| Question |
Answer |
| Larynx |
Transitional. Control Speech, prevent Aspiration. |
| Single Cartilages of Larynx |
Epiglottis(Attaches to medial surf of Thyroid), Thyroid(ADAM's Apple) sits cephalad to cricoid and gives Larynx triangular shape. Cricoid is a complete ring and singlet shaped. |
| Paired Cartilages of Larynx |
ARYTENOIDS - vocal chords attache dto vocal process@base, CORNICULATES - posterior wall of larynx on top arytenoids, CUNEIFORMS - anterior and lateral to corniculates |
| Conducting Airways UPPER |
Nose, Mouth, Pharynx, Larynx |
| Conducting Airways LOWER |
Trachea 1, Mainstem 2, Lobar 5, Segmental 18/19, Subsegmental, bronchioles, Terminal bronchioles |
| Conducting Airways GAS EXCHANGE |
Resp. Bronchioles, Alveolar Ducts, Alveolar Sacs, Avleoli |
| Airway Landmarks |
Trachea from C5-T5, cricoid to carina, Carina 21-23cm from lips, 11-13 cm long with 15-20 C shaped carts, 1.5-2.5 wide |
| A-C Membrane |
Alveolar epithelium, Alveolar Basement Membrane, Interstitium, Cap Base Membrane, Cap ENDOTHELIUM |
| Lobes and Segments RIGHT |
UPPER 3 - apical, posterior, anterior MIDDLE 2- Lateral and medial and LOWER 5 - Superior, Med. Basal, ant basal, lat basal, post basal |
| Lobes and Segments LEFT |
UPPER 4 - apical-post, anterior, Superior Lingular, Inferior Lingular. LOWER 4 - Superior, ant. medial, Lat medial, post medial |
| Passive Inspiration Muscles |
Diaphragm via Phrenic Nerve, External Intercostals |
| Accessory Muscles INSPIRATION |
Scalenes, sternocleidomastoid, Pectoralis major, trapezius |
| Accessory Muscles EXPIRATION |
Rectus AB, Transverse AB, External Oblique, Internal Oblique, Internal Intercostals |
| Normal Compliance Value |
0.2L/cmH2O |
| Normal Specific Compliance Value |
0.080 |
| Normal Elastance Value |
5 cmH2O/L. Low indicates disease as emphysema |
| Low Compliance Diseases |
PA, PE, Pulm Fib, Atelectasis |
| P-V curve Horizontal |
Horrible Compliance as in PA, PE, atelectasis, Pulm Fibrosis(Silicosis)...Little V for lots of P |
| P-V curve Vertical |
Compliance goes up like Emphysems...Lots of V for little P |
| Normal Airway Resistance (Raw) Value |
1-2 cmH2O/L/S High values indicate disease like ASTHMA, CHRONIC BRONCHITIS |
| Normal Conductance (Gaw) Value |
0.5-1.5 L/Sec/cmH2O LOW values indicate disease like ASTHMA, CHRONIC BRONCHITIS |
| Airway Resistance Factors |
Bronchospasm, Secretions, Mucosal Edema, Low Elastance, Artificial Airways |
| Poiseuille's LAW - Laminar Flow |
Pr to the 4th power P=pressure, r=radius...16 fold jump in P as r decreases 50%. Radius is biggest factors affecting FLOW |
| Reynold's Number - Turbulence |
2rvd/n, r=radius, v=velocity, d=density, n=viscosity. >2000=turbulent flow. |
| Normal Time Constant Value (Kt)time for lung to empty 65% Vt |
.2 sec. Kt= compliance x Raw |
| Long Time Constant |
2.0 = ASTHMA, CHRONIC BRONCHITIS or 4.0=EMPHYSEMA |
| SHORT Time Constant |
.1 = PA, IRDS, ARDS, Pulm Edema |
| Normal STROKE Volume |
60-130 |
| STROKE V |
CO/HR, increase HR = decrease SV, increase SVR/PVR= decreased SV(BAD), Increase Ventrical Preload or Venous return = increase SV |
| Coronary Circulation |
Originates at AORTIC SINUS @ base of aorta, terminates at COONARY SINUS @ junction of SVC and R atrium |
| RIGHT Coronary Circulation |
Think RPM - RIGHT, POSTERIOR DESCENDING (serves R and L ventricles), and MARGINAL R atrium and ventricle |
| LEFT Coronary Circulation |
LEFT ANTERIOR DESCENDING (serves R and L Vetricles), CIRCUMFLEX ( L atrium and Vent) |
| SVR calculation |
[(MAP-CVP)/CO]x80 |
| Normal SVR |
800-1500 dynesxsecxcm |
| Factors to INCREASE SVR |
Vasoconstrictors - Dopamine, Norepi, Epi |
| Factors to DECREASE SVR |
Vasodilators - Morphine, Nipride, Apresoline, Hyperstat |
| PVR Calculation |
[(Mean PAP- PCWP)/CO]x80 |
| Normal PVR |
120-240 dynesxsec.xcm |
| Blood Chem of increased PVR |
ACIDIC, Hypercapnic, Hypoxemia, fix w/PEEP CPAP, all due to constriction |
| Diseases assoc w increaed PVR |
Pulm. Emboli, Emphysema, Interstitial Pulm fibrosis |
| Drugs to decrease PVR |
O2, Nitric Oxide, Aminophylline causes Alkalemia |
| Capillary Fluid Balance |
Hydrostatic Pressure (B/P) pushes out. Osmotic Pressure(electrolytes, Prteins, glucose, solutes) push in oin cell |
| Capillary Balance factors in Pulm Edema |
Increased Hydrostatic P(CHF), Decreased Osmotic P(Ca), Increased Cap Membrane Perm(ARDS) |
