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Upper Airway Functions
- Conductor of Air
- Humidify and warm or cool inspired air
- Prevent foreign material from entering
- Involved in speech and smell
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Epiglottis Function
Prevents the aspiration of food or liquids
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Everything Begins
At the terminal bronchioles
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Inferior of larynx is composed of
Cricoid Cartilage
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Which has the greatest cross section in the lungs
Terminal Bronchioles
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Normal Respiratory Rate
12-22
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Eupnea
Nommal, Spontaneous breathing
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Tachypnea
Rapid rate of breathing
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Orthopnea
Condition in which the individual is able to breath most comfortably only in the upright position
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Dyspnea
Difficulty breathing
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Biot's Breathing
- Irregular breathing followed by apnea
- (Damage to medulla)
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Cheyne - Stoles Breathing
- Apnea followed by irregular breathing followed by apnea
- (Cerebral disorders and CHF)
-
Kussmaul's Breathing
- Irregular breathing
- (Diabetic Acidosis)
-
Hyperventilation
↑ pH ↓ CO2
-
Hypoventilation
↓ pH ↑ Co2
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Barometric Pressure @ Sea level
760mmHg
-
Water Vapor Pressure @ Sea level
47mmHg
-
Alveolar Equation
PaO2=(PB-47)FiO2-PaCO2 x 1.25
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The canals of Lambert are found on the
Terminal brochioles
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Major Muscle of ventilation
Diaphragm
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Right Lung
- Upper Lobe
- Horizontal Fissure
- Middle lung
- Oblique Fissure
- Lower Lobe
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Left Lung
- Upper Lobe
- Oblique Fissure
- Lower Lobe
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What produces Surfactant
Granular Pneumocytes (Type II cells)
-
Apnea
Complete absence of spontaneous ventilation
-
Difference between Alveolar and Pleural Pressure
Transpulmonary
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How many alveoli do we have
300 Million
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What does the Foramen Ovale become
Small depression called Fossa Ovalis in the wall of right atrium
-
Ductus Arterious eventually forms
A fibrous cord called Ligamentum Arteriosum
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Airway Resistance
- Adult: 0.5 - 1.5 cm H20/L/sec (Higher for COPD)
- Neonate: 30 cm/H2O /L/sec
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Tidal Volume
- Adults: 5 to 7 mL/kg
- Neonate: 15 mL/kg
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Heart Rate
- Adult: 60 to 100 bpm
- Neonate: 130 to 150 bpm
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Hold of air in the lungs
Static Compliance
-
Movement of air in the lungs
Dynamic Compliance
-
Average Lung Compliance
0.1 l/cmH2O
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Boyles Law
Temperature Constant, Pressure Vary
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Charles Law
Pressure Constant, Volume & Temperature Vary
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Gay Lussac's Law
Volume Constant, Pressure & Temperature Vary
-
Henry's Law
Gas that dissolves in a liquid at a given temperature
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Increase in Ventilatory Rate
Decreases Tidal Volume
-
Type I Cells
- Squamous Pneumocytes
- 95% of alveolar surface
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CBABE
- C = Cystic fibrosis
- B = Bronchitis
- A = Asthma
- B = Bronchitasis
- E = Emphysema
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Superior Lingula is found
In the Left Lung, Lower Division of the Upper Lobe
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Umbilical Arteries atrophy and become
The lateral Umbilial Ligament
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Ductus Venosis becomes the
Ligamentum Venosis
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In the placenta, maternal blood is continuously pumped though the
intervillous Space
