Respirasi

Dr.Erniody, Sp.An.,KIC,M.Kes.
10 Juli 2015
- Bohr effect was first discovered by a guy named Bohr! He
discovered that there were other factors that affected the
loading/unloading of oxygen by Hb.
- One of the factors that he discovered was pH.
- He found that if the pH was lower than normal (normal
physiological pH is 7.4), then Hb does not bind oxygen as
well.

Deoxygenation of the blood increases its ability to carry

carbon dioxide; this property is the Haldane effect.
Conversely, oxygenated blood has a reduced capacity for
carbon dioxide.
Stroke volume (isi sekuncup) adalah jumlah darah yang
dipompa jantung ke dalam aorta setiap denyut ventrikel.

Preload adalah tenaga yang menyebabkan otot ventrikel

meregang sebelum mengalami eksitasi dan kontraksi.
Preload ventrikel ditentukan oleh volume darah dalam
ventrikel pada akhir diastolik.

Afterload adalah suatu tekanan yang harus dilawan ventrikel

untuk menyemburkan darah-->jantung harus bisa
mengeluarkan seluruh darah dari ventrikel kiri.
Pada klien yang mengalami krisis hipertensi akut, afterload
meningkat, sehingga meningkatkan beban kerja jantung.
VO2 is oxygen consumption (ml O2 min−1 kg−1)

Q is blood flow (ml min−1 kg−1)

[O2]a and [O2]v are arterial and venous oxygen content (ml
O2 dl−1)

In words, oxygen consumption equals blood flow times the a–

v O2 difference.
 The extraction ratio (ER):

is the ratio of oxygen consumption to oxygen delivery

Normally around 25%.

One of the primary functions of the cardiorespiratory system,
including the blood, is to ensure that all tissues are
adequately oxygenated at all times, i.e., that the PO2 in the
immediate environment of a cell exceeds the critical PO2
needed for normal mitochondrial oxygen consumption and
ATP production.
1. Stagnant hypoxia --> blood flow is abnormally low as occurs
in shock, syncope or other “low-flow” states.
- decreased blood flow (hypoperfusion) is the primary limitation
--> problem resides with the cardiovascular system.
- can be local (i.e., ischemic perfusion) or systemic (i.e.,
reduced cardiac output, C.O.).
- O2 delivery is abnormal since Q is less than normal. In order
to meet the continuing demand for O2, the amount of O2
extracted from the blood must increase. This means that
[O2]v will fall, as will venous PO2.
- Since PaO2 is normal, this defect is not sensed by the
respiratory chemoreceptors (i.e., carotid bodies). Thus,
increasing inspired oxygen fraction is not helpful to correct
the problem.
- Interventions to improve cardiac output or peripheral blood
flow (use of vasodilators) would be appropriate.
2. Hypoxic hypoxia: PO2 of arterial blood falls.
- inspired PO2 is lower than normal (high altitude) or it could be due to a
respiratory problem (e.g., hypoventilation, diffusion impairment caused by
pulmonary edema, ventilation–perfusion mismatch, or anatomic shunt of
blood past the gas exchange region).
- decreased arterial blood oxygenation (hypoxemia) is the primary
limitation --> problem resides with the respiratory system. Oxygen
delivery is abnormal since [O2]a is less than normal.
- The circulatory system responds in two ways to improve tissue
oxygenation. First, additional capillaries open to reduce diffusion
distances and increase the surface area for oxygen exchange; oxygen
extraction subsequently increases. Second, resistance vessels
(arterioles) dilate in response to decreased tissue PO2 to increase
perfusion and, hence, oxygen delivery. Venous oxygen content, [O2]v
and PvO2 will be less than normal due to the higher oxygen extraction.
- Since PaO2 is lower than normal (and presumably lower than the 50 mm
Hg threshold for respiratory chemosensory response), this defect is
sensed by the respiratory chemoreceptors (i.e., carotid bodies)
- increasing FiO2 Will be helpful except for the case of a pulmonary shunt
3. Anemic hypoxia occurs when the oxygen carrying ability of
the blood decreases, and thus, this defect is specifically
associated with the blood.

