basics- stuff i should remember Flashcards
which part of the thorax is designed for mobility?
stability?
anterior thorax; ribs and sternum are for mobility
posterior thorax; spine is for stability
skeleton of thorax
ribs (2)
sternum (3)
components and sternal angle
ribs:
1. designed for mobility- go from lesser -> greater mobility as you move down ribs
2. 1 -7 true ribs,
8-12 are false ribs with greater potential for mobility 11&12 don’t insert on sternum
sternum:
3. mobility driven
4. 3 components are maubrium. body, and xyphoid
5. sternal angle = level of 2nd rib = level of carina
spine (3)
basics (2) costotransverse joints (1)
- stability driven, vertebral column stacking is for mechanical alignment and support
- ligamentous support, 3 articulations = very stable
- difference in upper and lower ribs costo-transverse joints:
ribs 1-7 rotate in ant/ sup direction
ribs 8-10 glide in lateral/ superior direction
functional movements of thorax
potential mobility of the chest (2)
primary directions of movements (3)
potential mobility of chest:
1. increases as you move inferior
2. increases as you move anterior
primary directions of movements:
3. upper ribs- primarily anterior and superior
4. middle ribs- transition btwn upper and lower
5. lower ribs- primarily lateral and superior
sequence of a normal breath (3)
- easy onset and subtle rise of upper abdomen
- lateral costal expansion of lower chest
- gentle rise of the upper chest, primarily in superior and anterior planes
3 primary respiratory muscles
- diaphragm
- intercostals
- abdominals
6 accessory muscles of respiration
and 2 comments
every muscle originating or inserting on trunk is a respiratory and postural muscle flexion muscles= expiration, extension muscles = inspiration ** except serratus anterior 1. erector spinae 2. pectoralis muscles 3. serratus anterior 4. scalenes 5. sternocleidomastoid 6. trapezius
diaphragm (4)
innervation
how much of TV effort and volume does it provide?
primary movement is dependent on…
- innervation- phrenic nerve C3-C5 (C3,4,5 keeps the diaphragm alive)
- major muscle of passive ventilation, provides 2/3-3/4 of TV effort and volume
- primary movement: dependent on intercostals and abdominal muscles to help generate adequate pressure changes btwn thoracic and abdominal cavities during inhalation.
- uses positive pressure of abdominal cavity to help stabilize central tendon of movement of ribs in lateral and superior direction
concentric and eccentric contraction of diaphragm
- concentric- quiet and forceful inhalation
2. eccentric- controlled exhalation and speech - can test by long term vocalization of any vowel sound
intercostals (6) innervation primary function primary movements in upper and lower chest and during forceful exhalation (3) eccentric contraction
- innervation- T1-T12
- primary function- stabilize rib cage during
inhalation to prevent chest wall from being pulled inward toward negative pressure created in thoracic cavity.
primary movement - upper chest- anterior and superior expansion
- lower chest- lateral and superior expansion
- forceful exhalation- medial and inferior compression in lower chest and posterior and interior compression in upper chest
- eccentric contraction- needed for controlled exhalation and speech
abdominals (5)
innervation
4 functions
- innervation- T6-L1
primary function: - stabilize inferior border of rib cage
- visceral support
- positive pressure for diaphragm
- necessary intrathoracic pressure for effective cough
erector spinae (2) innervation function
- innervation -T1-S3
2. stabilizes thorax posteriorly to allow normal anterior chest wall movement to occur
pectoralis muscles (4) innervation
- innervation- C5-T1
- when used in reverse order (arms binded down) can provide ant and lateral chest wall expansion
- assist in forced expiratory maneuvers when trunk moves into flexion
- substitute as rib cage stabilizer
serratus anterior (3)
- inn- C5-C7
- provides posterior expansion of rib cage when extremities are fixed
- only inspiratory muscle paired with trunk flexion (rather than extension)
scalenes (3)
- inn- C3-C8
- privides superior and anterior expansion of chest wall
- stabilizes upper chest during inhalation
SCM
- inn- C2-3, CN 11 (spinal accessory n.)
- provides superior and anterior expansion of chest wall
- stabilizes upper chest during inhalation
trapezius (3)
- inn- C2-4, CN 11 (spinal accessory n.)
- provides superior expansion of upper chest
- least energy efficient muscle
upper airways (2) 4 components and functions
- components: nose, mouth, pharynx and larynx
2. function- cleanse, heat and humidify air and resonance for phonation
lower airways (4)
3 portions
2 layers
what protects opening of lower airways?
- components of conducting airways: trachea, and right and left mainstem bronchi
- components of repspiratory airway: alveoli, cilia (sol = 90% and gel layer = sticky layer)
- cilia start around the 12th generation and hydration is key for bronchial hygiene and minimizing risk of bacterial infection
- vocal folds protect opening of lower airways
a note on lung lobes
where is lingula and cardiac notch?
which lung is most commonly aspirated? why?
