be out
and 100 will be back « the normal partial
pressure of oxygen « when a side is 70 and
the other is 100 it will take 170\2 «
about 80~~ « 80~~ of the channels out
another 100 coming down, so by the end of
this distance I will have 100ml hg oxygen,
and the same thing applied to CO2 I will
have 40ml hg «.. So saturation by the end
of the blood flow to the alveoli it will
get the same partial pressure of the
alveolar compartment, for O2 and CO2.
So now the blood leaving the lungs going
back to the heart and then to the tissues
« systemic circulation, we have 100ml hg
of oxygen and 40ml hg CO2 ««« now it
reaches the cell, in the cell we have 40ml
hg O2 and 46ml hg CO2 of course those

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could be lower depending on the metabolic

rate of that cell, and here the
equilibrium is the same as in the lungs
"that will be 40 O2 and 46 for CO2" and it
will go back and this cycle will be
repeated many times every day every second
every minute in your life.
Gas exchange which is between alveoli and
the blood « oxygen and carbon dioxide this
is our concern they should cross the
respiratory membrane, they should cross
the epithelial cell of alveoli "type1",
they should cross the basement membrane
between the alveoli and capillary, and
they should cross endothelial cell layer
in the capillary, then they go inside the
blood, where they dissolve in the plasma,
when they are dissolved in the plasma they
will create partial pressure which is 100
and 44 carbon dioxide, In the blood gas
will be transported not as a dissolved
content, in blood we have plasma, small
amount of oxygen will be dissolved in the
plasma, but major amount of that oxygen
will be bound with hemoglobin, so oxygen
should cross not only the plasma of the
blood it should cross the cytoplasmic

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membrane of the red blood cells, and

fortunately when the blood cell going
through the capillaries in the lungs the
diameter of the capillary is so small so
the red blood cells will be squeezed in
the capillary it will not be swimming in
the plasma, why is that? « Because we want
less distance between hemoglobin and the
O2 coming from the alveoli, so the RBCs
will change their shape and they will be
squeezed in the capillaries, so between
capillary and hemoglobin we will have only
the cytoplasmic membrane of the RBCs. Now
the way oxygen transported in blood is so
beautiful "zaykom :P " in a way it helps
our life « so let's discuss it in details.
Now if you take a portion of blood from a
human being this blood will be RBCs and
plasma, let's measure the O2 in the plasma
and the O2 in the RBCs, let's assume that
we have a 100ml of O2 in that portion, we
will find out that from these 100mls of O2
only 1.5ml is dissolved in the plasma but
97.5 it's inside the red blood cells bound
with hemoglobin and you remember how many
hemoglobin we have huge amount of
hemoglobin carrying that O2 and this

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binding assay between O2 and hemoglobin is

reversible, so it's not oxidation « it's
oxygenation so remember oxygen 98% bound
with hemoglobin but only 2% or 1.5% is
dissolved in the plasma even that it's a
fact the partial pressure of oxygen in the
blood related to the dissolved oxygen« the
bound oxygen has nothing to do with the
partial pressure of oxygen so if you
measure the partial pressure of oxygen in
the blood when you do that you measure the
effect of the dissolved O2 which is small
amount. xhe amount of bound oxygen depends
on the partial pressure of oxygen, even
98% is bound but they are dependent on the
partial pressure of oxygen >>> partial
pressure of oxygen depends on the
dissolved oxygen. So the more you dissolve
the O2 the more partial pressure you get
in the blood >>> the more PP you get the
more bounds O2, now this relationship
between O2 inside RBCs inside the blood is
a special one and it has a curve :  
  
 ¦  
«

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you take 1gram of hemoglobin and you

saturate that one gram with oxygen 100%
that gram will take 1.34ml of O2, now what
is the normal concentration of hemoglobin
in normal human blood? "la t8oolo ma
bte3rfo O.o" the normal hemoglobin
concentration is 15gram/deciliter if you
take a blood each 100ml of blood they
contain 15gram of hemoglobin, if you have
reduction of that that will cause anemia.
I told you that 1gram of hemoglobin
carries when it's fully saturated 1.34ml
of oxygen now 15gram of hemoglobin in
100ml of blood when I saturate a 100ml of
blood 100% saturation how many mls of
oxygen? It will be {1.34X15gram} each gram
contains 1.3 «. It will equal 20mls of
oxygen per deciliter of blood this is the
full saturation of blood.
In this experiment we took the blood and
we exposed it to zero O2 now we started at
that point« in the scale we measure the
ppO2 each time we change the situation,
then we take a sample and we measure how
much O2 is contained in that sample, now
after being exposed to zero pp « there is
no O2 and the ppO2 is zero« now we start
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) ϊΟέϭ ϪϛEϭ ϩάϏ ϭ Ξ FΎϋ ϡΪ  β

