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AS - N932 Advanced Pathology > Respiratory Physiology > Flashcards

Respiratory Physiology Flashcards

1
Q

Parietal Pleura

A

Membrane that lines the inner chest wall surface

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2
Q

Visceral Pleura

A

Membrane that lines the outer lung surface

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3
Q

Pleural Space

A

Potential space

Contains mucoid/serous fluid that allows the parietal & visceral pleura to slide easily ↓friction

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4
Q

Inspiratory Muscles

A

Diaphragm 1° ventilation muscle
External intercostals
Accessory muscles - sternocleidomastoid, trapezius, & scalene

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5
Q

Expiration

A

PASSIVE

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6
Q

Forced Expiration

A

Internal intercostals

Accessory muscles - internal/external obliques, transversus abdominus, & rectus abdominus

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7
Q

Alveolar Interdependence

A

Alveoli connected

Negative pressure gradient transfers from outer alveoli to innermost

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8
Q

Radial Traction

A

Outside airways are tethered to alveolar wall

↑Pel ↑radial traction ↑airway diameter ↓resistance

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9
Q

LaPlace

A

P = (surface tension x 2) / radius

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10
Q

Air-Liquid Interface

A

H2O molecules have mutual attraction

Surface tension b/w air & water

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11
Q

Surfactant

A 
Amphipathic molecule (detergent)
Polar & non-polar
↓Pel ↓WOB
Prevents alveoli from emptying small → large
Atelectasis ↓gas exchange
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12
Q

Deadspace

A

= VT [(PaCO2 - PeCO2) / PaCO2]
Over ventilation and/or under perfusion
Impaired gas exchange → V/Q mismatch ↑V/Q
Causes: PE, hypovolemia, cardiac arrest, shock, ↓pulmonary blood flow

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13
Q

Shunt

A

Ø alveolar ventilation d/t blockade or edema
Ø gas exchange → V/Q mismatch ↓V/Q
Absolute shunt V/Q = 0
Hypoxia unresponsive to supplemental oxygen

Causes: ETT mainstem, mucus plug, atelectasis, pneumonia, pulmonary edema, anything collapse alveoli

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14
Q

Oxyhemoglobin Dissociation Curve

Right Shift

A

↑CO2 hypercapnia
↓pH
↑H+ ion
↑temperature
↑BPG (2,3 diphosphoglycerate) ↑metabolism
Acidotic - oxygen more easily dissociates from hemoglobin
↓affinity

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15
Q

Oxyhemoglobin Dissociation Curve

Left Shift

A 
↓CO2 hypocapnia
↑pH alkalosis
↓H+ ion
↓temperature
↓BPG
Alkalotic - more difficult to unload oxygen
↑affinity
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16
Q