- left lobe has lingula (instead of middle lobe) and cardiac notch
- right lower lung is most common to aspirate because angle of bronchi
lung physiology; control of breathing
3 respiratory centers in brain stem
2 chemoreceptors
2 reflexes
respiratory centers in brainstem 1. respiratory center in medulla 2. apnueustic center in pons 3. pneumotaxic center in pons chemoreceptors (CO2 sensitive) 4. central- medulla- very sensitive and efficient at monitoring CO2 5. peripheral- carotid bodies, less sensitive reflexes 6. cough/gag 7. muscle spinde
compliance- a mechanical factor in respiration
what is it?
what happens if you have too much/ too little?
chest wall fractures…
- compliance = ease at which lungs expand
not enough => can’t get in enough air
too much => can’t expirate all the air - chest wall fractures = too much compliance
lung volumes (4) TV IRV ERV RV
- tidal volume = amount of air moved in and out of lungs during quiet respiration
- inspiratory reserve volume= amt of air moved into lungs above normal tidal inhaltion
- expiratory reserve volume = amt of air moved out of lungs above normal tidal exhalation
- residual volume = amt of air that remains in lungs after forced exhalation
lung capacities (5) IC FRC VC TLC MV
- inspiratory capacity= TV +IRV
- functional reserve capacity = ERV + RV
- vital capacity= ERV + IRV + TV
- total lung capacity = IRV + ERV + RV + VC
- minute volume = TV * # breaths/ min
innervation of lungs (2)
- visceral- no somatosensory inn so no pain
2. parietal- innervated = can feel pain
where is ventilation best? (rule)
standing
side ly
supine
where gravity is pulling blood,
standing: its in the lower lobes of lungs
side ly: is on the bottom lung
supine: posterior aspect of lungs
airway resistance (2)
- excessively high airway resistance - air cannot move in unidirectional flow
- excessively low airway resistance- small airway collapse at end of inspiration
ventilation/ perfusion (V/Q) matching
what they are dependent on
mismatches -shunt vs. dead space and where they occur
- perfusion is position (gravity) dependent
- ventilation follows path of least resistance
- (V< Q) = dead space - lower lung
- (V>Q) = shunt - upper lung
2 things that affect diffusion
- ability of O2 to be transported
2. pulmonary- capillary membrane wall thickness
2 things that transport O2
- plasma
2. Hb
oxygen hemoglobin dissociation curve- shifts to the R under these 4 conditions
shifts to R = unloading O2 to tissues
- increase temperature
- increase PCO2
- increase 2,3 DPG
- decrease [H]
three major influences of chest wall development
- gravity
- muscle strength
- muscle tone
normal chest wall development- newborn (5) size and shape musculoskeletal developemnt development breathing pattern RR
- size and shape- triangluar in frontal plane and circular in horizontal; occupies 1/3 trunk
- musculoskeletal development- functions similarly to pelvis for stability
- parallel gross motor development- holding head up?
- breathing patterns- obligatory diaphragm breathers
- RR- 40-60
normal chest wall development - 3-6 months size and shape musculoskeletal developemnt development breathing pattern (2) RR
- size and shape- more rectulangar not elongated
- musculoskeletal development- upper thorax still functioning similar to pelvis; no axial rotation in T/S
- parallel gross motor development- leg rolling
- breathing pattern- upper and anterior chest expansion is possible
still primary diaphragmatic breathers, anterior - RR - decreasing
normal chest wall development- 6-12 months
* this is the most significant stage of normal chest wall development
size and shape- how does this compare to size at birth?
musculoskeletal developemnt
development
breathing pattern
- size and shape- more rectangular, now elongating and ribs being to rotate downwards; lung size increased 4x since birth
- musculoskeletal development- once ribs have rotated downward, elongation and rotation is possible
- parallel gross motor developemt- transition from creeping to walking = greater O2 demands
- breathing pattern- all patterns are available
normal chest wall development over 12 months
- trends continue but less dramatic, flaring ribs beecome less apparent as abdominals and intercostals become strongers
trends in aging (3)
- increased lung complaince, because of decreased elastic recoil of lung tissue
- decreased chest wall complainc
- decreased lung volumes and expiratory flow rates, except residual volume which increases
paradoxical breathing (2) paralyzed intercostals or abs
- upper chest collapses during inspiration
2. belly rises excessively, diaphragm does not encounter any resistance as central tendon descends
paralyzed breathing (2) paralyzed diaphragm
- lower chest and abdomen collapses during inspiration
2. upper chest rises excessively
7 other examples of paradoxical breathing
- diaphragm and upper accessory muscles only
- isolated diaphragm
- upper accessory muscles only
- lateral breathers
- asymmetric breathers
- shallow breathers
- altered speech support patterns
- diaphragm and upper accessory muscles only- paralyzed intercostals
- isolated diaphragm- SCI
- upper accessory muscles only- high SCI
- lateral breathers- weakness, not paralysis of trunk muscles
- asymmetric breathers- hemiplegia, post surgical
- shallow breathers- high tone patients
- altered speech support patterns- poor breath support or eccentric control
pulmonary circulation (2) normal and high Pressures, and why you have high P
- normal = 25/10, high= 50/30
- hypertension in lung comes from trying to shunt blood to where there is 02 is which is accomplished by vasoconstriction