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In the fetal circulation once the blood enters the right atrium most of the blood enters the left atrium by passing though the
Foramen Ovale
-
-
In a healthy man, hematocrit is about
45%
-
Cause pulmonary vascular constriction
Epinephrine & Dopamine
-
The force the ventricles must work against to pump blood is called
Ventricular afterload
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Ventilation
Process that moves gases between the external environment and the alveoli
-
During what phase do you produce more cardiac output
Systolic
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Blood Flow though the HEART
- Superior/Inferior Vena Cava ⇛Right Atrium ⇛
- Tricuspid Valve ⇛Right Ventricle ⇛ Pulmonary Valve ⇛ Pulmonary Artery⇛ Lungs ⇛ Pulmonary Vein ⇛ Left Atrium ⇛ Biscuspid Valve ⇛ Left Ventricle ⇛ Aortic Valve ⇛ Aorta ⇛ Body
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Systolic (Contraction)
Maximum pressure generated during ventricular contraction
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Diastole (Relaxation)
Lowest pressure that remain in the arteries
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Right Venticular Heart Failure
Enlargement of the right ventricle caused by primary lung disease, Increase in pulmonary resistance and work in the right heart
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Baroreceptors
Regulate Blood Pressure
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Chemoreceptors
Regulate Respiration
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Cholinergic (Cholinomimetic)
Drug that stimulates a receptor for Acetylcholine
-
When arranged for Flow Poiseuille's Law states that Flow is
Directly proportional to P and inversely proportional to n
-
Usually elevated in patients with asthma
Eosinophils
-
Suggest a bacterial infection
Neurophils
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Causes Pulmonary Vasoconstriction
- Hypercapnia
- Hypoxia
- Acidema
- Increased H+ concentration
-
Pulmonary System
Begins with the pulmonary trunk and ends in the left atrium
-
Systemic System
Begins with the Aorta and ends in the right atrium
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Hematocrit
- Males: 45%
- Females: 42%
- Neonates: 45-60%
-
Granulocytes (WBC)
- Neutrophils: 65% of total WBC, Phagocytize invading bacteria
- Eosinophils: Elevated in Asthma patients
- Basophils: Increased in Allergic and Inflammatory reactions
-
Agranulocytes (WBC)
Lymphocytes: T-cells act directly against virus infected cells and tumors. B-cells give rise to plasma which produce antibodies
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Dissolved
O2 is in the plasma
-
Bound
O2 is in Red Blood Cells
-
Total Blood Content
CaO2= (Hb x 1.34 x SaO2) + (PaO2 x 0.003)
-
Functional unit of the kidney
Nephrons
-
Functional unit of the lungs
Alveoli
-
Hypoxic Hypoxia
- Low O2 in the tissue cells
- (Hypoventilation, High Altitude)
-
Anemic Hypoxia
- Low O2 carrying capacity of hemoglobin
- (Anemia, Hemorrhage)
-
Stagnant (Circulatory) Hypoxia
- O2 not adequate to meet tissue needs
- (Venous shunt)
-
Histotoxic Hypoxia
- Impaired ability of the tissue cells to metabolize O2
- (Cyanide Poisoning)
-
Hypoxemia ( Low O2 in the Blood)
- Normal: 80-100
- Mild: 60-80
- Moderate: 40-60
- Severe: <40
-
Stoke Volume
Volume of blood ejected from the ventricle during each contraction
-
Cardiac Output
- Blood pumped per minute from the heart
- CO=SV x HR
-
Carbonic Acid - Bicarbonate
- Buffer system and acid base balance
- Work to resist sudden changes in blood pH
- Ratio: 20:1
-
ADH
- Produced by the hypothalamus and is released by the pituitary gland
- Allows re absorption
-
Glomerular Filtration
- Capsule that gets the blood into the kidneys
- Filtrates 99% of blood going into kidneys
-
Newborns have 24 million
Alveoli
-
Apnea
- Complete absence of spontaneous ventilation
- Anything more than 20 sec
-
Eupnea
Normal, Spontaneous breathing
-
Dyspnea
Difficulty breathing
-
Expiration
Passive ventilation
-
Inspiration
Active ventilation
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Kidney Location
Posterior wall of the abdominal cavity
-
Deactivates Acetylcholine
Cholinesterase
-
Normal Urine Output
60mL/hr
-
Sympathetic system
When activated neural transmitters such a epinephrine and noreepinephrine
-
Parasymthathetic System
When activated the neural transmitter Acetylcholine is released
-
Normal calculated anatomical shunt
2-5%
-
Glomerular filtration is directly proportional to
Hydrostatic Pressure
-
Tubular readsorbtion occurs primary in the
Proximal convoluted tubule
-
