Case 1 Flashcards
too hug yaffa
How is normal breathing achieved ( inspiration)
Internal intercostal relax
external intercostal contract
Diaphragm contracts inferiorly
How is normal breathing achieved ( expiration )
Internal intercostal contract
external intercostal relax
Diaphragm relaxes
elastic recoil of lungs
How is forced expiration achieved
accessory muscles force diaphragm up
internal and external obliques
transversus abdominas and rectus abdominas
How is forced inhalation achieved
accessory muscles
scalene , sternocleidomastoid, serratus anterior and pec minor increase thoracic cavity volume
Diaphragm contracts and external intercostal muscles contract
what do young children have to rely on for breathing
the descent of the diaphragm
Where are the group’s neurons located that control breathing
Medulla oblongata
pons
what are the 3 major collections of neurones
dorsal respiratory group
ventral respiratory group
pneumotaxic centre
what provides the basic rhythm of respiration
dorsal respiratory group of neurones
what signal neurones to the diaphragm
RAMP
what is the advantage of neurones ramp
causes a steady increase in the volume of the lungs during respiration rather than gasps
what initiates RAMP signal
apneustic centre
what calms down RAMP
pneumotoxic centre
what part controls the filling phase of the lung
pneumotoxic centre
what can a strong pneumotoxic signal do
Inspiration is short.
Breathing rate increases
what does the apneustic area do
coordinates transition between inhalation and exhalation
what can override apneustic area
pneumotoxic signal
what respiratory group controls normal quiet respiration
dorsal respiratory group
What lies next to the dorsal respiratory group
ventral respiratory group
what can cause the dorsal respiratory signals to spill over into the ventral respiratory neurones
when you are breathing rapidly
what is the ventral respiratory group used for
very heavy exercise and thus this is an overdrive system. It can stimulate both inspiration and expiration
What is the Hering Breuer inflation reflex
stretch receptors that activate when the lungs become overstretched. when they do become overstretched they activate a feedback loop that switches off the inspiration ramp
what chemoreceptors does oxygen act on
peripheral chemoreceptors
Excess carbon dioxide what does that act on
access carbon dioxide acts directly on the respiratory centre itself thus increasing respiration
Where is Alpha 1 antitrypsin made and what is it for
The liver and it protects the lungs
What is Tidal Volume
The volume of air exchanged during normal inspiration or expiration
What is IRV (inspiratory reserve volume)
The maximum volume that can be inspired in addition to a tidal inspiration
What is ERV ( Expiratory reserve volume)
The maximum volume that can be expired in addition to a tidal expiration
What is RV ( residual volume )
The volume remaining in the lungs at the end of a maximum expiration.
Which Lung volume can’t be measured during a test
Residual Volume
What do these stand for FVC/VC TLC RV TV IRV ERV IC FRC
Forced/vital capacity Total lung capacity Reserve volume Tidal volume Inspiratory reserve volume Expiratory reserve volume Inspiratory capacity Functional reserve capacity
What kind of process is Inspiration
Active process
What kind of process is Forced inspiration
Active process
What kind of process is expiration
Passive process
What kind of process is Forced expiration
Active process
What muscles are used in Forced inspiration
Accessory muscles - sternocleidomastoid, scalene muscles, serrated anterior and pec minor
What prevents lungs collapsing in expiration
Surfactant and inter-pleural pressure
What muscles are used in inspiration
Diaphragm and external intercostal
What muscles are used in Forced expiration
Internal ones - innermost and internal intercostal and transversals thoracis
Abdominal - external and internal obliques and Transversus abdominis and rectus abdominis
What are the layers of muscles on the belly deep to superficial
Transverse abdominis then rectus abdominis
What does the apneustic center do
Adjusts output of the DRG by continually stimulating it to build up the ramp signal from the DRG
What does DRG stand for
Dorsal respiratory group
What happens when respiratory drive increases for ventilation
DGR spills to the VGR and the inspiratory center of the VGR becomes activated
What nerves do the Dorsal respiratory group
Phrenic nerve
Intercostal nerves
Nerves for the accessory respiratory shite
What does the phrenic nerve innervate
Diaphragm
What nerves send nerve shite to the PONS
Vagus
Glossopharyngeal
What does Oxygen act on in terms of respiration group
Peripheral chemoreceptors
Where are peripheral chemoreceptors located
Carotid and aortic bodies
What do hydrogen ions do in terms of stimulation respiration
The have a direct effect in stimulating the neurones as CO2 reacts with water to form carbonic acid which dissociates into hydrogen and bicarbonate ions
What is the Hering Breuer Reflex
When the lungs are over inflated the stretch receptors activate
What does the hering breuer reflex do to the rate of respiration
Increase it
What does rising Pco2 do on smooth muscle in walls of arteries and capillaries
Vasodilation and increases blood flow
What does hypoxia mean bitch
Lack of o2 motherfucker
What is cyanosis caused by
Hypoxia
Where is the lung suspended from
It’s hilum from the mediastinum
What is the pressure normally of the fluid in the pleural cavity
Slightly negative
What does hypoxia mean
Lack of oxygen
What does pleural pressure mean
Pressure of “fluid” between visceral and parietal pleurae
When the Diaphragm is relaxed what are the relative pressures in Plural pressure , alveolus and atmospheric
Ppl>Palv
Palv=Patm
In inspiration what are the pressure differences in Ppl, Palv and Patm
Ppl<
In terms of long/short and narrow and wide what would cause greater airways resistance
Longer the airway and the narrower the airway the greater the airways resistance
What is compliance
An indication of a lungs expandability / how easily the lungs expand and contract
What type of alveolar epithelial cells secretes surfactant
Type II alveolar epithelial
What is surfactant a mixture of
Phospholipids, proteins and ions
What is a pneumothorax
Collection of air between the visceral and parietal pleura causing a real rather than potential pleural space.
