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  <head>
    <title>013-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Ventilation, perfusion, diffusion, and gas transport">
      <outline text="Orientation and functional anatomy">
        <outline text="Oxygenation and ventilation are distinct">
          <outline text="Alveolar ventilation determines carbon dioxide removal"/>
        </outline>
        <outline text="Conducting airways warm, humidify, filter">
          <outline text="Cartilage in large, smooth muscle in small"/>
        </outline>
        <outline text="Type one cells form the thin surface"/>
        <outline text="Type two cells make surfactant and repair"/>
        <outline text="Interface: epithelium, interstitium, endothelium, plasma, red cell"/>
        <outline text="Pulmonary circulation is low pressure, low resistance">
          <outline text="Bronchial arteries add small physiological shunt"/>
        </outline>
      </outline>
      <outline text="Ventilation and dead space">
        <outline text="Minute ventilation: tidal volume times frequency"/>
        <outline text="Anatomical dead space stays in conducting airways"/>
        <outline text="Alveolar dead space: ventilated, barely perfused"/>
        <outline text="Alveolar ventilation subtracts dead space first">
          <outline text="Twelve by five hundred: four point two litres"/>
          <outline text="Twenty-four by two fifty: two point four litres"/>
          <outline text="Same minute volume, less carbon dioxide cleared"/>
          <outline text="Mechanism explained, not a ventilator prescription"/>
        </outline>
        <outline text="Dependent alveoli smaller but more compliant"/>
      </outline>
      <outline text="Alveolar gas and partial pressure">
        <outline text="Humidification lowers inspired oxygen pressure"/>
        <outline text="Alveolar oxygen: inspired gas, pressure, carbon dioxide"/>
        <outline text="Altitude lowers barometric pressure, not fraction"/>
        <outline text="Hypoventilation raises carbon dioxide, lowers oxygen">
          <outline text="Coupled change separates pure hypoventilation"/>
        </outline>
      </outline>
      <outline text="Diffusion">
        <outline text="Rises with area, coefficient, pressure gradient"/>
        <outline text="Falls with membrane thickness"/>
        <outline text="Carbon dioxide more soluble, diffuses readily"/>
        <outline text="Emphysema destroys exchange surface area"/>
        <outline text="Fibrosis and oedema lengthen diffusion distance"/>
        <outline text="Carbon monoxide keeps capillary pressure low">
          <outline text="Low in emphysema, fibrosis, anaemia, vascular disease"/>
          <outline text="Alveolar haemorrhage can raise the value"/>
        </outline>
      </outline>
      <outline text="Ventilation-perfusion matching">
        <outline text="Whole-lung average hides regional variation"/>
        <outline text="Apex: perfusion falls more than ventilation"/>
        <outline text="Bases: perfusion predominates, ratio lower"/>
        <outline text="Hypoxic vasoconstriction diverts blood from poor units">
          <outline text="Widespread hypoxia raises pulmonary pressure"/>
        </outline>
        <outline text="Shunt is perfusion without ventilation">
          <outline text="Collapse, fluid or pus, intracardiac flow"/>
          <outline text="Incomplete response to supplemental oxygen"/>
        </outline>
        <outline text="Dead space: ventilation without effective perfusion"/>
        <outline text="Alveolar-arterial difference widens with mismatch or shunt"/>
      </outline>
      <outline text="Oxygen transport">
        <outline text="Content: haemoglobin, saturation, dissolved oxygen"/>
        <outline text="Pressure drives diffusion and saturation"/>
        <outline text="Sigmoidal curve from cooperative binding">
          <outline text="Plateau protects saturation in the lung"/>
          <outline text="Steep region promotes tissue unloading"/>
        </outline>
        <outline text="Right shift: carbon dioxide, acid, heat, bisphosphoglycerate"/>
        <outline text="Anaemia lowers content despite normal saturation"/>
        <outline text="Carbon monoxide occupies sites, raises remaining affinity"/>
        <outline text="Methaemoglobin iron cannot bind oxygen normally"/>
      </outline>
      <outline text="Carbon dioxide and acid-base">
        <outline text="Carried dissolved, as carbamino, mainly bicarbonate"/>
        <outline text="Carbonic anhydrase speeds red-cell hydration"/>
        <outline text="Haemoglobin buffers hydrogen, chloride shift follows"/>
        <outline text="Lung oxygenation reverses the reactions"/>
        <outline text="Acute hypoventilation raises carbon dioxide, lowers pH"/>
        <outline text="Hyperventilation lowers carbon dioxide, raises pH"/>
      </outline>
      <outline text="Exercise, altitude, and fetal circulation">
        <outline text="Output, ventilation, perfusion, diffusing capacity rise"/>
        <outline text="Mixed venous oxygen falls, arterial maintained"/>
        <outline text="Breathlessness alone does not localise failure"/>
        <outline text="Altitude hypoxaemia drives respiratory alkalosis">
          <outline text="Kidneys excrete bicarbonate over days"/>
          <outline text="High-altitude pulmonary and cerebral oedema"/>
          <outline text="Descent and oxygen in severe illness"/>
        </outline>
        <outline text="Fetal exchange occurs at the placenta">
          <outline text="Fetal haemoglobin has higher affinity"/>
          <outline text="Birth: expansion, separation, shunt closure"/>
        </outline>
      </outline>
      <outline text="Applied interpretation and oximetry limits">
        <outline text="Hypoxaemia has five mechanisms"/>
        <outline text="Hypoventilation is the main hypercapnia mechanism"/>
        <outline text="Saturation on oxygen does not prove ventilation"/>
        <outline text="A normal carbon dioxide can be inappropriate"/>
        <outline text="Oximetry reads pulsatile light absorption">
          <outline text="Perfusion, movement, dyshemoglobins distort readings"/>
        </outline>
        <outline text="Measures no carbon dioxide, pH, or content"/>
        <outline text="A reassuring number never overrides deterioration"/>
      </outline>
    </outline>
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