Thoracic Deep and Respiratory System Flashcards
Insertion of a chest drain (tube) is a commonly performed procedure and is indicated in the presence of pneumothorax, malignant pleural effusion, empyema, hemopneumothorax and postoperatively after thoracic surgery.
The position of the chest drain (tube) is determined by the “safe triangle.” This triangle is formed by the anterior border of the latissimus dorsi, the lateral border of the pectoralis major muscle, (the area superior to a line horizontal to the level of the nipple) and the apex below the axilla. The position of the ribs in this region should be clearly marked. Anesthetic should be applied to the superior border of the rib and the inferior aspect of the intercostal space. The neurovascular bundle runs in the neurovascular plane, which lies in the superior aspect of the intercostal space, hence the reason for positioning of the tube on the superior border of a rib (i.e., at the lowest position in the intercostal space).
Safe TriangleChest drain (tube) insertion
Safe Triangle
1.Mid-axillary line / boarder of latissimus dorsi.
- Lateral boarder of pectoral major.
- Imaginary horizontal line from the nipple.
Respiratory System Consists of :
- Conducting zone
- Respiratory zone
Provides rigid conduits for air to reach the sites of gas exchange
Includes all other respiratory structures (e.g., nose, nasal cavity, pharynx, larynx, trachea.
Conducting zone (upper respiratory)
Site of gas exchange
Consists of bronchioles, alveolar ducts, and alveoli
Respiratory zone (lower respiratory)
Respiratory muscles:
- Diaphragm- promote inhalation
- Internal intercostals - promote exhalation
- External intercostals- promote inhalation
Diaphragm and external intercostals
promote inhalation
Internal intercostals
promote exhalation
Major Functions of the Respiratory System
To supply the body with oxygen and dispose of carbon dioxide
Respiration – four distinct processes must happen
1. Pulmonary ventilation – moving air into and out of the lungs
2. External respiration – gas exchange between the lungs and the blood
3.Transport – transport of oxygen and carbon dioxide between the lungs and tissues
4. Internal respiration – gas exchange between systemic blood vessels and tissues
- Cellular Respiration- takes place in the cell in the mitochondria and produces energy.
O2 + GLUCOSE= ATP+CO2+H20+HEAT
moving air into and out of the lungs
Pulmonary ventilation
gas exchange between the lungs and the blood
External respiration
transport of oxygen and carbon dioxide between the lungs and tissues
Transport
gas exchange between systemic blood vessels and tissues
Internal respiration
passes through the central tendon at approximately vertebral level TVIII
The inferior vena cava
passes through the muscular part of the diaphragm, just to the left of midline, approximately at vertebral level TX
The esophagus
pass through the diaphragm with the esophagus
The vagus nerves
passes behind the posterior attachment of the diaphragm at vertebral level TXII
The aorta
passes behind the diaphragm with the aorta
The thoracic duct
may also pass through the aortic hiatus or through the crura of the diaphragm.
The azygos and hemiazygos veins
Because the anterior ends of the ribs are inferior to the posterior ends, when the ribs are elevated, they move the sternum upward and forward. Also, the angle between the body of the sternum and the manubrium may become slightly less acute. When the ribs are depressed, the sternum moves downward and backward. This “pump handle” movement changes the dimensions of the thorax in the antero-posterior direction and allows for more air to enter the lungs inferiorly.
Pump Handle
As well as the anterior ends of the ribs being lower than the posterior ends, the middles of the shafts tend to be lower than the two ends. When the shafts are elevated, the middles of the shafts move laterally. This “bucket handle” movement increases the lateral dimensions of the thorax increasing area for lung inflation.
Bucket Handle
Although the visceral pleura is innervated by visceral afferent nerves that accompany bronchial vessels, pain is generally not elicited from this tissue.
The lungs do not completely fill the anterior or posterior inferior regions of the pleural cavities. This results in recesses in which two layers of parietal pleura become opposed. Expansion of the lungs into these spaces usually occurs only during forced inspiration; the recesses also provide potential spaces in which fluids can collect and from which fluids can be aspirated.
Visceral pleura
The parietal pleural is innervated by somatic afferent fibers. The costal pleura is innervated by branches from the intercostal nerves and pain would be felt in relation to the thoracic wall.
The diaphragmatic pleura and the mediastinal pleura are innervated mainly by the phrenic nerves (originating at spinal cord levels C3, C4 and C5).
Referred Pain from these areas would refer to the C3, C4 and C5 dermatomes (lateral neck and the supraclavicular region of the shoulder).
Parietal pleura
The two lungs are organs of respiration and lie on either side of the mediastinum surrounded by the right and left pleural cavities. Air enters and leaves the lungs via main bronchi, which are branches of the trachea.
The pulmonary arteries deliver deoxygenated blood to the lungs from the right ventricle of the heart. Oxygenated blood returns to the left atrium via the pulmonary veins.
The right lung is normally a little larger than the left lung because the middle mediastinum, containing the heart, bulges more to the left than to the right.
Each lung has a half-cone shape, with a base, apex, two surfaces, and three borders (Fig. 3.39).
▪The base sits on the diaphragm.
▪The apex projects above rib I and into the root of the neck.
▪The two surfaces—the costal surface lies immediately adjacent to the ribs and intercostal spaces of the thoracic wall. The mediastinal surface lies against the mediastinum anteriorly and the vertebral column posteriorly and contains the comma-shaped hilum of the lung through which structures enter and leave.
▪The three borders—the inferior border of the lung is sharp and separates the base from the costal surface. The anterior and posterior borders separate the costal surface from the medial surface. Unlike the anterior and inferior borders, which are sharp, the posterior border is smooth and rounded.
Lungs
PET is a nuclear medicine medical imaging technique that produces a 3-D image of functional processes in the body. A PET scan uses a small amount of a radioactive drug, or tracer, to show differences between healthy tissue and diseased tissue. The most commonly used tracer is called FDG (fluorodeoxyglucose), so the test is sometimes called an FDG-PET scan. Before the PET scan, a small amount of FDG is injected into the patient. Because cancer grows at a faster rate than healthy tissue, cancer cells absorb more of the FDG. The PET scanner detects the radiation given off by the FDG and produces color-coded images of the body that show both normal and cancerous tissue.
Currently, many PET scanners also include a conventional computed tomography (CT) scanner. This allows images of both anatomy (CT) and function (PET) to be taken during the same examination.
Example of uses: PET scans can be used to view, monitor, or diagnose
Tumors
Blood flow to the heart
Brain disorders
FDG PET Scan
Nasal cavity has bumps
conchae
Olfactory Nerve (cranial nerve 1)
Top of nasal cavity
Nasal Pharynx
runs from nasal cavity to uvula
Oral Pharynx
Runs from Uvula to Epiglottis
Laryngeal Pharynx
Epiglottis to larynx
Anabolic activity
Energy
Catabolic
Break down
where the trachea splits
Carina
Auditory tube
middle ear
Goes up to vocal cords allowing speech
Recurrent Laryngeal Nerve
96-100
Normal
92-95
Respiratory problems
85-89
Moderate COPD
90-91
Mild COPD
< 84
Severe COPD
