Lecture 4/3 - Pulmonary Anatomy Flashcards
Test 3
How much oxygen is in the lung, in between breaths, in a healthy adult, at rest, in the upright position? Please solve.
- Volume in between breaths is FRC = 3L
- PAO2 = 100 mmHg
- Solve for O2 concentration in lung:
- 100mmHg/760mmHg = 0.1316 - solve for total volume of gas:
3L x 0.1316 –> 0.395 L or 395 ml of O2 in the lung
______mls of inhaled air in the lungs will reduce the PCO2 in the lungs by _____ mmHg
350 mls
4 mmHg
We bring in _____ ml a fresh air into the lungs. How much is already there? What happens to the rest of the VT?
350
3L
150ml = anatomic dead space
Blood leaves the lung via the pulmonary ________
Vein (right)
Blood comes into the lung via the pulmonary _______
Artery (left)
The oxygen tension is ________ in between breaths
100 mmHg
PA = (after equilibration)
Pressure in pulmonary vein
The O2 concentration in dry atmosphere is ____% and in humidified inspired air is _____%. Why is there a difference?
21%
19-20% (displaced by water vapors)
The O2 concentration _______ as we go deeper into the system. What is that? concentration value?
Decreases
13% (still correspondence to PO2 of 100mmHg)
We have _____ ml of O2 in the lungs in between breaths, if we are healthy, resting, and upright
395 ml
The body consumes ______ of O2 per minute
250 ml
If we have 395ml of O2 in the lungs and our body consumes 250ml of O2 per minute, can we hold our breath for 2 minutes?
Yes.
Although uncomfortable, we can. We have less than two minutes of O2 in the lungs, but pulmonary blood can absorb more oxygen that’s tucked away in the lungs.
(we cannot do this for a very long time though)
How does anesthesia affect oxygen in the lungs?
Pt is no longer upright, awake, at rest –> pt is supine, sedated, paralyzed
lung volumes drop below RV
Can drop under 1L
Decreased RV –> completely decreased O2 reserve
(remember has 395ml when at FRC and upright/healthy at FRC!!, now we are BELOW RV)
Why is preoxygenating before intubating important? Give a few examples.
Decreased RV –> decreased O2 reserve –> decreased time to intubate
- Known difficult airway.
- Need more time to secure the airway (Student just learning like myself)
Giving 100% oxygen (pre-oxygenating) will help increase their O2 reserve to give me more time in case something goes wrong.
Anesthetized patients RV can drop below ____ L
1L
The ____ lung is bigger. Give a brief description.
Right
Heavier
More volume
Why is the left lung smaller?
Piece carved out to fit the heart
The _____ lung is taller
Left
The R lung has ___ lobes and the L lung has ____ lobes. All the lobes are separated by _______.
2
1
Fissures
How many lobes does the R lung have? What are they called?
3
Superior lobe
Middle lobe
Inferior lobe
How many fissures does the R lung have? What are they called?
Horizontal fissure (top): separates superior & middle lobes
Oblique fissure (bottom): separates middle & inferior lobes
Describe the oblique fissure
In the R lung
At an angle
Separates middle & inferior lobe
What allows the lungs to slide around in the chest cavity? (2) Describe them.
- Visceral pleura: attached to lung.
- Parietal pleura: attached to chest cavity.
Both have thin layer of slippery fluid/ mucus to help decrease friction when the lungs are expanding/contracting during breathing
Pain/inflammation between these two spaces is from _______. What symptoms would you see?
Infection
Pain when breathing –> lungs not being able to slide freely in chest from friction
Subdivisions w/i lung/lobe are called _________
Bronchopulmonary segments
There are ____ bronchopulmonary segments in the R lung and ______ in the L lung.
R = 10 (larger)
L = 8 (smaller)
What does visceral mean?
Organ
What is the pleural space? What is there?
“potential space” between visceral pleura & parietal pleura.
-Usually just fluid.
-sometimes a pocket of air
Is there is air located in the “potential space” where would it form? What is this?