| High V/Q diseases >.8 |
Pulmonary Emboli and Circulatory Shock = Deadspace. Responsive Hypoxemia. ABG = ALK, O2 above 100 |
| Low V/Q diseases <.8 |
Atelectasis, PA, Pulmonary Edema = SHUNT/Refractory Hypoxemia ABG = ACID, O2 - under 100 |
| Fick's Law |
Diffusion over A-C Membrane, directly proportional to SA, Press Gradient, and Diffusion Coefficient...INDIRECTLY to THICKNESS |
| OxyHb curve p50 |
Normal 27 |
| Decreased p50 LEFT |
LEFT=LOAD O2 is Easy in Lung and harder to unload in tissues |
| Increased p50 RIGHT |
RIGHT=RELEASE O2 in tissues but loading in Lung id harder |
| LEFT shift factors |
LEFT-L-aLkalemia, decreased CO2, decreased 2,3,DPG, Hypothermia |
| RIGHT shift factors |
ACIDEMIA, increased CO2, Increased 2,3,DPG, HYPERTHERMIA/FEVER, since O2 is RELEASE in tissues, that's why Fever is hot to touch |
| Total O2 delivery calculation |
CO x (CaO2x10) Normal is 5 x (20x10)=1000ml...if given dl, multiply by 10 |
| O2 Consumption |
CO x [C(a-v)O2x10], normal = 250ml.min |
| Increased O2 consumption...common sense |
FEVER, Exercise, Seizures, Shivering all >250 |
| Decreased O2 consumption |
Peripheral shunting, bllod not reaching limbs, Cyanide poisoning-block mitochondria from processing O2, Hypothermia-MET rate goes down, ,250 |
| Normal a-v gap |
20-15 = 5ml/min |
| Factors increased a-v gap |
Exercise, Shivering, Fever, DECREASED CO, tissues are asking for more |
| Decreased a-v gap |
Peripheral shunting, cyanide poisoning, hypothermia, INCREASED CO |
| O2 Extraction Ratio |
O2ER = (CaO2-CvO2)/CaO2 NORMAL is (20-15)/20= 25% |
| Shunt Calc (QS=shunted bl, QT=total bl flow, CCO2=content O2 in Pulm. Cap . Bed) |
QS/QT = (CCO2-CaO2)/(CCO2-CvO2) |
| Severity of shunt |
<10%=NORMAL, 10-20%=MILD, 20-30%=MODERATE, >30%= SEVERE |
| Control Centers for Ventilation - Cerebral Cortex |
Conscious Control like singing and speech |
| Control Center Vent. - DRG, VRG |
DRG maintain norm breathing, VRG when exercise |
| Control Center Vent - Apneustic Center |
GASP, boosts INP effort, located in caudal PONS |
| Control Center Vent. - Pneumotaxic Center |
PANTING, increase rate and decrease Vt, located in cePhaled PONS |
| Peripheral Chemoreceptors |
Located at Aortic Arch(VAGUS) and Carotid Sinus(glossopharyngeal), PaO2 <60 and LOW pH makes them go crazy |
| LOWEST Minute Ventilation (Ve) |
LOW CO2, HIGH PO2, HIGH pH |
| HIGHEST Minute Ventilation (Ve) |
HIGH CO2, LOW PO2, LOW pH |
| Vagal Reflexes 3 |
Pulmonary Stretch Receptors, Irritant, and "J" |
| Pulmonary Stretch Receptors |
in Smooth Muscle of Conducting Airway, respond to Increased Lung V, Decreased intrapleural P...Inhibit INSP, BROCHODILATE, INCREASED HR |
| Irritant Receptors |
Between epithelial cells of large conducting airway. Respond to smoke, dust, chlorine, ammonia or froeign bodies. COUGH, HYPERNEA, BRONCOCONSTRICTION, EXP GRUNT |
| "J" Receptors |
in Pulmonary interstitum, respond to interstital edema and pulmonary emboli. HYPONEA, TACHYPNEA, EXP GRUNT |
| Fetal shunts 3 |
Ductus Venosus, Foramen Ovale, Ductus Arteriosis |
| Ductus Venosus |
Umbilical chord with IVC |
| Foramen Ovale |
Fetal Atria ( R and L atrium) one way valve |
| Ductus Arteriosis |
Pulmonry Artery with Descending Aorta |
| Effect of Exercise Pulmonary |
Increases Ve, increases diffusion capacity x 3, increases alveolar Ventilation(up to 65% of Max breathing Cap) |
| Effect of Exercise Cardio |
Increased O2 consumption, Increase Extraction Ratio, Decreased SvO2, Increased a-v gap, |
| Normal Work of Breathing |
0.5 joules/L |
| Increased WOB |
INC Raw, LOW Gaw, LOW Compliance, LOW elastance |
| O2 cost |
is the total O2 consumption of RESP muscles = less than 5%(12ml/min out of 250) |
| O2 cost increases with |
INC Raw, Decrease Gaw, Decrease Compliance, Decrease Elastance...Emphysema >120 ml/min |
| Tubular Structures |
Glomerulus, Bowman's Cap, Proximal Tubule, Loop of Henle, Distal Tubule, Collecting Duct |
| Monitor Renal Function |
Creatinine is best indicatorn 16mg/min |
| ADH |
secreted by POST Pituitary Gland, infuenced by Serum Osmolarity, increased Osmolarity triggers ADH= decreased urine ourput=Water Retention |
| Plasma Cations |
Na -140, K-5, Ca-5 |
| Plasma Anions |
Cl-105, HCO3-24 |
| Aldosterone |
Adrenal hormone, releases in response to Hyponatremia, HyperKalemia, Hypovolemia, Decreaed CO...increases Na reabsorbtion and K secretion |
Ch.18 LTI-MA 509