(Θ΋G
xhe ppO2 in the venous blood « its 40 so
when you look to this curve "above" and we
put a point of the venous blood, from the
arteries to venous the oxygen difference
was utilized by tissues« blood was
carrying 100ml hg after leaving the tissue
it was carrying 40ml hg where the
difference went?! It was given to the
tissue« this difference in that curve if
you want to calculate it by number; at
first the saturation was 100% or 20mls "at
the first one", "at the 2nd one: ", it
became 75% or 15ml which means when the
blood is fully saturated it carries 20ml
of oxygen, when if feeds the tissues and
leave them under normal physiological
conditions, it will leave 5ml of O2 to the
tissues and still have 15ml of oxygen
carried ad bounds to hemoglobin. Under
exercise 5ml of O2 is not enough we need
more, we don't need 7 we don't need 8 we
don't need 10, we need 15ml of O2, 75%of
the total, if that happens « that exercise
is on in this case the ppO2 which is in
the venous blood from 40 it goes down to

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30 only, just 10ml hg reduction of pp the

amount of O2 released will be significant,
so this in the blue color in the curve
it's sharp just to give us more O2 if we
need them by not changing the partial
pressure of O2 significantly. And the
first part which is the rose one "red" it
tells us that if the reduction of O2 from
100 to 70 « to 75 « to 65 it will not
affect the amount of O2 carried by blood
"this is the wisdom", we want the O2 to be
in our hands inside the blood, whenever we
need more we will take more
But if there is a small reduction of O2
{from 100 to 70}, we don't want to be
affected, so the saturation of O2 will not
be changed on the plateau level of the
curve, even you reduce the partial
pressure from 100 to 60 you still have 90%
full saturation of O2, which is good for
the tissues which is good for life, {to
the curve} but in that sharp sloop any
difference in the partial pressure of O2
will cause a significant change of the O2
released, and that what we need, when we
need more O2 we can get them from that
part.

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Ëxhe Dr is sure when we read the text book

we understand it more «.
ËBut if you understand what the Dr said no
need to go to the book.
In the first lecture of respiration the Dr
mentioned a term of hemoglobin affinity «.
Breaaaaaaaaaaaak «.
xhe affinity of hemoglobin to bind oxygen
« how hemoglobin strong to carry oxygen,
we said that it's not good to carry the O2
and stop, it's good to carry the O2 in the
lung region, but when are close to the
tissue region it's good to release that
O2. If I get a situation which leads to
increase the affinity in the lung area «
the hemoglobin will be strong and it will
take oxygen, when that hemoglobin moves to
the tissue region and there if there is a
situation leads to decrease the affinity
so the release of O2 will be available,
now there are many factors which affects
the affinity of hemoglobin, not many they
are 4 « one of them is carbon dioxide
concentration or the ppCO2 it's the same,
if you increase the carbon dioxide

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concentration you will decrease the

affinity « 1
2« if you increase the acidity you will
decrease the affinity, so when the Ph is
low the affinity is less.
3« if you increase the temperature the
affinity will be less.
xhe 4th is a chemical called 2, 3
bisphosphoglycerate it's available in the
tissue, if the concentration is increase
the affinity will decrease.
Let's take these factors 3 of them, and
let's take the lung region and the tissue
region, in the lungs we always have
ventilation {if we want to ventilate a
room we make the air inside it fresh}, so
we expel out CO2, and gain O2 this is the
respiratory cycle, so the CO2
concentration will be less, and that
increases the affinity, so a decrease of
these factors will increase the affinity.
So in the lungs we have less CO2, we will
have more affinity. Go down to the tissue
it's the factory for metabolism where the
CO2 production is continues so the CO2
concentration will be high because it's
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high the affinity will be less, so in this