Costodiaphragmatic recess: opening between top of diaphragm & side of rib cage
This is found at the corner of the lung
The diaphragm is fastened into the base of the ______
Thorax
The muscle fibers of the diaphragm connect here; also the heart and lungs sit here ________
Central tendon
T/F: the heart moves up and down with the diaphragm during breathing
T
Why is the L lung taller?
Both the heart and lung sit on the central tendon depressing the L side of the diaphragm more than the R side
Where are the diaphragm anchoring points?
Muscle fibers of diaphragm: central tendon
Leaflets/cusps of diaphragm: vertebral bodies on L spine
Healthy, quiet breathing is primarily a result of the ________
Diaphragm
During healthy, quiet breathing getting air out of the lungs is a result of _________. Why does this occur?
Passive recoil
This pressure is generated when the diaphragm drops (contracts) during inspiration –> lung stretch –> air pulls in –> recoil is generated
What are scalene muscles? How many of them do we have? What do they do?
Muscles that assist when increased WOB is necessary
3 sets on each side of neck = 6 total
Stabilize the top of the thorax as the diaphragm drops
Where are the scalene muscles located?
Anchored to base of skull/neck vertebrae = C spine & rib 1/2
What do the scalene muscles do/prevent?
-helps hold the thorax in place –> provides more effective inspiration
-thorax/ribcage from being pulled down when diaphragm contracts (drops) during inspiration
As this would prevent as much air from entering into the lungs
What and where is the mastoid process?
Bone behind the ear
What does the sternocleidomastoid muscle attached to?
-midline sternum (top of ribcage)
-mastoid process of skull (behind ear)
sternocleidomastoid muscle works similar to _______ muscle
Scalene
How does the sternocleidomastoid muscles work during inspiration?
Contracting this muscle at the same time as diaphragm contracts (drops) helps stabilize the thorax ribcage and prevents it from being pulled down
There are ____ sets of intercostal muscles. What are they called? Where are they located?
2
External intercostals: superficial/outer part of rib cage
Internal intercostals: inner side of rib cage
Where are intercostal muscles located in general?
Within the rib cage between the ribs
What does the term costal mean?
Rib
The external intercostals aid with _________. How?
Inspiration
They have two attachment points outside of rib cage –> when contract –> muscles pulled rib cage out –> thorax expands –> thorax move forward/anterior –> more area for air to enter in
With external intercostals aid the thorax moves _________
anteriorly/forward
The internal intercostals aid with _________. How?
Forced expiration
They have two attachment points inside of rib cage –> when contract –> muscles compress thorax –> thorax comes closer together –> air pushed out of lungs
When are the internal intercostals normally only used?
When breathing at a much faster rate and need to get air out of lungs, forcefully/quickly
How does contracting abdominal muscles assist with breathing?
Assists with forced expiration when needing to get air out faster than passive recoil allows
Contract abdomen muscles –> pushes abdomen contents upward towards diaphragm –> forces air out of lungs
Which abdominal muscles assist with forced expiration? Where are they located?
Rectus abdominis: front abdominal muscles
Oblique muscles: side abdominal muscles
The abdominal muscles aided in increasing the ______ of forced expiration
Speed
What are the pectoralis muscles that assist with breathing? Where are they located?
Pec major: big superficial muscle on top, upper part of chest (more superficial)
Pec minor: lies deep to the pec major
They attach to the shoulder blades & top of the rib cage
How do the pectoralis muscles assist with breathing?
Stabilize the position of the thorax
They attach to the shoulder blades & top of the rib cage
When supporting your upper body with your arms (like leaning on a table) –> stabilize the thorax during inspiration when under stress –> put diaphragm and a great position to pull down more effectively –> easier deep inspiration
Why does someone lean on a table when they are out of breath?
Stabilizing the arms –> stabilizing the shoulder blades –> allows, pectoralis muscles to stabilize the position of the thorax to assist with deep inspiration
The upper part of the airway is called the _______ and it has ____ parts
Pharynx
3
What are the 3 parts of the Pharynx called? Describe them.
