Mid-Term Exam - Part 1, Basics Flashcards
Sternal Angle
Level of the 2nd rib
Level of the carina
Potential Mobility of the Chest
increases as you move inferior increases as you move anterior Sternum: mobility driven Spine: stability driven the most potential mobility lies along the xiphoid process and the inferior borders of the anterior and lateral ribs
Movement of Ribs 1-7 (costo-transverse joints)
rotate increasing the thoracic dimensions primarily in the anterior and superior directions
upper ribs: primarily anterior and superior
Movement of Ribs 8-10 (costo-transverse joints)
glide increasing thoracic dimensions primarily in a lateral and superior direction
lower ribs: primarily lateral and superior
Spine:
a) Posterior Ligamentous Support
b) Anterior Ligamentous Support
a) three articulations, very stable (superior, lateral and posterior costo-transverse ligaments)
b) one flat articulating surface (ALL)
Sequence of a Normal Breath
Easy onset and subtle rise of the upper abdomen
Lateral costal expansion of the lower chest
Gentle rise of the upper chest primarily in the superior and anterior planes.
Lung Volumes / Capacities (8)
a) Tidal Volume
amount of air moved in and out of the lungs during quiet respiration
Lung Volumes / Capacities (8)
b) Inspiratory Reserve Volume
amount of air moved into lungs above normal tidal inhalation
Lung Volumes / Capacities (8)
c) Expiratory Reserve Volume
the amount of air that can be moved out of the lungs above normal tidal exhalation
Lung Volumes / Capacities (8)
d) Residual Volume
the amount of air that remains in the lungs after forced exhalation
Lung Volumes / Capacities (8)
e) Inspiratory Capacity
Tidal Volume + IRV
Lung Volumes / Capacities (8)
f) Functional Residual Capacity
ERV + Residual Volume
Lung Volumes / Capacities (8)
g) Vital Capacity
ERV + TV + IRV
Lung Volumes / Capacities (8)
h) Total Lung Capacity
IRV + TV + ERV + RV
Minute Ventilation
TV * # of breaths per minute
Upper Airways
Nose, Mouth, Pharynx, Larynx
Cleanse, Head, Humidity
Resonance for Phonation
Lower Airways
Conducting Airways: Trachea, Right Mainstem Bronchi (3), Left Mainstem Bronchi (2)
approximately 23 generations to reach the respiratory airways
Respiratory Airways: (gas exchange) alveoli
Lung Landmarks
Upper lobes: mostly anterior thorax
Middle lobe & Left lingula: tip at mid-axillary line, larger part anterior around level of the nipple line
Lower lobes: mostly posterior thorax, beneath the spine of the scapulae.
Respiratory Centers
Respiratory Center: medulla - not quite normal breathing
Apneustic Center: pons - inspiratory gasps
Pneumotaxic Center: pons - balances the above 2
Cilia
Sol Layer: 90% water
Gel Layer: sticky, catches pollutants
mobilize secretions upward
present to the 12th generation of lung divisions
Hydration is key for bronchial hygiene and minimizing the risk of bacterial infection
Chemoreceptors: CO2 sensitive
central: medulla, extremely sensitive
peripheral: carotid bodies, less sensitive
Distribution of Gas
Upright: better ventilation of the lower lobes of the lungs
Supine: better ventilation of the posterior aspects of the lungs
Side-Lying: better ventilation of the side which is dependent (left side lying: left lung least resistance, gravity pulls blood to left side)
generally, greater air exchange occurs toward the gravity -dependent areas.
Airway Resistance
High Airway Resistance: air cannot move in a unidirectional flow
Low Airway Resistance: below the level of cartilage support, small airways collapse at the end of inspiration
Ventilation
the process by which air moves into the lungs.
the air that reaches the alveoli
the movement of air between the environment and the lungs via inhalation and exhalation
ventilation follows the direction of least resistance
Perfusion
the blood flow of the pulmonary circulation available for gas exchange.
the blood that reaches the alveoli
position dependent, gravity dependent (in upright lungs, the bases are better perfused than the apices)
the process of a body delivering blood to a capillary bed
Ventilation / Perfusion Matching (V/Q)
the ratio of the amount of air reaching the alveoli to the amount of blood reaching the alveoli.
constitute the main determinants of the blood oxygen concentration.
when V/Q mismatching occurs:
Deadspace, ventilation in excess of perfusion
Shunt: perfusion in excess of ventilation (atelectasis)
V/Q should be about 1.