factor the CO2 « in the lungs hemoglobin
will be strong, and it will be weak in the
tissue region.
Let's take the 2nd one« which is the
acidity it depends on hydrogen
concentration and H concentration depends
on bicarbonate, bicarbonate depends on
carbon dioxide, we know the will known
reaction CO2+H2O2 => H2CO3
H2CO3 will be dissociated to hydrogen and
bicarbonate, so in the lungs we don't have
CO2, when we have less CO2 we will have
less H, so we will have less acidity, more
Ph, and that will increase the affinity of
hemoglobin, going to the tissue the
production of CO2 will create a lot of H
around, and that will increase the acidity
so the affinity will be less.
xhe 3rd factor is the temperature, when you
are ventilating you will cool the body
temperature, so if you take the lungs as a
region during the ventilation you will
cool that temperature it will be less than
37', and that will increase the affinity
of hemoglobin, but if you go down to the

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tissues where the metabolic rate is high,

a production of energy, energy produces
heat, so more temperature less affinity,
so Allah gave us that gift of changing the
environment of the lung region compared to
the tissue region, by doing so this more
hemoglobin without knowing by those
factors only, in the lungs they will
increase the strength of that hemoglobin,
those factors in the tissue they will
decrease the affinity, and the 4th one is
still with a big question on how it works
with the same explanation we don't know
but still it has an effect on hemoglobin
affinity.
Now the unfortunate one is the binding
affinity to O2 is X, where is the binding
affinity for CO is 240X, so when you
compare the strength by which hemoglobin
carries the O2, it will love to carry CO
240 times more "w mena el 7obe ma 8atal :P
", what does it mean in real life? It
means if you have 1molecule of CO and
240molecules of O2 the hemoglobin will
take the CO almost equally, but if you
have 2molecules of CO and 300molecules of
O2 hemoglobin will go and take the CO

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which is very bad, if we have CO in our

blood, the hemoglobin will take the CO and
it will not release them, no matter how
much you increase the O2, the max amount
of O2 you can intake in your body is 160,
unless you breathe pure O2 it could be
increased to 500 , 600 , or so.
So carbon monoxide poisoning is very
dangerous, why because it is happening
every year, when people try to be in
enclosed area, especially in winter time,
when they sleep in small rooms, and
keeping the heater on, during the night,
the heater produces a lot of CO, the
person is sleeping without knowing
anything, breathing the CO with O2, step
by step you are increasing the amount of
hemoglobin bound to CO and decreasing the
amount of hemoglobin bound with O2, until
it reaches that point which is killing
that person, with our noticing neither
pain nor stress, they die in peace (^^;)
because of carbon monoxide poisoning this
is real fact, and it is happening every
year in our country, especially with those
who use the heater without expelling out

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the gas, the problem is the affinity of

hemoglobin to carbon monoxide.
Look to the oxygen hemoglobin dissociation
curve, the red one is the one in the lung
region, the binding or saturation of
hemoglobin in the lung region, the blue
dashed one is in the tissue level, because
the effect of these factors there is a
shift to the right, which means the
affinity is less.
Oxygen in our blood as we said 1.5% is
dissolved, about 98% is bound, now if you
go to the CO2 which is the other part of
respiratory function, CO2 will be in 3
forms in the blood, 1)which is the minimum
one which is dissolved in the plasma about
10% , 2) the other is bound to hemoglobin
we said that hemoglobin binds to different
substances, about 30% is bound with
hemoglobin, 3)but the major part of CO2 is
dissolved in the blood as bicarbonate and
it's the combination between carbon
dioxide and water, with the presence of
carbonic enhydrase the enzyme.
Now we finished with the mechanism of
breathing, we're done with the different

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content and concentration of different

gases in different regions, we talked
about the gas exchange through the
respiratory membrane, and we talked about
the blood transport, O2 transport, and CO2
transport.
Now we will talk about the main issue of
our respiratory function it's not enough
to know the mechanism of breathing it's
not enough to know the regulation of
exchange and transport, it's more
important to know how we regulate the
whole function in our life, even it is
complicated it is simple when you think
about it in a simple way, always when we
talk about control system you should
remember control system: either nervous
system or hormonal and chemical system,
let's take the first part which is the
nervous system effects on respiration, if
I ask you to stop breathing you can do
that « but you can't hold your breath
until you die, this is the difference, you
can control your breathing rate
voluntarily, I can ask you to
hyperventilate and you can do that, and I
can ask you to hypo ventilate and you can