Fick’s Law

A

Gas diffusion across the alveolar-capillary membrane

= (area x diffusion coefficient x ΔP) / thickness

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17
Q

Air Components

A

79% nitrogen
21% oxygen
1% trace gases

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18
Q

Atmospheric Pressure

A

760mmHg

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19
Q

Upper Airway

A

Nose, mouth, pharynx, larynx, trachea

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20
Q

Nose

A

Filtration, smell, & air humidification

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21
Q

Larynx

A

Epiglottis, thyroid, & cricoid

Paired - arytenoid, corniculate, cuneiform

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22
Q

Motor Innervation

A

RLN motor all EXCEPT cricothyroid muscle

SLN external - cricothyroid muscle

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23
Q

Sensory Innervation

A

SLN internal - above & vocal cords

RLN - below the vocal cords

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24
Q

Posterior Cricoarytenoid

A

Please come apart

Vocal cord ABduction

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25
Lateral Cricoarytenoid
Let's close airway | Vocal cord ADduction
26
Cricothyroid
Cords tense | Vocal cord tension = laryngospasm
27
Thyroarytenoid
They relax | Vocal cord relaxation
28
Trachea
Incomplete cartilage rings - open posteriorly to prevent tracheal collapse Transports gases b/w atmosphere & lung parenchyma Begins at C6 (cricoid cartilage inferior border) & extends to carina 10-15cm Cricoid = only complete ring Bifurcates to R/L mainstem bronchus at T5
29
R Main Bronchus
T5 Shorter, wider, & more vertical 25-30° angle R mainstem intubation
30
L Main Bronchus
T5 | 45° angle
31
R Lung
55% TLC | 3 lobes
32
L Lung
45% | 2 lobes
33
Diaphragm Innervation
C2-5 | Phrenic nerve
34
Pneumocytes
Type 1 structural Type 2 surfactant producing Type 3 macrophages (alveolar)
35
Conducting Zone
NO gas exchange (anatomic dead-space) Nose/mouth → terminal bronchioles Pseudostratified ciliated epithelium transitions → ciliated columnar epithelium → cuboidal epithelium (terminal bronchioles) mucus-secreting goblet cells also present Blood supply from thyroid, bronchial, & internal thoracic arteries (systemic circulation) 150mL 1/3 VT 2mL/kg IBW
36
Respiratory Zone
Gas exchange (diffusion) 350mL/500mL Respiratory bronchioles, alveolar ducts, alveolar sacs, & alveoli Cuboidal cells transitions → squamous epithelium Blood supply from pulmonary circulation Diameter 0.5mm & smaller
37
Average Adult CARINA
Front incisors to larynx = 13cm Larynx to carina = 13cm ETT ideal location 2cm above the carina
38
Transpulmonary Pressure
Difference b/w intrapleural & intra-alveolar pressures | *Determines lung size
39
Neuronal Control
Brainstem - medulla & pons
40
Medulla Control
Medulla control = DRG Stimulates inspiration "Pacemaker" VRG helps w/ forced inspiration/expiration
41
Pons Control
Modifies medulla output Pneumotaxic center located high in the pons ↓VT Apneustic center located lower in the pons ↑VT - Output limited by baroreflex input from the lung & input from the pneumotaxic center
42
Humoral Control
Central chemoreceptors response to hydrogen ion levels | Peripheral chemoreceptors respond to CO2, pH, & hypoxemia
43
Normal Stimulus to Breathe
Hypercapnia
44
Vagus
Cranial nerve X | Carries aortic arch & lung stretch signal to the DRG
45
Glossopharyngeal
Cranial nerve IX | Carries the carotid body signals to the DRG
46
Autonomic Control | PARASYMPATHETIC
Vagus Mucus secretion, ↑vascular permeability, vasodilation, & bronchospasm M3 receptor activation → bronchoconstriction
47
Autonomic Control | SYMPATHETIC
Inhibit mediator release from mast cells ↑mucociliary clearance β2 exogenous activation → bronchodilation
48
FRC
Functional residual capacity Point where lung elastic recoil = chest wall elastic recoil *Equilibrium point* Impacted by positioning, muscle relaxation, & insufflation
49
Normal Respiratory Quotient
0.8 200/250 CO2 diffuse 200mL from the pulmonary capillary blood into the alveoli O2 diffuse 250mL from the alveoli into the pulmonary capillary blood
50
Compliance
Volume / Pressure
