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Physiology 3
Respiration; Spirometry
| Term | Definition |
|---|---|
| Goals of Spirometry | 1. aid in diagnosis (restrictive/obstructive) 2. check for presence of disease w mild symptoms 3. stage to determine therapy 4. assess for pre-op or disability 5. assess baseline and detect pulmonary toxicity measure Forced Vital Capacity |
| Who? | every smoker over 45 Y.O. and every COPD pt |
| Office Base Spirometry | handheld device; checks forced vital capacity and forced expiratory volume |
| Pulmonary Function Testing | closed chamber; checks forced vital capacity and forced; diffusion capactiy and total lung capacity |
| FEV1 | Amount of air you can blow out in the first second; max amount of air expired occurs within the 1st second; normal is above 80% |
| FVC | Forced Vital Capacity; amount of air that can be blown out after maximal inspiration; normal > 80% COPD: <80% > 60% FEV1/FVC due to air trapping restrictive: <80% >70& FEV1/FVC |
| 3 factors for determining "normal" | age sex height |
| FEV1:FVC ratio | amt of air blown out in first second: total amt of air blown out in approx 6 sec ; normal 0.8 |
| Obstruction indication FVC | <70% indicates obstruction <85% kids (age 5-18) |
| Performing Spiromtetry | - at least 3 acceptable spirograms - exhale for at least 6 seconds and stop when no volume change for 1 second - difference btw 2 largest measurements should be within <5% contraindications: sick, steroids, bronchodilator, sitting |
| Spirometry Test Steps | 1. calibrate via computer 2. clamp nose, only breathe through mouth 3. lips sealed 4. hard and fast as you can for 6 seconds 5. breathe in after 6 seconds *repeat 3 times * repeat with albuterol tx to see if improves lung fx |
| TLC | Total Lung Capacity: amt of gas in lungs after max inspiration (TLC= VC + RV), 5L adult male, 4.2 L adult Female |
| VC | (Forced) Vital Capacity; (ERV+IRV+TV) amt of gas exhaled after max inspiration "take breath all the way in and all the way out" |
| RV | Residual volume: amt of gas remaining in lungs after max expiration "blow air all the way out, then it is amt of gas remaining in lungs" normally: 1500 cc; maintains alveoli space for availability for next breath; measured in lab |
| TV | Tidal Volume: amt of gas pt inspires and exires during normal breathing 500cc ; greatest with DEEP SLOW breathing |
| IRV | Inspiratory Reserve Volume: normal tidal inspiration plus deep breath all the way in; normal1500cc |
| ERV | Expiratory reserve volume amt of gas ind can exhaled beyond tidal expiration, "exhale normal then push remaining gas out"; normal 1500cc |
| VC | TV+ IRV + ERV= VC |
| FRC | Functional Residual Capacity: (ERV + RV) amt of gas remaining in lungs after tidal expiration; normally 40 % TLC; cannot measured by spirometry bc RV cannot be exhaled, so use He or Ni; *work of breathing is lowest* |
| 3 types of capacity | 1. lung capacity: inspiratory (RV, FRV, VC + TLC) 2. inspiratory capacity: amt of gas a pt can inhale starting from tidal exhale (TV +IRV); nomrally 60% TLC 3. FRC: (ERV + RV) |
| Alveolar Ventilation | (TV-dead space) x RR = 4.2 L/min Always < pulmonary ventilation due to dead space between alveoli and atm |
| obstructive lung disorders | A. Asthma B. Bronchiectasis C. COPD - difficulty and inc time of exhalation - expiratory wheezing - inc residue volume (stacks air) and inc capacity - FCR ratio is the same - tx: inhaler is a bronchodilator to dec RV * |
| Restrictive Disorder | "belt on chest"; dec RV, ERV, TV and IRV |
| "physiological" or alveolar dead space | area where alveoli not adequately perfused with blood ; inc significantly with disease |
| Minute Ventilation | Tv x RR (6L per minute) cardiac complications increases minute ventilation *inc TV is more effective than inc RR to improve oxygenation |
| Ventilation/Perfusion while standing | V/P >1 top of the lung; V/P<1 at base of lung - explains why the lung fills 80%; disease V/Q < 0.8% pulmonary embolism: |
| Pulmonary Embolism (V/Q) | V/Q= infinity bc no blood flow but air still moves and inc physiological dead space |
| 3 goals of oxygen | 1. bronchiole dilator 2. pulmonary artery dilator 3. PERFUSE TISSUES? |
| Flow Volume Curve | Normal: exhalation on top is centered triangle; inhalation semicircle same width on bottom Obstructive: exhalation peak becomes lower & slope downward curves; inhalation the same Restrictive: compression of curve from L and R; inhalation width decreases |
| Hb O2 dissociation curve | acidosis shifts the curve to the right and increase the PO2 for increase dissociation on the tissues (as well as inc in Temp, CO2, DPG lactate) |
Created by:
cln8692
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