- The most common example occurs with decreased hematocrit

or true anemia.
- When the hemoglobin concentration inside RBCs decreases,
this also reduces the capacity of the blood to carry oxygen.
- Another example is CO poisoning, in which there is virtually
irreversible combination of CO with some heme-binding sites
on the hemoglobin molecule.
In order to maintain tissue oxygen consumption at baseline
levels associated with a normal oxygen carrying capacity of
blood, the reduction in oxygen delivery will lead to an increase
in capillary perfusion, and oxygen extraction will increase.
Arteriolar dilatation and viscosity reduction (for the case of a reduction
in Hct) will cause blood flow and oxygen delivery to increase. Both
oxygen extraction and oxygen delivery will continue to increase until
the oxygen requirements of the tissues are met or until the capacity to
increase oxygen extraction and delivery has been reached.
- venous oxygen content and PvO2 are less than normal.
- PaO2 is normal for all the anemic situations considered, this defect
is not sensed by the respiratory chemoreceptors.
- Thus, increasing the inspired oxygen fraction is not helpful except for
the case of CO poisoning, where high inspired oxygen (e.g., 100%
oxygen at ambient barometric pressure or placement of the subject
into a hyperbaric chamber) competes with CO binding at the heme
site (recall Haldane's first law).
Histotoxic hypoxia refers to a reduction in ATP production by the

- An example of histotoxic hypoxia is cyanide poisoning. There is

- Oxygen extraction decreases in parallel with the lower

oxygen consumption, with a resulting increase in venous
oxygen content and PvO2.

- Although cyanide stimulates the peripheral respiratory

chemoreceptors, increasing the inspired oxygen fraction is
not helpful, since there is already an adequate amount of
oxygen which the poisoned cells cannot use.
Effects of decreased oxygen saturation
(Broken Link 6 Jan 2015)

SaO2 Effect
85% and above No evidence of impairment
65% and less Impaired mental function on average
55% and less Loss of consciousness on average
 Mati menurut Agama:
• Islam: Pisah roh dari tubuh kita --> tidak ada tanda2
kehidupan
Dr. Bakr Abu Zaid's (1) Fiqh an-Nawazil (2) (Vol. 1, pp. 215-236, Article No. 4, printed by Maktabah ar-Rushd, Riyad, 1407).

• Katolik: Kematian bukanlah akhir dari segala-galanya tetapi

merupakan suatu perjalanan menuju kediaman abadi dalam rumah
Bapa.

an untuk-Mu ya Tuhan, jiwa kami belum tenang sebelum beristira

• Kristen: “mati” yang dimaksudkan di dalam kitab Kejadian
2:17 mempunyai makna ganda:
- mati secara rohani, yaitu hilangnya kemuliaan Tuhan, atau
citra Allah, yang menjadi pakaian mereka --> pertanda
putusnya hubungan mereka dengan Tuhan, Pencipta alam
semesta.
- mati secara fisik, yaitu putusnya nafas dari raga.

• Hindu/Budha: Reinkarnasi
Pengertian mati secara Hukum

meninggal dunia adalah keadaan insani yang diyakini oleh ahli k

Pasal 117 UU Kesehatan No.36 thn 2009

 Mati (PB IDI 1990)
• Fungsi spontan Pernafasan dan fungsi jantung
berhenti secara pasti.

• Terbukti Mati batang otak.

a.Mati Klinis/Somatis
Penderita dinyatakan mati secara klinis apabila berhenti bernapa
Kematian klinis masih reversibel apabila dilakukan BHD.

b.Mati Biologis
Kerusakan sel-sel otak dimulai 4-6 menit berhentinya pernapasa
setelah 10 menit biasanya sudah terjadi kematian Biologis.
c.Mati suri
kematian yang terjadi setelah mati secara biologis ini berlangsun

Jadi seseorang benar" dikatakan mati apabila 2 jam setelah tida

Seseorang dapat hidup lagi karena sel masih bisa memperbaiki

keracunan obat tidur, tersengat aliran listrik dan tenggelam

Mati serebral
kematian akibat kerusakan kedua hemisfer otak yang irreversible

Mati otak (mati batang otak)

kematian dimana bila telah terjadi kerusakan seluruh isi neurona
Jangan pernah berhenti berusaha menyelamatkan seseorang sa

Mengatakan seseorang mati hanya dapat dilakukan oleh seoran

KETERLAMBATAN KEMUNGKINAN BERHASIL

1 Menit 98 dari 100

4 Menit 50 dari 100

10 Menit 1 dari 100

Catatan: Bila ada tanda kematian pasti,seperti kaku mayat ata

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