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Paramedics Y1S2 > BEH Breathing and Ventilation > Flashcards

BEH Breathing and Ventilation Flashcards

1
Q

What are the three main gases in the atmosphere and there concentrations?

A
  • Oxygen, O2 - 20.946%
  • Nitrogen, N - 78.084%
  • Carbon Dioxide - 0.035%

*Also Water Vapour*

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2
Q

What is Dalton’s Law of Partial Pressures?

A

The total pressure exerted by a mixture of gases is equal to the sum of the pressures that could be exerted by the gases independently.

PTOTAL = P1 + P2 + P3 …

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3
Q

What is the Atmosphereic Pressure at Sea Level?

A

760 mmHg

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4
Q

How do you work out the partial pressure of a gas in a mixutre?

A

The partial pressure is directly proportional to the percentage of gas, in the gas maxture

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5
Q

Define Inspiration and Expiration.

A

Inspiration (Inhalation): the movement of air from the external environment through the airways into the alveoli during breathing

Expiration (Exhalation): the movement of air from the alveoli through the airways to the external environment during breathing

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6
Q

What are the 3 functional components of a respiratory system?

A
  1. Gas Exchange - Gas transfer with the atmosphere
  2. Air Pump - Mechanics of Breathing
  3. Regulation - Driver of Ventilation
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7
Q

Map the Pathway of Air into the lungs.

A

Atmosphere → nose/mouth → pharynx → larynx → trachea → bronchi (singular, bronchus) → bronchioles → terminal bronchioles → alveoli

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8
Q

Label the components of the Respiratory System.

A
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9
Q

What is the difference between the Conducting Zone and the Respiratory Zone?

A

Conducting Zone: air passages that extend from top of trachea to beginning of respiratory bronchioles and have walls too thick for gas exchange between air and blood

  • Makes up the anatomical dead space, ~30% will sit in this region

Respiratory Zone: portion of airways from beginning of respiratory bronchioles to alveoli; contains alveoli across which gas exchange occurs

  • ~70% of air makes it to the respiratory zone
  • Includes:
    • Respiratory bronchioles
    • Alveolar ducts
    • Alveolar sacs
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10
Q

What is the Anatomical Dead Space?

A

Space in respiratory tract airways where gas exchange does not occur with blood.

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11
Q

What is the difference between Respiration and Ventilation?

A

Respiration: (cellular or internal) oxygen utilization in metabolism of organic molecules; (respiratory system or external) oxygen and carbon dioxide exchange between organism and external environment

Ventilation: air exchange between atmosphere and alveoli; alveolar air flow. It is a mechanical process that depends on volume changes in the thoracic cavity, consists of inspiration and expiration.

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12
Q

Describe the pathway Oxygen takes when Diffusing across the respiratory membrane.

A
  • Alveolar surfactant
  • Alveolar epithelium
  • Epithelial basement membrane
  • Interstitial fluid
  • Capillary basement membrane
  • Capillary endothelium
  • Blood plasma
  • Erythrocyte membrane and intracellular fluid
  • Haemoglobin

*Vice Versa for Diffusion of CO2*

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13
Q

Identify some differences between the Pulmonary and Systemic Circuits.

A
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14
Q

Label components of the Respiratory System.

A
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15
Q

What is Fick’s Law?

A

an observed law stating that the rate of diffusion across a membrane is directly proportional to the concentration gradient of the substance on the two sides of the membrane and inversely related to the thickness of the membrane

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16
Q

What is the equation for Fick’s Law?

A

Gas Transferred ∝ A x D x (P1O2 − P2O2)/T

  • A = area for diffusion
  • (P1O2 - P2O2) = pressure difference between tissue
  • D = diffusion constant which depends on the properties of the gas and the tissue its passing through
  • T = thickness of the tissue

*Fick’s Law = Governs the rate of diffusion in the alveoli*

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17
Q

How does Fick’s Law apply to Alveoli?

A
  • Alveoli have a surface are of 50-100 m2
  • Partial pressure difference of oxygen between the alveoli and the oxygen in the blood to be oxygenated is about 60-65 mmHg
  • The thickness of the alveoli → very small, only several microns thick

*ALL ADVANTAGEOUS FOR DIFFUSION TO OCCUR*

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18
Q

How do Gases such as O2 and CO2 cross plasma membranes?

A

Via the process of Diffusion → from areas of high partial pressure to areas of low partial pressure

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19
Q

What are the two methods of transport for oxygen in the blood?

A
  1. bound to Haemoglobin (Hb)
  2. dissolved in blood plasma
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20
Q

How many molecules of O2 bind to one molecule of Hb?

A

Four

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21
Q

What is the equation to work out the O2Saturation of Blood?