51
Static Compliance
= VT / (Pplat - PEEP) Normal 60-100mL/cmH2O Lung & chest wall compliance w/ NO air movement ↓static compliance Fibrosis, obesity, edema, vascular engorgement, ARDS, external compression, & atelectasis Set an inspiratory pause to measure Pplat (only available in volume control)
52
Dynamic Compliance
= VT / (peak pressure - PEEP) Normal 50-100mL/cmH2O Lung & chest wall compliance DURING a breath ↓dynamic compliance Bronchospasm, tube kinking, mucous plug, external pressure, ↑RR, anything ↑airway resistance
53
Surface Tension
SURFACTANT = 2/3
54
Laminar Flow
Small airways ↓resistance | Reynold's number <2,000
55
Turbulent Flow
Large airways Reynold's number >4,000 Medium-sized bronchi = highest airway resistance
56
Reynold's Number
Indicates laminar or turbulent flow | 2,000-4,000 considered transitional flow
57
Poiseuille's Law
= [(π ∙ ∆P ∙ r^(4 )] / (8 η l)
58
West Zones
1 alveolar > arterial > venous pressure V/Q > 1 2 arterial > alveolar > venous pressure V/Q = 1 3 arterial > venous pressure > alveolar V/Q = 0.8 4 arterial > interstitial > venous pressure > alveolar V/Q < 1
59
Closing Volume
Volume above residual when small airways close
60
Closing Capacity
Absolute gas volume in the lung when small airways close Factors that ↑closing capacity - COPD, obesity, supine position, pregnancy, CHF, aging Closing volume > FRC Airway closure during normal tidal breathing → poorly or unventilated alveoli & intrapulmonary shunting
61
Haldane Effect
Blood oxygenation displaces CO2 from hemoglobin Ability to carry CO2 in different oxygen environments Occurs at alveolar-capillary membrane
62
Bohr Effect
Hemoglobin O2 affinity inversely proportional to CO2 levels Acidic environment causes R shift Occurs at the tissue level ↑CO2
63
P50
PaO2 26-28mmHg | 50% Hgb saturated
64
SpO2:PaO2
90: 60 70: 40 60: 30
65
DLCO
Tests lungs capacity to diffuse carbon monoxide Normal >75% Mild 60-75% Moderate 40-60% Severe <40% Intrinsic lung issue - tissue damage Breathe in & hold 10 sec then exhale fully
66
CO2 Transportation
1. Dissolved 2. Chemically combined w/ amino acid proteins (bound to Hgb) 3. Bicarbonate ions 80-90% *Carbonic anhydrase assists reaction
67
Hypoxic Hypoxia
``` Issue w/in lungs ↓FiO2 Alveolar hypoventilation V/Q mismatch R → L shunt ***Supplemental FiO2*** Examples: COPD, overdose, high altitude, fibrosis, atelectasis, pulmonary embolism, congenital heart disease ```
68
Circulatory Hypoxia
↓CO Severe heart failure, dehydration, sepsis, SIRS ***Treat underlying problem***
69
Hemic Hypoxia
↓hemoglobin content and/or function Anemia, carboxyhemoglobin, methemoglobinemia ***Treat underlying cause***
70
Demand/Histoxic Hypoxia
↑O2 consumption or inability to utilize O2 Fever, seizures, cyanide toxicity ***Supplemental FiO2***
71
HPV
Hypoxic pulmonary vasoconstriction ↑PCO2 (acidosis) → vasoconstriction ↓PCO2 → vasodilation Vasoconstriction in response to low regional PAO2 Diverts blood away from hypoxic → ventilated & oxygenated areas Aims to optimize & correct V/Q mismatch
72
Anatomical Deadspace
Air present in the airway that never reaches the alveoli | Unable to participate in gas exchange
73
Alveolar Deadspace
Air w/in non-functional alveoli (disease or abnormal blood flow) Unable to participate in gas exchange
74
Physiological Deadspace
= anatomical + alveolar deadspace
75
Upper Respiratory Infection
``` ↑WBCs Inflamed & reddened mucosa Mucopurulent nasal secretions Congestion or rales > 37°C Tonsillitis Viral oropharynx ulcer Fatigue Laryngitis Sore throat ```
76
Allergies
``` HISTAMINE MEDIATED Sneezing Ash or boggy mucosa Itchy/running nose Conjunctivitis Wheezing Hives Swollen lips, tongue, eyes, or face Dry, red, & cracked skin ```
77
PAO2
(PB - PH2O) x FiO2 - (PaCO2/0.8)
78
A - a
PAO2 - PaO2 | Normal 5-15mmHg
79
a/A Ratio
PaO2/PAO2 | Normal >75%
80
Oxygen Content
CaO2 = (Hgb x 1.34 x SaO2) + (PaO2 x 0.003) | Normal 20.4mL per 100mL blood
81
Oxygen Delivery
DO2 = CO x CaO2
82
PaCO2
VCO2/VA | Total CO2 production / alveolar ventilation
83
PaO2/FiO2
``` P:F ratio PaO2/FiO2 Normal 400 <300 mild ARDS <200 moderate <100 severe ```

AS - N932 Advanced Pathology (8 decks)

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