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Physiology 3

Respiration; Spirometry

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
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