Every Breath You Take and Some of Your Heartbeats Flashcards
understand the foundation of cardiopulmonary system
What is the path of the blood through the heart?
- Blood enters the right atrium from the superior and inferior venae cavae and the coronary sinus.
- From the right atrium, it goes through the tricuspid valve to the right ventricle.
- From the right ventricle, it goes through the pulmonary semilunar valves to the pulmonary trunk.
- From the pulmonary trunk, it moves into the right and left pulmonary arteries to the lungs.
- From the lungs, oxygenated blood is returned to the heart through the pulmonary veins.
- From the pulmonary veins, blood flows into the left atrium.
- From the left atrium, blood flows through the bicuspid (mitral) valve into the left ventricle.
- From the left ventricle, it goes through the aortic semilunar valves into the ascending aorta.
- Blood is distributed to the rest of the body (systemic circulation) from the aorta.
Lobes of the lung?
Left: 2 lobes, Superior, inferior. Right lung: 3 lobes, Superior, Middle, inferior
Key features of thoracic vertebrae
Thick vertebral bodies, inferiorly pointing spinous processes, long transverse processes
True ribs?
1-7, directly articulate with the sternum
False ribs?
8-10, don’t directly articulate w sternum, 10th rib is the costal margin
Floating ribs?
11-12, no contact w sternum
Body of sternum?
3-7th rib
Degrees of thoracic flexion and limitations?
30-40 degrees, limited by tension in posterior tissues
Degrees of thoracic extension and limitations?
20-25 degrees, limited by anterior longitudinal ligament and spinous processes
Degrees of thoracic lateral flexion and limitations?
25-30 degrees, limited by ribs
Degrees of thoracic rotation?
25-30 degrees
IRV?
Inspiratory reserve volume, Breathe in as much air as possible on top of normal inhale IRV=IC-TV
IC?
inspiratory capacity, how much inspiration can occur in total, IRV+TV
ERV?
expiratory reserve volume, max amount of air exhaled after a normal exhale, FRC-RV
RV?
residual volume, air left in the lung after a normal exhale, FRC-ERV
TV?
tidal volume, normal inhale and exhale, IRV +TV=IC
FRC?
functional residual capacity, erv +rv, equilibrium point for lung at rest
TLC?
Total lung capacity, IRV+TV+ ERV+RV OR VC+RV
VC?
vital capacity, top of max inhale and bottom max exhale, IRV+TV+ ERV
Pressure gradient of inspiration?
Muscle contraction, thoracic volume increases, thoracic pressure decreases, air flows IN to equalize pressure
Pressure gradient of quiet exhalation?
muscle relaxation, thoracic volume decreases, thoracic pressure increase, air flows OUT to equalize pressure
What nerves innervate the diaphragm?
R and L phrenic nerves (C3-C5)
Diaphragm insertion?
costal, sternal, and crural portions insert on central tendon, r hemidiaphragm higher than L
Primary muscles responsible for inspiration?
Diaphragm (60%), scalenes, external intercostals, internal intercostals, innermost intercostals
What are the accessory muscles of breathing of inspiration?
sternocleidomastoid, pec major, pec minor, serratus anterior, latissimus dorsi, erectors spinae
What is the role of the scalenes?
Active during inspiration to elevate and stabilize upper ribs, originate on transverse processes of C3-C7, insert on ribs 1 and 2, insert on ventral rami of C3-C7
Direction and location of external intercostals?
Fibers run inferiorly and medially, most prominent on lateral chest wall
Direction and location of internal intercostals?
Fibers run inferiorly and laterally, most prominent on anterior chest walls, primarly inspiration for anterior fibers and forced expiration for lateral fibers
Direction and location of innermost intercostals?
Fibers run inferiorly and laterally, most prominent in lower thorax
Role of abdominals is force expiration?
Active contraction, direct effects: flexes thorax, depresses ribs and sternum, indirect effects: increased abdominal pressure drives diaphragm superiorly. (also lateral fibers of internal intercostals transversus thoracis)
Requirements for coughing?
strong inspiratory effort (60% of vital capacity), control of glottis, strong contraction of abs
Ventilation in pulmonary fibrosis? Is this restrictive or obstructive?
Restrictive. Lung compliance decreases, increased muscular effort req for ventilation, increased work of breathing
What muscles elevate and stabilize the ribs during inspiration?
scalenes
sternocleidomastoid
What are the three articulations of the sternum?
chostochondral
chostosternal
interchondral: 5-10
Explain the bucket/pump handle of the thoracic cage?
Elevation of the lateral shaft of the rib with superior and anterior movement of the sternum with inspiration
Does exhalation decrease or increase thoracic pressure? Thoracic volume?
increase pressure
decrease volume
Which intercostals are used for inspiration?
external intercostals AND anterior internal (lateral are for forced expiration)
What three things are needed for a cough?
strong inspiratory effort
control of glottis
abdominal contraction
What does ECG monitoring reflect?
The electrical activity that immediately precedes mechanical activity
Normally: electrical activity and mechanical activity are synchronous, but separate events
What is a PEA?
dissociation, pulseless electrical activity in an ECG, electrical activity and mechanical activity has no relationship
What are the 4 basic steps of ECG interpretation?
Rate, regularity, intervals/waveforms, rhythm
When reading an ECG 1 large box = ____mm and ___ seconds?
1 Large box = 5mm and .2 sec
What is the rate of each of Sinus Bradycardia?
<60 bpm
What is the rate of Sinus Tachycardia?
> 100bpm
What are two reasons an Echocardiogram would be used instead of an X-Ray? What can the echocardiogram test for?
Greater detail and 2. less radiation -Measures chamber dimensions, wall thickness, chamber pressures, estimates EF%. -Assesses wall motion and valve function
Why would you use a transesophageal echocardiogram instead of a regular echo?
The view is critically important and the traditional isn’t clear or enough
What method of imaging gives you the best anatomical view of the heart’s anatomy?
MRI, can give better image quality if echo’s quality of image isn’t good.
What test gives you the best view of the coronary arteries?
CT scan
