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Saturday, September 29, 2012

Dr. Creed: The Kreb Cycle theory of oxygen

Warning: What follows is top secret information surreptitiously leaked to me via one of the nations elite pulmonologists from an elite teaching hospital. Read at your own risk. This is not edited.


The Kreb's Cycle Theory of CO2 Depreciation:
The following is an excerpt from a speech made by Dr. Ven Tolin on March 17, 1960.  
Kreb's Cycle
It's an old theory, yet it's important to understand especially when dealing with CO2 retainers.  

Today I would like to present yet another brilliant theory as to why we doctors refuse to oxygenate hypoxic COPD patients.  The idea will give you a better understanding of why doctors have historically chosen to lower oxygen instead of increasing it or keeping it the same.

Many times a doctor will lower a patient's oxygen even when the RT "just knows" the patient needs oxygen to survive.  You know what I mean?  The PO2 will be 47, the CO2 100 or something like that, and the doctor says, "Lower the flow from 2lpm to 1pm."

RTs cringe at this because they can't seem to grasp that there is a deeper thought about this.  They can't seem to see beyond the surface.  Shallow minds they have, you might say.  Your RT will whine, "The patient needs oxygen!"  

Once again, ignore their silly rants.  You may even add a note on the chart that says something like, "Don't increase oxygen no matter what!"  That usually sets the RT in his place.  Anyway, I digress. 

Surely we doctors think too much and RTs not enough, that's my point. RTs need to stop thinking and just do what they're told, because my new theory will explain why doctors do this -- why we refuse to oxygenate CO2 retainers. 

It has to do with the Krebs Cycle.  Ah, so now I'm forcing you to remember way back in Anatomy and Physiology 101.  In case you don't remember you can check the picture I brought. Yet you don't need to remember all the details of that complicated scheme, just know what I'm about to tell you. 

Warning though:  don't tell an RT this because all the thought will swell his head and cause an aneurysm of the brain and his head will blow up or something.  We don't want that.  So keep it to yourself just like the rest of this DR. Creed shit.

First you have to have a recollection of the Krebs Cycle.  It's something like C6 H12 O6 to get 6 CO2 6H20.  This is your basic aerobic metabolism. 

So, if you don't have oxygen you can't have aerobic metabolism, and if you don't have aerobic metabolism you will get no CO2 product.

(Worded another way, if you don't add the 6 oxygen to the body, you won't get the 6 CO2.  By this way, by depriving the patient of oxygen, you will be helping the patient lower his CO2.)

Get the idea.  If you have a high CO2 you decrease the oxygen to prevent aerobic metabolism.  This will decrease the CO2 level. This is the best way to decrease the CO2 in the blood. 

It doesn't matter what the PO2 is because COPD patients can tolerate low PO2.  Surely RTs will cringe at this idea, but who cares what RTs think anyway. 

Check out the full Doctor Creed here.  

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