respiratory 221 cardiopulmonary anatomy and physiology
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RESPIRATORY RESPIRATORY 221 221
CARDIOPULMONARY CARDIOPULMONARY ANATOMY AND ANATOMY AND PHYSIOLOGYPHYSIOLOGY
Chapter 1Chapter 1
Main function of lungs – bring Main function of lungs – bring atmospheric gases into contact with the atmospheric gases into contact with the bloodblood
Ventilation – The process of moving gas Ventilation – The process of moving gas in and out of the lungsin and out of the lungs
Respiration – moving oxygen and Respiration – moving oxygen and carbon dioxide between air and bloodcarbon dioxide between air and blood
Upper AirwaysUpper Airways
Most important functionMost important function warmswarms humidifieshumidifies filtersfilters
Consists of Consists of nosenose oral cavity (mouth)oral cavity (mouth) pharynx (throat)pharynx (throat) larynx (“voice box”)larynx (“voice box”)
inspired gas (air)
1. Nose1. Nose Air conditioningAir conditioning and filtering device and filtering device
Nose is more resistant to airflow than Nose is more resistant to airflow than mouthmouth
Despite that resistance: Most adults Despite that resistance: Most adults breathe through the nose at times of restbreathe through the nose at times of rest
***High nasal resistance from swollen ***High nasal resistance from swollen mucous and rapid breathing from mucous and rapid breathing from exercise usually cause people to switch exercise usually cause people to switch to mouth breathing. to mouth breathing.
NASAL CAVITYNASAL CAVITYSeptumSeptum
Cartilage – Divides nose Cartilage – Divides nose Right and Left NostrilRight and Left Nostril Clinically = Right and Left Clinically = Right and Left NASAL FOSSAENASAL FOSSAE
Some deflection occurs slightly to the Some deflection occurs slightly to the leftleft Clinical Significance ___________________Clinical Significance ___________________
Difficulty breathing through nose?Difficulty breathing through nose? Deviated Septum? (Next Slide)Deviated Septum? (Next Slide)
Nasal Cavity - Anatomical Nasal Cavity - Anatomical StructuresStructuresCONCHAECONCHAE
Three Conchae bonesThree Conchae bones Superior, Middle, InferiorSuperior, Middle, Inferior Create TurbulenceCreate Turbulence AKA TurbinatesAKA Turbinates
Conchae – covered with mucous Conchae – covered with mucous membranesmembranes
Main purpose is to filter, Main purpose is to filter, humidification, heat inhaled airhumidification, heat inhaled air
Source: mayoclinic.com/health/medical/IM02743
Nasal FossaeNasal Fossae
3. Pharynx
Greek – “throat” Comprised of 3 landmarksComprised of 3 landmarks
Where the Nasal Cavity ends all the way down right Where the Nasal Cavity ends all the way down right before the Larynx and Trachea- Fig 1-1 page 3before the Larynx and Trachea- Fig 1-1 page 3
1. Nasopharynx 1. Nasopharynx -behind nasal cavity down to soft -behind nasal cavity down to soft palatepalate
2. Oropharynx 2. Oropharynx --behind oral cavity from soft palate to behind oral cavity from soft palate to base of tonguebase of tongue
3. Laryngopharynx aka Hypopharynx - 3. Laryngopharynx aka Hypopharynx - below base below base of tongue and above larynxof tongue and above larynx
By the time air reaches the nasopharynx, inspired air By the time air reaches the nasopharynx, inspired air gains water vapor and heat from the nose and gains water vapor and heat from the nose and humidificationhumidification
Concept Question 1-1, pg. 5 Answer:
Nasal Cannula: At what flow rate does the nose lose its ability to humidify oxygen?
Recommendation:
Ventilator Artificial Nose – or HME
Drawback –
If thick secretions -
Back to the Pharynx NASOPHARYNX- pg 5
Connected to the middle ear by the Eustachian Tubes aka _______________
AUDITORY TUBESAUDITORY TUBES
OuterMiddle
Inner
Eustachian Tube
Ear Drum
Middle Ear = Space behind ear drum
Pharynx (cont) pg 6 The laryngopharynx (hypopharynx) separates
the Esophagus and Trachea.
(digestive &respiratory tracts)
Sensory & motor nerves effect on pharyngeal muscles prevents food and liquid aspiration in the trachea
PHARYNGEAL REFLEX Stimulation of this nerve = Gag & Swallow
Deeply unconscious patients may lose gag reflex Aspiration risks increase Intubation and mechanical ventilation is necessary
Pharyngeal Muscle Tonepg 6
Loss in muscle tone Base of tongue may fall back and occlude the
laryngopharynx Snoring
Excessive occlusion/blockage = apnea• Apnea = No air movement… No breathing
Intubation
Often done in patients who need support in ventilation
Endotrachael Tube is inserted into the trachea (Nasally, Orally, Tracheostomy)
Pharynx
Fig. 1-5
C – Sniffing position. Pulls the tongue forward out of the way of the airway. Best for intubation
Pharynx
4. LARYNX4. LARYNX•Sometimes called the “VOICEBOX”•Vocal cords control the size of the opening of the trachea (glottis)
•Main Cartilage of the Larynx (the middle of neck)is the Thyroid Cartilage, aka “ADAM’S APPLE”
• Function – Speech and __________________
Epiglottis – FlapLarynx – aka Voice BoxCartilage beneath it – Thyroid Cartilage “Adam’s Apple
At the opening of the Larynx
Epiglottis
The epiglottis does not “seal” the airway, instead, the upward movement of the larynx toward the base of the tongue pushes the epiglottis down, diverting food away from the glottis.
