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CardioPulmonary

CardioPulmonary Physiology - Final - SPC

QuestionAnswer
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
Created by: mac6672