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do that so there is a part of the nervous

system effect which is voluntarily part,
but it is limited when we are talking
about survival it's not allowed to that
voluntary to continue, that¶s why people
who wants to commit suicide will hang
themselves and put their hands back
tighten them, just to keep anything far
from asphyxia which is the pert where you
cut the inspiration otherwise you can't
die easily by just holding yourself up to
death. xhis voluntary part of the nervous
system you can hypo you can stop you can
hyper ventilation.
Without thinking of nervous system we are
breathing without knowing that we are
breathing, why is that? Because there are
special centers in the nervous system
located in the Medullary part of the bone,
those centers are respiratory centers, we
have "slide 36" the blue ones called the
dorsal respiratory group, and the ventral
respiratory group.

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after finishing it relax so this is the

part for quiet breathing, on the muscle
contacts > inspiration, off the muscle
relaxes and that¶s it.
xhe ventral respiratory group it has both
inspiratory neurons and expiratory
neurons, if the inspiratory neurons are on
we are talking about forceful inspiration,
when they are of it's not enough when the
expiratory neurons are on then we do the
forceful expiration, few years ago they
discovered what Pre-Bötzinger complex
(center) the small blue one on the top
they found out because the dorsal group
they have regular stimulus on/off "we call
that in physiology circadian rhythm
sleeping, waking, breathing, and walking
all of these are on/off mechanism", they
found that this small center it's like the
peace maker you it in the heart which
gives the signals this is the one like
that center for inspiratory breathing.
In the upper part of the bones we have:

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pneumotaxic center if you stimulate it
will switch off the dorsal group, now
remember that the group does the
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inspiration, so if the pneumotaxic center

is on you stop the inspiration, you
decrease the rate of inspiration, instead
of breathing one second you breath 5
seconds by stimulating that pneumotaxic
center. Apneustic center the other one
does the opposite if you stimulated it it
will inhibit the switching off of the
dorsal group, dorsal group doing
inspiration when they are done they are
inhibited, Apneustic center if it is
stimulated it will not lead to that
finishing so the inspiration will be
deeper and will not be stronger, so these
are the centers in the brain.
Now there is another type of receptors
located in the air way conducting
channels, the functions of these
receptors, when you inspire deeply,
remember the tidal volume which is half
liter, if it is more than 1liter more than
the tidal volume inspiratory reserved
volume with it, the air way conducting
channels will realize that there is
something wrong this is too much air it
could rupture the lungs, so the receptors
there will send a signal to stop the

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respiratory center from stimulation, they

don't allow you to inspire deeply long
time, they try to inhibit that to keep the
lungs in shape, this is the nervous part
of regulation, it's easy and simple.
Now the other one which is the chemical
control, when we say chemical the ultimate
for respiratory function is to keep the
oxygen normal and CO2 normal, we don't
want less O2 and we don't want more O2, we
don't want more CO2 and we don't want less
CO2, how is that achieved there are
special receptors which is called
peripheral receptors " look to the wisdom
of our god" they are in only two places:
the aorta (aortic bodies), and in the
Carotid arteries "which feeds the brain",
if there is any change in the blood
circulation, the brain should reserve
exact amount of blood, it doesn't matter
your legs are dying, your liver is dying,
the brain should reserve enough O2 so the
amount of blood going to the skull by
these carotid arteries always constant and
god put these receptors in that place,
what is their function? xhey can sense a
decrease in oxygen pp, if they do so they

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fast and in this fast blood there is O2

its rich of it, when these receptors will
sense the reduction of O2? If there is
real reduction of O2 in the atmospheric
area or in the lungs area.
" ϭ ϛ΃ ϡ Ϟ 100 Ϟ Ύ
ϡΪ ϥΎϛ 
 ͕όϳ
ϙϼϬΘK ΐΒ 65 ϭ 70 ϭ 80 ϭ 90Ϟ ϝΰFϳ ϩΪ
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xhey respond only if the ppO2 is less than
60ml why is that? Let me remind you when
we talked about O2 hemoglobin dissociation
curve we said if you reduce the amount of
O2 from 100ml to 60ml the saturation level
of O2 still 90% so why should I
hyperventilate if I have 90% saturation of
O2 I want to hyperventilate if the
reduction of O2 is less than 60ml, if the
pressure is less than 60ml they will fire
that signal, and that signal will
stimulate the respiratory center and you
will hyperventilate. At the same time
those receptors they are sensitive but
with less sensitivity to CO2 concentration
if it is increased, and H concentration if
it is increased, but not that much as
oxygen reduction.