Left – No breathing or swallowing
Right – Swallow is initiated. Larynx moves up…. Forces the epiglottis to bend down
Left – Epiglottis bends downward… Redirects from the the larynx and trachea… Doesn’t seal it… just diverts food to the esophagus
Right – Food passes to Esophagus
Left – After a complete swallow, the Epiglottis starts lifting up againRight – Epiglottis continues to lift up now as the patient begins to exhales
Left – as exhalation continues to the oropharynx, epiglottis is now nearly shut
Right – As the air flows out the mouth, epiglottis is completely shut
Epiglottitis
Life Threatening Drooling/Difficulty Swallowing/Breathing Intubation
INTUBATION VISUAL INTUBATION VISUAL
Thyroid and Cricoid
Fig. 1-6
Thyroid is what we refer to as the Adams Apple… It encloses the main cavity of the Larynx
Cricoid
Narrowest portion of the upper airway in the infant
Not the narrowest in the adult, however passing Endotracheal through may still be difficult
Vocal Cords Form triangular opening into trachea
narrowest part of adult larynx Can open and close
when closed allows pressure generation needed to cough• Cough = important defense mechanism for lung
artificial airway removes vocal cords’ ability to seal airway and cough effectively
Vocal cord edema (croup - Pediatrics; stridor - ETT)
Laryngospasm during extubation - hoarseness
Upper Airway Summary
The nose alters inspired air by:
A. Humidifying, cooling, and reducing flow velocity
B. Cooling, filtering, and humidifying
C. Humidifying, filtering, and warming
D. Warming, reducing flow velocity, and filtering
Upper Airway Summary
The ________ is referred to as the voicebox
A. Pharynx
B. Larynx
C. Trachea
D. Cricoid
Upper Airway Summary
The Adam’s Apple is the name given to the:
A. Thyroid
B. Larynx
C. Trachea
D. Cricoid
Airways Vs. Alveoli
Lower Airwayspg 10
Dichotomous branching pattern from trachea Each airway divides into two smaller airways
(See next slide)
Each bifurcation creates new generation of airways
Tracheobronchial “tree” Figure 1-8
Lower Airways
Fig. 1-8
Also referred to as:
Conducting AirwaysNo gas exchange takes placeThis are can be obstructed with secretions and mucus
This is part one of the lung… the other part is the parenchyma where the alveoli and tissues exist.
Trachea and Main Bronchi Trachea
8-20 C-shaped cartilages Begins at 6th cervical vertbra 11 cm long in adults 1.5-2.5 cm in diameter
Carina – point of division fig-1-8 bifurcation of trachea into right and left bronchi right bronchus at 20-30 degrees from midline left bronchus at 45-55 degrees from midline
• smaller in diameter, but twice as long air is 100% saturated and at 37o C at this point
• ISB (Isothermic Saturation Boundary… See Fig. 1-10)
Application
During intubation, if the Tube is pushed too far, it most likely will enter the
____________________________
Chest Auscultation
Chest Excursion
Carina
Conducting AirwaysNo gas exchange takes placeThis area can be obstructed with secretions and mucus
Lung parenchyma where the alveoli and tissues exist is where gas exchange starts
Conducting Airway Anatomy Conduit or passage or pathwayonduit or passage or pathway
Airways: trachea to just before alveolar level: no gas exchange conduit for air to reach alveoli 23-27 subdivisions beginning at trachea
Right and left mainstem bronchi
Fig. 1-12
position patients during PD&P.
Problem with airway disease
Obstruction Airflow resistance
Lung Parenchyma ACINUS (pg 14) Functional tissue of the lung Contains elastic fibers
surrounds airways Gas Exchange takes placeGas Exchange takes place
Elastic fibers can be destroyed by disease Emphysema Prevents air from escaping the lung during
exhalation• “Air Trapping”
The AcinusThe Acinus
Fig. 1-13
THE ACINUS IS THE FUNCTIONAL RESPIRATORY UNIT OF THE LUNGS. ( ALL ALVEOLI ARE CONTAINED IN THE ACINUS) EACH TERMINAL BRONCHIOLE GIVES RISE TO AN ACINUS.
Alveoli and CapillariesAlveoli and Capillaries((Alveoli-Capillary Membrane)Alveoli-Capillary Membrane)
AlveoliAlveoli 300 million (300 x 10300 million (300 x 1066) alveoli in adult lungs) alveoli in adult lungs
100 to 300 microns (100 to 300 microns (m) in diameterm) in diameter
Pulmonary capillaries Pulmonary capillaries in contact with alveolar membranein contact with alveolar membrane just large enough to allow passage of red blood just large enough to allow passage of red blood
cellscells facilitate gas exchangefacilitate gas exchange
Alveoli and Capillaries
Fig. 1-17
Problem with Alveolar Disease
Compliance Elastance Restriction- where volume is restricted
Alveolar Disease
Alveolar Collapse Atelectasis ??
Clinical focus 1-5
Resistance
Airflow ObstructionAirflow Obstruction
Compliance
Distending Distending PropertiesProperties
Elastance
Recoiling Properties
Summary
Patients requiring a tracheostomy would benefit most from:
A. High airflows provided to the trachea
B. Dehumidified air provided to the airway
C. Cool mist for adequate hydration
D. Heated, humidified inspired air
CPR is often done outside the hospital setting. An important technique in ventilating the patient involves tilting the victim’s head back and thrusting the jaw forward. This is done to allow:
A. Better blood flow to the headB. Air forced into the mouth easier passage
to the lungsC. Easier mouth alignmentD. Reducing the chance of damage to the
upper airways
Certain lung diseases impair the A-C membrane’s gas-diffusing capabilities. An important consequence of this would be:
A. A decrease in blood oxygen levels
B. A decrease in blood carbon dioxide levels
C. An increase in blood oxygen levels
D. An increase in blood oxygen levels and carbon dioxide levels
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