hardcore diagrams i – resp + cvshardcore diagrams i – resp + cvs co 2 ventilation curve reduce...
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![Page 1: Hardcore Diagrams I – RESP + CVSHardcore Diagrams I – RESP + CVS CO 2 ventilation curve Reduce threshold (RIGHT shift) – sleep, low dose opioids, light anaesthesia, alkalosis,](https://reader034.vdocuments.us/reader034/viewer/2022042222/5ec80b63a5a558332b33db34/html5/thumbnails/1.jpg)
Hardcore Diagrams I – RESP + CVS CO2 ventilation curve
Reduce threshold (RIGHT shift) – sleep, low dose opioids, light anaesthesia, alkalosis, denervation peripheral chemoreceptors Reduce sensitivity (↓gradient) – anaesthesia, high dose opioids Increase threshold (LEFT shift) – acidosis, pain Increase sensitivity (↑gradient) – hypoxia Note: acidosis DOES NOT alter sensitivity (i.e. gradient) O2 ventilation curve
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Spirometry of pregnancy
Summary:
(1) TV 40% increase (2) TLC/FRC/RV all 20% decrease (cephalad migration of diaphragm)
Ageing TLC Unchanged FRC Increase slightly RV Increase FVC Decreased
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Single breath nitrogen washout technique Technique 1. Breathe room air 2. Breathe out 3. Breathe in 100% O2 to TLC 4. Breathe out – measure N2 conc 5. Plot N2 conc vs volume
Phase I – anatomical dead space Phase II – mixed alveolar + dead space Phase III – plateau phase = mixed alveolar Phase IV – terminal rise = apical low V/Q alveoli Measures (1) anatomical deadspace and (2) closing volume Pressure Volume Loop
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Work of Breathing vs Respiratory Rate
Resistive work – airflow Elastic work Flow Volume Loops in Disease
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V/Q Matching Curve
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Airway Resistance
Max airway resistance @ 4th generation Note: the unit should be cmH2O / (L/s)
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Alveolar, Intrapleural, Transpulmonary Pressures vs Time
Key features: Inspiration shorter duration than expiration Intrapleural pressure is see-saw (acceleration/deceleration) Alveolar pressure is sinusoidal
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Chest Wall + Lung + Total Compliance
Plot lung volume on y-axis vs recoid pressure on x-axis Positive recoil pressure = springing inwards Negative recoil pressure = springing outwards When total recoil pressure = 0 ! balance of lung and chest wall ! this is FRC When CW+L crosses L curve is when CW crosses 0 recoil pressure i.e. when lung volume exceeds certain threshold, BOTH chest wall and lung want to spring inwards Lung and CW curve y-axis should start from residual volume and go up to total lung capacity
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Wigger’s diagram
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Pulmonary Artery Catheter Trace
Note1: negative intrathoracic pressure transmitted to RV ! RV diastolic pressure may be negative, esp. during inspiration Note2: blip in RV trace prior to isovolumetric contraction = atrial kick Note3: dichrotic notch for PA trace CVP waveform vs Pathology
Lost a wave ! atrial fibrillation
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Prominent a-wave + attenuated y-descent ! tricuspid stenosis
Cannon a-wave ! junctional rhythm, complete heart block, retrograde conduction, etc
Fused c-v wave ! tricuspid regurgitation
Steep x and y descents ! pericardial constriction (don’t really understand why this occurs)
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Prolonged y descent ! cardiac tamponade (don’t really understand this bit) Arterial Trace
Features of ageing: - decreased contractility ! ↓dP/dt - decreased compliance ! higher peak - decreased incisura - loss of Windkessel effect ! rapid descent
Features of peripheral vs aorta trace: phase delay, ↑SBP/↓DBP, loss of incisura due to damping, diastolic hump due to reflection
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Coronary Blood Flow vs Time
Systole Mean aortic root pressure = 120 mmHg Mean RVP = 25 mmHg Perfusion pressure = 95 mmHg Mean LVP = 120 mmHg Perfusion pressure = 0 mmHg Diastole Mean aortic root pressure = 80 Mean RVP = 5 mmHg Perfusion pressure = 75 mmHg Mean LVP = 5 mmHg Perfusion pressure = 75 mmHg
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Cardiac Action Potential
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