What are the types of Pneumothoraxes
Primary Spontaneous
Secondary spontaneous
Traumatic
Tension
Explain the following pneumothorax PRIMARY and SECONDARY spontaneous
Primary = most common and caused by a rupture of a small subpleural emphysematous bulla .
Secondary = More deadly and caused by COPD or asthma (underlying Lung disease)
What is the difference in traumatic pneumothorax and tension
Traumatic = blunt trauma or penetrating, can also be associated with a haemothorax.
Tension = Most commmon during mechanical ventilation/ following a traumatic pneumothorax. Air flow is ONE WAY, LUNG INTO PNEUMOTHORAX . Air cant escape
What would the treatment for a tension pneumothorax be
Needle aspiration and chest drain
What is Dysponea
Laboured breathing
What would the percussion note be of a pneumothorax
Resonant
What is the most consistent finding in the clinical features of the pneumothorax
Reduction in breath sounds on the affected side
On an x ray what would the lung look like on the side with a pneumothorax
Extra black space
In a tension pneumothorax what can happen and be observed in an x ray
Trachea displacement and lung shrivels up away from the affected side
To confirm diagnosis what can be seen on the x ray in relations to the pleura
Clear line of visceral pleura with absence of peripheral lung markings beyond it
What will the arterial blood gases be in a pneumothorax
Hypoxia
What is a needle aspiration
Needle in 2nd intercostal space used as diagnostic tool for pneumothorax and to relieve pressure before a chest drain
What is a chest drain
Long tube that enters through the 5th intercostal space and goes down to a container with water that acts as a one way valve
What is the ATLS protocol for
Standard method for the initial management of severely injured patients
In the ATLS protocol what does ABCDE stand for
A = airways B = breathing and ventilation C= circulation with haemorrhage control D= disability and Neurological status E = exposure and environment
What are the two divisions of the Autonomic nervous system
Sympathetic and parasympathetic
What do the SNS and PNS secrete
Acetylcholine
Norepinephrine
What are the majority of the sympathetic in terms of adrenergic and cholinergic
Sympathetic are adrenergic
What are the fibres of Ach and Norepinephrine said to be
Ach = cholinergic N = adrenergic
What do the acetylcholine receptors activate
Nicotine receptors and muscarinic receptors
Where are the Ach nicotinic receptors found
Autonomic ganglia at the synapses between the preganglionic and postgangionic neurons - both SNS and PNS
Where are Ach muscarinic receptors found
All effector cells that are stimulated by the postganglionic cholinergic neurons of the PNS
What are all preganglionic neurons
Cholinergic
In the postganglionic system what are most of the sympathetic and parasympathetic
SNS = adrenergic PNS = cholinergic
What are the two major types of adrenergic receptors
Alpha and Beta
Where are alpha 1 found
Alpha 1 = found in the walls of blood vessels
What do Alpha 1 and Alpha 2 receptors do
Alpha 1 = smooth muscle dilation of walls of blood vessels
Alpha 2 = decreases cAMP formation. By inhibiting addenylate cyclase
What controls the Vasoconstriction and vasodilation of Alpha 1
SNS - stimulation of SNS causes vasoconstriction and less stimulation of SNS causes vasodilation
What do all beta receptors of adrenergic receptors stimulate
Adenylate cyclase
Where do Beta 1,2,3 live
Beta 1 = heart
Beta 2 = lungs
Beta 3 = fat cells
What do Beta 1,2,3 do to the Heart, Lungs and Fat cells
Increase cardiac output
Bronchodilation
Lipolysis of Adipose tissue
What receptors are G-protein couple receptors
Alpha and Beta