A

O2Saturation = O2Combined with Hb/O2Capcity x 100

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22
Q

Approximately what Percentage of O2 will bind with Hb and what percentage will dissolve in the blood plasma?

A

Hb = ~98.5%

Blood Plasma = ~1.5%

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23
Q

What is the equation for the total oxygen concentration in blood?

A

Total Oxygen Concentration in Blood = [1.39 x Hb x O2saturation (%)] + [0.003 x PO2]

*Units = (mls/ 100mls of blood)

24
Q

What is the Oxygen-Haemoglobin Dissociation Curve and what are some factors that affect it?

A

Oxygen-Haemoglobin Dissociation Curve: S-shaped (sigmoid) relationship between the partial pressure of oxygen and amount of haemoglobin saturation.

  • As PO2 drops due to O2 being diffused into the tissues, more O2 will dissociate from Haemoglobin

Factors that Affect O2 binding are:
• pH
• PCO2
• Temperature
• 2,3-BPG (Biphosphoglycerate - binds to haemoglobin which increases ability of haemoglobin to release O2)

25
Q

List some factors that will shift the Oxygen-Haemoglobin Curve to the right or left.

A
26
Q

How is CO2 transport in the blood?

A
  • Dissolved in plasma (7-10%)
  • Bicarbonate ion in plasma (about 70%)
  • Carbaminohaemoglobin (about 20%)
    • CO2 + Hb ↔ HbCO2
27
Q

What are the muscles of inspiration and expiration?

A

Inspiration:

  • Sternocleidomastoid
  • Scalenes
  • External Intercostals
  • Diaphragm

Expiration:

  • Internal Intercostals
  • External Oblique
  • Internla Oblique
  • Rectus Abdominus
  • Transverse Abdominus
28
Q

What is Boyle’s Law and what process does it relate to?

A

Applies to ventilation and is a law that states; At a constant temperature, the pressure of a fixed amount of gas in a container is inversely proportional to container’s volume; P1V1 = P2V2

29
Q

What is Tidal Volume, Respiratory Rate, Minute Ventilation (Volume) and Alveolar Ventilation Rate?

A

Tidal Volume (Vt): air volume entering the or leaving lungs with single breath during any state of respiratory activity

Respiratory Rate (RR): number of breaths per minute

Minute Ventilation (Volume): total ventilation per minute; equals tidal volume times respiratory rate

Alveolar Ventilation Rate (AVR): volume of atmospheric air entering alveoli each minute

  • AVR = RR x (Vt - anatomical dead space)
30
Q

What is Inspiraotry Reserve Volume, Expiratory Reserve Volume, Residual Volume, Total Lung Capacity, Vital Capacity, Inspiratory Capacity and Functional Residual Capacity?

A

Inspiratory Reserve Volume (IRV): amount of air that can be forcefully inhaled after a normal tidal volume inspiration

Expiratory Reserve Volume (ERV): amount of air that can be forcefully exhaled after a normal tidal volume expiration

Residual Volume (RV): Amount of air remaining in the lungs after a forced expiration

Total Lung Capacity (TLC): Maximum amount of air contained in the lungs after a maximum inspiratory effort

Vital Capacity (VC): Maximum amount of air that can be expired after a maximum inspiratory effort

Inspiratory Capacity (IC): Maximum amount of air that can be inspired after a normal tidal volume expiration

Functional Residual Capacity (FRC): Volume of air remaining in the lungs after a normal tidal volume expiration

31
Q

What is the average tidal volume of an Adult an resting levels?

A

500 ml

32
Q

What is the Pleural Sac?

A

Membrane enclosing each lung

33
Q

What is the difference between Parietal Pleura and Visceral Pleura?

A

Parietal Pleura: serous membranes covering the inside of the chest wall, the diaphragm, and the mediastinum

Visceral Pleura: serous membranes covering the surface of the lung

34
Q

What is Intrapleural Fluid and name two of its functions?

A

Intrapleural Fluid: thin fluid film in thoracic cavity between pleura lining the inner wall of thoracic cage and pleura covering lungs

  • Allows the membranes to glide across each other during inspiration/expiration
  • Provides a strong adhesive force between the two pleural membranes
35
Q

What is Intrapleural Pressure, Transpulmonary Pressure and Intrapulmonary Pressure?

A

Intrapleural Pressure: pressure in pleural space; also called intrathoracic pressure

Transpulmonary Pressure: difference in pressure between the inside and outside of the lung (alveolar pressure minus the intrapleural pressure)

Intrapulmonary Pressure or Alveolar Pressure: air pressure in the pulmonary alveoli

36
Q

List the mechanical steps of Inspiration.

A
37
Q

List the mechanical steps of Expiration.

