the process by which air is moved from the atmosphere to the terminal units of the lungs
the gas must pass from the air, across tissue, to the blood and back again
upper respiratory includes:
lower respiratory includes:
factors that affect the height of the diaphragm:
- rotation of the patient
- loss of lung volume
- abdominal pressure due to the supine position
rotation will affect:
- hilar region
- magnification of one lung
- heart size
depressed sternum that can displace the heart
a bony tubular density in the posterior thorax
thoracic cavity divisons:
- right and left pleural cavity
- parietal pleura (lines thoracic cavity)
- visceral pleura (adheres to lung tissue)
- great vessels
the thymus of an infant is large and is shaped like a sail on the chest xray
(it is unusual to have a mass in the mediastinum of an infant)
air is trapped in the medistinum b/c of a disruption to the esophagus or airway
caused by: trauma to the chest
- mediastinal emphysema
air that is located in the soft tissues of the neck or chest
can be caused from a sever pneumomediastinum
air bubbles in the skin can be palpated
fluoro of the chest can be done to evaluate:
- fixation of the diaphragm
- differentiate b/w a lung nodule and a pseudonodule
- cardiac valvular calcifications
in the chest lesions are usually benign and lesions may be malignan
- less than 1 cm
- more than 1 cm
calcium in the of a lesion are usually benign and in the of a lesion may be malignant
CT of the chest is done to:
- evaluate the pulmonary adenopathy
- analyze questionable pathology
- detect emboli in the thoracic vessels
- percutaneous transthoracic needle aspiration
performs perfussion and ventilation studies especially in cases of obstructive disease and pulmonary emboli
PET scan is used to:
- give info about the metabolic activity in the chest
- can distinguish benign from malignant lesions
- uses fluorodeoxyglucose for injection
insterted through the mouth or nose into the trachea.
helps to manage airway.
shoule be positioned below the vocal cords, but above the carina
endotracheal tube (ET tube)
large plastic tube inserted through the chest wall between ribs into the lungs.
allows drainage of air from a pneumothorax or fluid from PE or hemothorax
container must be kept below the level of the chest
a catheter for the injection of fluids and allows measurement of central venous pressure.
placed through the subclavian vein with the tip in the distal superior vena cava.
CXR is done to r/o pneumothorax or hemothorax.
incorrect placement can cause arrythmias
- central venous pressure
most commonly used in the diagnosis and management of heart failure resulting from M.I or cardiac shock.
inserted through the subclavian vein to the pulmonary artery.
multilumen catheter that evaluates cardiac function and cardiac pressure.
has taken the place of CVP b/c of their accuracy.
- Swanz-Ganz catheter
- "Pulmonary artery catheter"
(inserted through the subclavian vein and used for making injections)
- hickman catheter
placed under the skin, just below clavicle (subclavian)
not open to the outside to reduce chance of infections.
used for chemo patients
has a 40 cc balloon at the end of the catheter (in the descending aorta) to allow inflation and deflation by a pump that is synchronized to the patients cardiac cycle to provide support of the left ventricle.
inserted surgically, percutaneous, at bedside
- intra-aortic balloon pump catheter
inserted through the antecubital vein into the right ventricle for bradycardia
temporary ventricular pacing electrodes
pacemaker generator is inserted under the skin below to right clavicle. electrodes are in the right ventricle
permanent ventricular pacing electrode
lack of respiratory function or exchange of gases.
failure may be within lungs or just impaired breathing
low levels of oxygen in arterial blood
toxic gas or smoke inhalation
congenital heart defects
the inability to move air into and out of the lungs. there is an increase in the carbon dioxide.
resp failure resulting in hypercapnia and hypoxemia may be caused by:
- an obstructed airway
- insufficient resp drive
- resp muscle fatigue
- intrinsic lung disease
- dysfunction of the central nervous system
resp failure sugns and symptoms:
- parodoxic abdominal motion
- for acute failure: cardiac arrythmias
diagnosis of resp failure is by
arterial gas measurements
a genetic disorder which consists of a defect in the exocrine glands causing abnormal secretions.
in the resp system secretions increase form hypertrophy of bronchial glands and leads to obstructions
most common lethal genetic disease for white children
thickening of linear marking throughout the lungs-bronchial thickening and hyperinflation.
prone to staph infections
chronic cough, wheezing with recurring or chronic pulmonary infection
complications include: pneumothorax
Right heart failure
incomplete maturation of hte surfactant-producing system causing unstable alveoli.
results in alveolar collapse with widespread atelectasis.
rapid and labored breathing immediately or shortly after birth, common in premature babies less than 37 weeks
severe resp and metabolic acidosis will result
- hyaline membrane disease
- "respiratory distress syndrome"