- Nasopharynx: top
Opening in nose - Oropharynx: middle.
Oral cavity - Laryngopharynx: lower.
Everything below oral cavity in through larynx
The Laryngopharynx travels from the _______ to the _______
Pharynx
Larynx
The _______ is the portion attaches the pharynx to the trachea
Larynx
What type of muscle is the tongue and the floor of the mouth? What consideration should we have with this?
Striad = skeletal muscles
These muscles are affected by paralytics!!!
When supine and paralyzed –> tongue is flaccid & falls back –> blocks larynx –> need to manipulate to get an ETT in
THIS IS WHY WE USE MAC AND MILLER BLADES
Why are the boney projections in the nose porous?
Where blood vessels sit
What are 2 roles of the upper airway? What is required for these two things to happen?
- Filter: mucus in nose make sure things don’t down into the lung
- Heat/humidifier: rapidly brings inhaled air up to body temperature, almost immediately and adds water papers
Rich blood flow is required for these two things to happen (porous boney projections in nose)
Where is the ethmoid bone located?
Middle of the face
Behind opening of nose
T/F: the ethmoid bone is sturdy
F
It is small, fragile, & easy to Fx
What are the bony projections in the nose called? How many do we have? Where are they located?
Conchae (singular = concha)
6 total
3 sets; 1 on each side of the nose
-Superior concha: Top of nose
-Middle concha: Middle of nose
-Inferior concha: Bottom of nose
The _______ bone is the main bone connecting the nasal ______
ethmoid
nasal sinuses
_______ is another name for concha (conchae)
Turbinate(s)
What is the shape on concha? Which is more or less prominent? What is the purpose of this shape?
They are curved
Most curved = inferior concha
Fairly curved = superior concha
Curved shape from the concha in the nose generates turbulence during inspiration
Turbulence is generated by ________ in the nose during ________. What is the purpose of this?
concha
inspiration
Turbulence = increased particles getting stuck in mucous in nose wall –> helps with filtration in the upper airway
Turbulence helps with _______ in the upper airway. This is caused by ______. What does this prevent?
filtration
concha
This prevents particles going into the lower airway (lungs)
The turbulence in the upper airway filters what types of particles? What are some examples?
Large particles: dust, pollen
(does not work well for small particles, such as smoke)
At rest, in a healthy adult about ______ of the air that we inspire comes through the nose. What happens to the remainder
1/2
nose
other half is inspired thru mouth
What is turbulence?
Spinning air
T/F: the turbulence in the upper airways can filter smoke
F
Only large particles. Smoke is too small.
A Coronal section view is looking from ________
Above (superiorly)
The superior & middle conchae are projections off of the _________ bone
Ethmoid
The inferior concha is continuous with the __________
Roof of the mouth/ hard palate
The inferior concha our projections off of ________ bone
Maxillary
What is the Maxillary bone?
Top part of the jaw/ upper mouth
Teeth are anchored in here
Teeth are anchored into the _______ bone
Maxillary
Porous conchae = increased risk of ________ –> increased risk of ________
Fracture
Bleeding
Porous bones increases the risk of ______
fx
Which conchae are the strongest?
inferior conchae
During nasal intubation, where would you want to insert the tube? Why?
Along the floor of the nose
-Should be flat
-can go underneath and to the side of inferior conchae
-avoids more fragile conchae
This helps to prevent breaking a conchae which can cause extensive bleeding into the lungs
Pressure can build up in the _________ with bad allergies. What symptoms might you see?
Maxillary sinus
HA
Uncomfortable breathing
worse with infection
What are sinuses surrounded by?
Fleshy material
The Crista Galli is an ______ projection off of the _____ bone and runs ______
Upward
Ethmoid
midline
The ______ is ________ that separates the L & R brain hemisphere
Falx Cerebri
connective tissue/membrane
The Crista Galli is projected into the _______ and is the connection point for the ________
cranium
falx cerebri
Cranial nerve V =
Trigeminal nerve
What is the main nerve that covers sensory in most areas of the face?