Diffusion
the movement of oxygen from the capillaries to the mitochondria.
determined by: metabolic rate, vascular resistance, capillary recruitment and tissue oxygen consumption and extraction.
can be effected by the ability of the oxygen to be transported or the pulmonary-capillary membrane wall thickness
Oxyhemoglobin Dissociation Curve
Y-Axis: % Saturation
X-Axis: partial pressure of O2
increases in temp, H+, PCO2 moves curve to the right and more apt to release oxygen.
Hgb holds 4 oxygen, more bound, greater affinity, less likely to give up.
Diaphragm
Phrenic Nerve: C3-5
2/3 - 3/4 of TV effort and volume
thoracic (neg), abdominal (pos)
uses positive pressure of the abdominal cavity to “stabilize” the central tendon. Once stable, the peripheral fibers of the diaphragm can produce lateral and superior expansion.
Concentric Contractions: quiet and forceful inhalation
Eccentric Contractions: controlled exhalation and speech
Intercostals
T1-T12
stabilize the rib cage during inhalation to prevent chest wall collapse toward the negative pressure generated in the thoracic cavity.
Abdominals
T6-L1
stabilizes the inferior border of the rib cage as it interlaces the lower rib cage onto the abdomen.
visceral support
positive pressure support
Innervation:
a) Erector Spinae
b) Pecs
c) Serratus Anterior
a) T1-S3
b) C5-T1 - used in reverse, provide upper chest anterior and lateral expansion.
c) C5-C7 - posterior expansion of the rib cage. only inspiratory muscle that is paired with trunk flexion movements rather than extension
Innervation:
a) Scalenes
b) SCM
c) Traps
a) C3-C8
b) C2-C3 & accessory cranial nerve
c) C2-C4 (least energy efficient accessory muscle)
Hilum
point at which the nerves, vessels, and primary bronchi penetrate the parenchyma of each lung.
Root
comprised of the structures entering the hila of each lung: principle bronchus pulmonary artery pulmonary vein pulmonary nerve plexus lymph vessels
Compliance
ease at which the lungs expand
too much: can’t return to baseline effectively, resulting in air trapping
too little: can’t expand easily, resulting in decreased inspiratory capacity
Newborn: Shape, Size, Breathing Patterns
triangular in the frontal plane and circular in the horizontal plane. occupies ~ 1/3 of trunk. narrow intercostal spacing and horizontal ribs.
obligatory diaphragm breathers. no accessory muslces and no pulmonary reserves.
RR of 40-60bpm
3-6 months: shape, size, breathing patterns
more rectangular, but still not elongated
log-rolling
upper chest expansion is possible, still primarily diaphragmatic breathers, RR is decreasing.
6-12 months: shape, size, breathing patterns
more rectangular, now elongating and ribs begin to rotate downward, lung size has increased 4x since birth.
greater O2 demands: creeping to walking
breathing patterns: all patterns available.
Over 12 Months
trends continue but at a less dramatic rate
flaring of the ribs becomes less apparent as the abdominals and intercostals become stronger
Trends with Aging
increased lung compliance (decreased elastic recoil)
decreased chest wall compliance (stiff)
decreased lung volumes and expiratory flow rates (except residual volume which increases)
Cheyne-Stokes:
consists of alternating crescendos to hyperpnea and decrescendos to apnea. associated with lesions deep inside the cerebellum and the basal ganglia.
Central Neurogenic Hyperventilation
respirations that are rapid (>24), continual, regular and deep. associated with lesions in the lower midbrain to middle pons area.
Apneusis
prolonged inspiration with a pause at the inspiratory peak and sometimes the expiratory peak. associated with lesions in the middle to lower pons area with extensive brain stem damage.
Cluster Breathing
irregular spurts of breathing interspersed with period of apnea. associated with lesions in the upper medulla.
Biot’s Respirations
completely irregular, unpredictable patterns with deep and shallow random breaths and pauses. associated with lesions in the medulla.
Central Apnea
All respiratory centers of the CNS are impaired resulting in complete apnea. associated with severe increased intracranial pressure and patient’s often require long term mechanical ventilation
Paradoxical Breathing
paralyzed intercostals &/or abdominals
- upper chest collapses during inspiration
- belly rises excessively, diaphragm does not encounter any resistance as the central tendon descends.
paralyzed diaphragm (phrenic C3-C5)
- lower chest and abdomen collapse during inspiration
- upper chest rises excessively
Diaphragm and Upper Accessory Muscles only (paralyzed intercostals)
Isolated Diaphragm (eg SCI)
Upper Accessory muscles only (eg. high SCI)
lateral breathers: weakness, not paralysis of the trunk muscles
Asymmetrical breathers: eg. hemiplegia, post surgical patients
Shallow breathers: eg high tone patients
Altered speech support patterns: poor breath support or poor eccentric control