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Now the peripheral chemical control which

is located in the carotid and aortic
bodies they are "" sensitive "" only to
low O2 very weak to CO2 and H, why is
that? Because there are different
receptors they are located in the brain.
xhere are receptors they sense the
concentration of H, they don't sense the
concentration of O2, and CO2, they sense
only the H concentration. (Follow what the
Dr says word by word): we have blood
circulation feeding our tissues including
the brain but we have special structure
for blood circulation in the brain called
blood brain barrier, it don't allow to
many toxic materials to get inside the
brain, one of those toxic materials is H,
so if you increase the H concentration in
the blood it will be circulated but will
not get inside the brain, "decrease the Ph
increase the acidity" it will not
influence the brain extra cellular fluid
because the brain blood barrier does not
allow the H to get inside, now if you
increase the CO2 concentration in the
blood its easy permeable through the blood
brain barrier, CO2 will be elevated in the

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blood CO2 will be elevated in the brain

because of the CO2 exchange through the
barrier, when the CO2 concentration is
high if you remember the equation:
CO2+H2O => H2CO3
H2CO3 => H + CO3, increasing CO2 in blood
increases CO2 in the brain, with the
presence of carbon anhydrase, it will
transverse the CO2 to H, and it "H" will
be elevated in the brain only if CO2
concentration is high, if that happens
those chemical receptors will be
stimulated very strongly to do
hyperventilation because this signal means
H is high because of CO2, I want to expel
CO2 out, so hyperventilation starts and
you lose CO2.
Now whatever we said about chemical or
nervous or anything the opposite will
cause hypo ventilation, and this is the
way we live by hyper or hypo or normal
breathing, by sensing the situation of
gases inside our body inside internal
environment, with this perfect structure
of god's gift to help us to do our
breathing either we are sleeping or we are
awake.
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Now, there is a term which worries all

mothers in the world called sudden death
infant syndrome, which means newborn
normal without any disease, the parents
wake up in the morning and he is dead in
his bed no sign no symptoms at all, when
they discovered the reason « it was the
following,
Just let me remind you of something I
missed when we talked about control that:
too much of reduction of O2 not 60 not 50
but 20ml it will cause depression of
respiratory system, so there is a limit
for hyperventilation. Increasing CO2 up to
50,55,60,65 it will cause
hyperventilation, but 70ml hg of CO2 will
cause depression of respiratory, now those
newborns if they are premature the
development of physiology is not that
complete, which means that an increased
CO2 will not cause the respiratory centers
stimulation because they are premature,
now during sleeping all of us we have a
period called "Sleep apnea" apnea means to
stop breathing, and this is normal if it
does not cause a disturbance of your
health, but it will be a disease if it

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causes something, in these newborn

premature they have sleeping apnea, which
stops gas exchange, increase the CO2, when
it reaches to the point where it
stimulates the chemical receptors in the
brain it will cause the hyperventilation
or cause you to wake up and breath
normally "this is in our situation normal
one",
But if that level of CO2 does not affect
the centers because of prematurity in that
newborn it will reach 70ml hg of CO2
without waking up the centers, so it
causes a depression of respiratory centers
instead of stopping the apnea you go
deeper in it without shouting without
crying without moving until the
respiratory system is dead and the baby is
dead :'(
So this is the last thing that you should
know for the exam, study well, the doctor
hopes he has done good. Sorry for being
late and sorry for any mistake «.
Δϳ΍ΪΒ΍ Ϳ΍ ΔϋΎσ .... !ˮ΍Ϊ M ϦϳM Ϧϣ ϞϘE ϻ
Δϳ΍Ϊͫ΍ Ϳ΍ Δϋήη .... !ˮϲϘϳήσ ϦϳM ϞϘE ϻ

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ΔϳΎϔϛ Ϳ΍ ΔFN .... !ˮϲϤ όϧ ϦϳM ϞϘE ϻ

ΔϳΎϬF΍ ϲEQE Ύ͛έ .... ! MO M OP΍ ̼ ϞϘE ϻ

I believe in you NeRDzZz Ë

Your sister: nada nammas.

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