Cranial nerve V (trigeminal nerve)
What are the divisions of cranial nerve V? What areas of the face do they cover?
- Ophthalmic: forehead
- Maxillary: a proportion of mouth.
- Mandilubar: jaw.
What causes a brain freeze? What is the Tx?
Lots of nerves on roof of mouth/hard palate –> cold sensed in mouth by trigeminal nerve –> brain feel pain, but is confused about location dt trigeminal nerve having multiple divisions –> feels HA on forehead
Tx: push tongue on roof of mouth –> warms roof of mouth
The external acoustic meatus is directly ________ to the mastoid process
anterior
What is the opening for the inner ear called?
External acoustic meatus
The boney top of the mouth is the _______
Hard palate
The ethmoid bone is in the ______ of the cranium
Front
Smell sensors route through the __________ plate of the ________ bone
Cribriform plate
Ethmoid bone
Where are Olfactory neurons located? What is the significant of this?
Cribriform plate of the ethmoid bone
This area is a portion of the top of the nose where olfactory neurons work their way into the nose so we can smell what we are taking in
Smell sensors are located on the ______ of the ethmoid bone, cribriform plate
Top
T/F: pores in the ethmoid bone allows route for smell sensors to route smell back to brain
T
Why is the nose a great place to absorb drugs?
-has neurons
-highly vascular
-very porous
All of these things combined = direct connection to the brain
CN V covers sensory functions to what areas in the pharynx?
- Oropharynx
- Back of nose
CN X covers sensory functions to what areas in the pharynx? What other areas?
Larynx to trachea (back of oropharynx thru larynx & trachea)
Vallcula
Epiglottis
Posterior/inferior throat
CN IX covers sensory functions to what areas in the pharynx? What other areas?
Small portion of back of mouth
Anterior to the epiglottis (small part of the very back 1/3 of the tongue-where it looks bumpy)
CN IX =
Glossopharyngeal nerve
CN X =
Vagus nerve
Where/what is the epiglottis? What does it do?
Big piece of cartilage
Sits at back of tongue
Opens/closes airway when we need to swallow; prevent prevents food from going into larynx/trachea by closing off and allows food to go into the esophagus
T/F: somatic sensations include taste
F
Touch, pressure, pain, tickle, itch
Somatic sensation: The posterior ____ of the tongue is innerated by _______
1/3
CN9
Somatic sensation: The anterior ____ of the tongue is innerated by _______.
2/3
CN5 –> mandilubar division (V3)
What does CN5 - V3 mean?
Trigeminal nerve mandilubar division
T/F: the taste sensations are the same throughout the tongue and epiglottis
F
epiglottis doesnt have many taste sensations
What nerves innovate certain areas of the tongue for taste sensation?
Epiglottis: CNX
Posterior 1/3: CN9
Anterior 2/3: CN7
CN VII =
Facial nerve
The soft palate is _____ and ______ to the hard palate. Where is it located?
Posterior
Inferior
The soft palate hangs off the back of the hard palate
How could the soft palate create a difficult airway?
It is made out of soft tissue and is dangling at the back of your airway
If too much is hanging off of the back of the hard palate –> obstruction
What what typically causes people to snore?
Too much of the soft palate hanging off the back of the hard palate causing an obstruction in the airway
The uvula projects off the _______
Soft palate
How many types of tonsils do we have? Where are they located?
3 types
- 2 palatine tonsils: back of the mouth
- 1 pharyngeal tonsil: nasopharynx (back of nose); behind soft palate
- 1 lingual tonsil: hangs on at the base of the tongue
How many total tonsils do we have?
4
What happens if the Pharyngeal tonsils be becoming enlarged?
Situated behind soft palate –> push against soft palate –> make airway more difficult to access
Palantine tonsil is ______ to lingual tonsil
superior