A
38
Q

Fill in the pressures that occur during Inspiration and Expiration.

A
39
Q

What is lung compliance and what are its determinants?

A

Lung (Pulmonary) Compliance: the magnitude of the change in lung volume produced by a given change in the transpulmonary pressure, the greater the lung compliance, the easier it is to expand the lung at any given change in transpulmonary pressure.

Determinants of lung compliance include:

  • Stretchability of the lung tissue
  • Surface tension at the air-water interfaces within the alveoli

*Lung compliance can decrease with due to degenerative lung disease such as TB and pulmonary fibrosis*

40
Q

What is the most powerful respiratory stimulant?

A

Rising CO2 levels

41
Q

How is breathing regulated?

A
42
Q

What will occur if PO2 increases, PCO2 decreases and H+ decreases in the blood plasma?

A

Ventilation will be decreased to retain more CO2 and therefore, restore normal levels.

43
Q

What will occur if PO2 decreases, PCO2 increases and H+ increases in the blood plasma?

A

Ventilation will be increaed top blow of more CO2 and therefore restore the body to normal levels

44
Q

What are some causes of Hypoxaemia?

A
  • decreased inspired oxygen
  • diffusion abnormality
  • hypoventilation
  • ventilation/perfusion mismatches
  • shunting
45
Q

What is Hypoxaemia and how is it different to hypoxa?

A

Hypoxaemia: low levels of oxygen in the blood

Hypoxic: inadequate oxygen is available to the tissues

46
Q

What are some common causes of Hypoventilation?

A
  1. Depression of the respiratory centre by drugs, e.g. barbiturates and morphine derivatives
  2. Diseases of the medulla, e.g. encephalitis, haemorrhage, neoplasms (rare)
  3. Abnormalities of the spinal cord, e.g. following high dislocation
  4. Anterior horn cell disease e.g. poliomyelitis
  5. Diseases of the nerves to the respiratory muscles, e.g. in the Guillain-Barré syndrome or diphtheria
  6. Diseases of the myoneural junction, e.g. myasthenia gravis or anticholinesterase poisoning
  7. Diseases of the respiratory muscles, e.g. progressive muscular dystrophy
  8. Thoracic cage abnormalities, e.g. crushed chest
  9. Upper airway obstruction, e.g. tracheal compression by the thymoma
47
Q

What may cause an breathing to be ineffective or absent?

A
  • Direct depression of/or damage to the breathing control centre of the brain
  • Upper airway obstruction
  • Paralysis or impairment of the nerves and/or muscles of breathing
  • Problems affecting the lungs
  • Drowning
  • Suffocation
48
Q

What should be done when assessing breathing?

A
  • LOOK for movement of the upper abdomen or lower chest
  • LISTEN for the escape of air from nose and mouth
  • FEEL for movement of the chest and upper abdomen
49
Q

What is the aim when providing ventilations?

A
  • Assisted ventilation is to offer ventilator support to a patient whose alveolar ventilation is inadequate
  • to maintain normal partial pressures of oxygen and carbon dioxide
  • Assisted ventilations creates a positive pressure that pushes air into the lungs

*Failure to provide adequate ventilation for an indicated patient will lead to hypoxia, CO2 retention, development of acidosis and cardiorespiratory arrest*

50
Q

What are the signs and symptoms of respiratory failure/distress?

A
  • Decreased, asymmetrical or absent breath sounds
  • O2 saturations, <90% on room air or <93% on high O2 concentration
  • Tachycardia, >120 or bradycardia as a late sign
  • Arrhythmias
  • Pallor and/or cyanosis
  • Cool pale clammy skin
  • Falling BP (late sign)
  • Changed mental status - confusion, combative
  • Decreased level of consciousness
  • Exhaustion (+/- muscular chest pain)
51
Q

What are the indications for Ventilation?

A

when spontaneous ventilation is inadequate or absent

52
Q

What are some problems that can occur with ventilation?

A
  • Decreased oxygenation
  • Lung aspiration due to gastric dilation
  • Gastric rupture
  • Lung injury (barotrauma - due to overdistention of alveoli)
  • hyperventilation (has been associated with decreased coronary and cerebral perfusion pressures)
53
Q

What are the volumes of the different Bag Valve Masks?

A
  • Adult size → 1600 mls
  • Paediatric size → 500 mls
  • Neonate size → 240 mls
54
Q

What is requried for successful bag-mask ventilation?

A
  • a patent airway
  • adequate mask seal
  • proper ventilation
55
Q

When providing a ventilation, at what time frame should it be provided over?

A

Delivered over 1-1.5 seconds.

*with a TV of ~500 mL at a rate of 10-12 ventilations/minute*

Paramedics Y1S2 (5 decks)

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