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WEEK 18:
Mechanisms of ventilation:
| Question | Answer |
|---|---|
| innervation of diaphragm | phrenic nerve C3-5 |
| diaphragm anteriorly attaches to | xiphoid process and costal margin |
| diaphragm laterally attaches to | ribs 6-12 |
| diaphragm posteriorly attaches to | T12 vertebra |
| diaphragm | dome shaped muscular partition |
| describe intercostal muscle fibre arrangement | obliquely angled from rib to rib |
| what happens to intercostal muscles to make the rib cage raise | external and internal intercostal muscle fibres contract which raises each rib towards the rib above |
| what happens to intercostal muscles to lower the rib cage | internal and innermost intercostal muscles depresses each rib to the rib below |
| accessory muscles of respiration (3) | SCM (sternocleidomastoid muscle), scalene muscles, and pecs + trapezius |
| SCM (sternocleidomastoid muscle) | raises sternum |
| scalene muscles | help elevate ribs during forced breathing and prevent rib 1+2 from descending |
| pecs and trapezius function | fix pectoral girdle to raise rib cage |
| suprapleural membrane (cervicothoracic/ costovertebral fascia) | dense fascial layer |
| how do babies breathe | abdominal breathing by contracting diaphragm |
| why do babies use abdominal breathing | ribs are more horizontal so cant use pump/bucket handle movements, and intercostal muscles are weak |
| how does abdominal breathing occur | contracting diaphragm |
| respiratory distress | lungs fail to provide enough O2 to body |
| symptoms of respiratory distress (4) | cyanosis, rapid and shallow breathing, rapid heart rate, use of accessory muscles while at rest |
| factors making you more susceptible to respiratory disease/ airway obstruction (5) | short neck, narrow airways, tongue larger in proportion than mouth, smaller lung capacity, and underdeveloped chest muscles |
| harrisons sulcus | horizontal groove along lower ribs caused by the diaphragm moving inwards to the soft ribs during ventilation |
| cyanosis | bluish discolouration of skin and mucous membranes due to inadequate oxygenation and circulation |
| neonatal respiratory distress syndrome (NRDS) | premature babies do not have enough surfactant in lung |
| intercostal retractions | skin and muscles get sucked in around the ribs when you inhale because airways are blocked/narrowed |
| acute respiratory distress syndrome (ARDS) | acute onset and poor oxygenation due to non compliant lungs |
| common causes of ARDS | lung infections eg pneumonia |
| chronic bronchitis of COPD | destroy cilia |
| emphysema in COPD | alveoli become damaged (over inflate) affecting gas exchange |
| how does sitting up and leaning forward (thinker/tripod) posture relieve dyspnoea | maximises inspiratory pressure by lifting shoulder girdle to improve action of pectoralis major (acts as an accessory muscle and lifts rib cage in this position) |
| diaphragmatic excursion | distance diaphragm moves during breathing cycle |
| non tension pneumothorax | air enters pleural space but does not keep building up |
| tension pneumothorax | accumulation of air within pleural space originating from respiratory system |
| most important muscle in respiration | diaphragm |
| vertical dimension of rib cage during inhalation | diaphragm contracts and flattens, pushing abdominal viscera down |
| AP dimension of rib cage during inhalation | intercostals contract so upper ribs move up and forward (hand pump movement) |
| transverse dimension of rib cage during inhalation | intercostals contract so lower ribs move out (bucket handle movement) |
| location of lungs compared to ribs | above 1st rib |
| lung apex is covered by | suprapleural membrane |
| suprapleural membrane attaches anteriorly to | inner border of the 1st rib and its costal cartilage |
| suprapleural membrane attaches posteriorly to | C7 transverse process |
| suprapleural membrane attaches medially to | mediastinal pleura |
| types of respiratory distress (2) | neonatal respiratory distress syndrome and acute respiratory distress syndrome (ARDS) |
| acute respiratory distress syndrome (ARDS) affects who | anyone regardless of age |
| normal children are nasal breathers until | 4-6 weeks |
| respiratory rate in newborns | higher (30-60 breaths/min) |
| respiratory rate in early teens | 20-30 breaths/min |
| when does NRDS present | within hours after birth |
| who does NRDS affect | premature babies |
| when is surfactant produced | late in gestation (34-36 weeks) |
| on microscopic level, ARDS is associated with | capillary endothelial injury and alveolar damage leading to surfactant break down |
| symptoms of ARDS for differential diagnosing (3) | chronic cough, unilateral wheezing, and foreign body aspiration |
| why do lungs become over inflated (hyperinflated) in COPD | airways collapse during exhalation so air becomes trapped in lungs |
| describe the effect of diaphragm and intercostal muscles in COPD (emphysema) | lungs are already full of air which pushes down diaphragm making it shorter and weaker so it and intercostals cannot move the chest wall |
| how does the body compensate in COPD when it cannot use diaphragm/ intercostal muscles | uses accessory muscles (scalene muscles and SCM) to lift rib cage and pull air in |
| chronic use of SCM may lead to | development of noticeable hypertrophy (enlarged muscles) and elevation of clavicles (more than 5mm upward movement) |
| how far do the clavicles move when using accessory muscles in COPD | more than 5mm upwards |
| why is minor exhaling through pursed lips good | air leaves slowly meaning alveoli dont collapse |
| leaning forward | reduces abdominal pressure on diaphragm and uses accessory muscles so breathing requires less effort |
| inspiratory retraction of supraclavicular fossae and intercostal spaces occur | shows increased airway resistance because patient must generate strong negative pressure to inhale |
| explain chest expansion and inhalation in COPD where diaphragm is flattened | inhalation causes subcostal angle to decrease and chest moves medially |
| difference in inhalation in normal and COPD patients | chest expands laterally in normal patients but chest expands medially in COPD patients |
| difference in mediastinum in non tension and tension pneumothorax | mediastinum is not displaced in NT but is in T |
| difference in diaphragm in non tension and tension pneumothorax | diaphragm is not displaced in NT but gets pushed down in T leading to diaphragmatic excursion |
| patient may have pneumonia/ pneumothorax when diaphragmatic excursion is | less than 3-5cm |
| what else can cause issues with ventilation | tumour eg in carina of trachea |
Created by:
kablooey
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