resp anatomy Flashcards
anatomical functions of nose
inhaled air warmed by conchae and septum,
filtration & obstruction of foreign particles,
assists phonation& sensation of smell (CNI)
function of pharynx and tonsils
assists phonation,
initiates deglutition,
defense against pathogens,
enlarges with inflammation and tumor
ring of tonsils
adenoid, eustachian, palatine, lingual, sublingual
Mallampati class 1
full view of uvula and tonsillar pillars, soft palate
mallampati class 2
partial view of uvula or uvular base, partial view of tonsils, soft palate
Mallampati class3
soft palate only
Mallampati class 4
hard palate only
glossoptosis
collapse of oropharynx, tongue dropping posteriorly
Macroglossia
large tongue, (common in Down syndrome)
Micrognathia
small jaw, mandible
Microgenia
small chin
Microstomia
small mouth
Malocclusion
upper protrusion “buck teeth,” overbite
Location Adult Larynx
Anterior to 3rd-6th cervical vertebre
Location of Larynx at birth
level at C3-4
A-O extension
normally 35 degrees
Larynx function
functions as airway protective sphincter, closes off airway during swallowing, supports vocal cords, modulates speech, provides autoPEEP
Compartments of Larynx
Supraglottis,
Glottis(Ventricles),
Infraglottis
Supraglottis Compartment anatomy
Epiglottis,
False vocal cords
Glottis (ventricles) anatomy
True vocal cords,
Rima glottis- in adults the narrowest portion of upper airway,
Arytenoids
Infraglottis Compartment anatomy
Below vocal cords,
Cricoid Cartilage,
Trachea
Unpaired Cartilage Larynx
Epiglottis
Thyroid
Cricoid
Paired Cartilage Larynx
Arytenoid
Corniculate
Cuneiform
Attach larynx to bone or pharynx,
move larynx during swallowing
Extrinsic muscles of larynx
One set alters the size and shape of larynx,
other move the true vocal cords
intrinsic larynx muscle set (two sets)
pulls epiglottis down over larynx
Aryepliglottic (first set intrinsic muscle) (RLN)
Assist pulling epiglottis down
Thyroepiglottic (first set intrinsic muscle) (RLN)
Pulls arytenoids together, Adducter 1st set
Oblique Arytenoid (first set intrinsic muscle) (RLN)
Tensor of Vocal Cords
Cricothyroid (2nd set intrinsic muscles) (*External SLN)
Thyroarytenoid
Relaxor of VC (2nd set)
Adductors 2nd set
Lateral Cricoarytenoid
Transverse Arytenoid
2nd set
Abductors
Posterior Cricoarytenoid
Vocalis (weak)
2nd set
Direction larynx moves during swallowing
upwards
hyoid bone elevators
suprahyoid (indirectly move larynx)
Muscles directly attach to larynx
Thyrohyoid, Stylopharyngeus, Palatopharyngeus, Salpingopharyngeus, Inferior constrictor
Laryngeal membranes
Thyrohoid membrane,
Quadrangular Membrane,
Cricothyroid membrane
Left Recurrent laryngeal nerve provides sensory innervation to
infraglottis sensory innervation?
Damage to RLN
vocal cord adduction cause
Vagus nerve branch
CN X,
Recurrent laryngeal nerve,
Superior laryngeal nerve
Superior laryngeal nerves divides into two nerves
Internal SLN,
External SLN,
Internal SLN provides
Sensation to supraglottic and ventricle compartment,
STIMULATION CAUSES LARYNGOSPASM
Stimulation causes laryngeal spasm
Internal SLN
External SLN provides
motor innervation of cricothyroid muscle
Sphenopalatine ganglion innervation
(middle division of CN V),
nasal mucosa,
superior pharynx, uvula,
tonsils
Glossopharyngeal nerve innervation
(CN IX),
(lingual back 1/3, pharyngeal, tonsillar nerves),
oral pharynx,
supraglottic region
Internal branch superior laryngeal nerve innervation
(CN X),
mucous membrane above the VCs,
glottis
Recurrent Laryngeal nerve
(CN X),
trachea below VC’s
Epiglottis
positioned UPRIGHT to allow air passage during inspiration
Vallecula
space anterior to the epiglottis at root of tongue (mac laryngoscope end placed here)
Pressure on the hyoepiglottic ligament
LIFTS epiglottis during laryngoscopy
what pushes epiglottis downward during swallowing
base of tongue
Direct Laryngoscopy Grade 1
full view of vocal cords, glottis
Grade 2 laryngoscopy
partial view of vocal cords, arytenoid and corniculate cartilages
Grade 3
Only epiglottis visualized
Grade 4
Only soft palate visualized
Posterior Cricoarytenoid muscles only
Abductor muscles
Recurrent laryngeal nerve stimulation
opens vocal cords (think phlegm in trachea, open to cough out)
Recurrent laryngeal nerve responsible for
adduction of vf
SLN tenses VF via
cricothyroid muscle
air is forced between closed cords causes
vibration
Increased tension of VC creates
higher-pitched
Intensity
stronger blasts of air cause VC to vibrate more and louder sounds
Sellick Maneuver
Pressure on the cricoid applied posteriorly closes the esophagus,
prevent gastric regurg,
aligns glottic opening,
prevents vent of air into stomach
Narrowest portion of upper airway in children
Cricoid ring until age 8yrs, reason uncuffed ETT
Carina level
T5-7
Carina distance from teeth
25cm
Lenght and diameter of trachea
12.5-18cm,
18-20mm diameter
Shape of trachea cartilage and number
C-shaped (allow expansion of esophagus),
20-25
placement of ETT depth
3x tube size.
ex 7.0=21cm
primary bronchus is slightly straighter and wider, aspiration more likely
right
conducting airways
ventilation but no perfusion
amount of breath that remains in airway
30%, (150cc/700cc breath),
2cc/kg or pts wt. in lbs.
Acinus
gas exchange segment,
resp bronchiole, alveolar ducts and sacs, alveoli
What allows gas exchange between airspace and pulmonary cap
simple diffusion
Found from larynx to bronchi and removes trapped particles
pseudostratified ciliated columnar epithilium (cilia beat 1000-1500 cycles/min) disabled by smoke
Release mucous granules into airway lumen
Goblet cells,
increase with injury and infection
located in smaller bronchiole which lack goblet cells
clara cells-produce mucus- poor, watery proteinaceous material
Cell types of alveolar wall
Type I pneumocyte Type II pneumocyte, macrophages, septal cells (fibroblasts)(maintenance of conn. tissue of lung), mast cells(produce histamine)
Type I pneumocyte increase
alveolar surface area
Secretes surfactant
Type II Pneumocyte
Surfactant
mix of proteins, phopholipids (phosphatidylcholine) and ions.
Diminishes surface tension,
prevent alveolar collapse during expiration(important in neonates)
Maturation occur 24weeks.
Thin bone at top of nasal passage
Cribiform plate of ethmoid bone