The bulk of the CO2 produced in the cells is transported to the lungs as
HCO3
-
Protects the lungs from excessive inflammation
Hering-Breuer Inflation Reflex
-
Alveoli continues to increase until
12yr of age
-
Anatomical Dead space
Physical pressure - Alveolar pressure
-
What is decreased compliance
↑ Ventilation rate ↓Tidal Volume
-
Surfactant Appears
@ 36 weeks
-
Sends messages out to the CNS
Efferent
-
Anatomic dead space increases in response to
↑ Ventilatory Rate
-
P50
Partial Pressure at which hemoglobin is 50% saturated with O2 @ 27torr
-
Oxygen dissociation curve
Shows how blood carried O2 though the body
-
Left Shift (Alkaline)
pH ↑
- O2 affinity for hemoglobin Increases
- (easier time making the bond w/O2)
-
Right Shift ( Acidic)
pH ↓
- O2 affinity for hemoglobin Decreases
- (harder time making bond w/ O2)
-
Normal Hb
- Males: 14-16
- Females: 12-15
- Neonates: 14-20
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V/Q Mismatch
If @ 60% FiO2 patient gets better
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V/Q Shunting
If @ 60% FiO2 patient has no improvement
-
V/Q calculation
Divide V/Q
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Duration of flow
Pressure (psi) x Cylinder / Flow
-
-
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ASSS
- American Standard Safety System
- H cylinder / High pressure
- Have Threaded valve outlet
-
PISS
- Pin Index Safety System
- E cylinder / High Pressure
- Have Post Valve and Yoke Connector
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DISS
- Diameter Index Safety System
- Low Pressure
-
Low Flow Devices
- 8L/min or less
- Nasal Cannula
- Simple Mask
- Partial rebreathing mask
- Nonrebreathing mask
-
Air Entrainment Mask (Venturi)
Deliver controlled FiO2
-
ROP Retinophathy of Prematurity
Eye disease or blindness in premature infants caused by high concentration of O2
-
When the blood pH decreases the oxyhemoglobin dissociation curve shifts to the
Right and the P50 Increases
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What gas to use to treat hypoxic respiratory failure
Nitric Oxide (NO)
-
Gas used with O2 to manage severe airway obstruction
Helium
-
Oxygen toxicity is a concern when FiO2 is at or above
60% or more for 24hr
-
Nitrous Oxide
- Anesthetic gas
- Has been linked to fetal disorders
-
Heliox
Used to treat severe large airway obstruction sush as life threatening asthma
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The lowest PO2 would normally be found in what location
Cells
-
One what does the movement of gases between the lungs and the body tissues mainly depend
Gaseous Diffusion
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Autonomy
Uphold a patients right to refuse treatment
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Respiratory care programs are accredited by
CoARC
-
Branch of law concerned with the recognition and enforcement of the rights and duties of private individuals and organizations
Civil Law
-
Civil wrong committed against an individual or property for which a court provides a remedy in the form of damage
Tort Law
-
Code of ethic
How we should act/ Practice within our scope
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Quality assurance of a respiratory department
Any evaluation of service provite and the results achieved compared with accepted standards
-
Joint Commission are going to make sure that
Quality assurance is meet
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The scope of practice of respiratory care
Anything to do with the cardiopulmonary system
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Malpractice
Unprofessional misconduct that cause injury or harm to the patient
-
Risk Management
- Assessments done
- Identification assessment and prioritization of risks followed
-
CEU
Continuing Education Units
-
Respiratory Initial Association (AARC) formed in
1947
-
Beneficence
Passing on ones believes
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Negligence
Erratic Behavior
-
AARC
American Association of Respiratory Care
-
Vesicular
Normal breathing sound
-
Bronchial
Abnormal (Pneumonia)
-
Diminished
Reduced/Decreased (COPD, Athma) or Fluid (Pneumothorax, Pleural effusion)
-
Wheezing
Obstructed airway (Asthma, CHF)
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Stridor
Obstructed Upper Airway (Croup, Epiglottis)
-
Coarse Crackles
Inspiratory & Expiratory (Pneumonia & Bronchitis)
-
Fine Crackles
Late Inspiratory (Atelectasis, Pulmonary Edema)
-
O2 is measured by a
Clark Analyzer
-
CO2 is measured by a
Servinghouse Analyzer
-
Lest Shift (Increased affinity)
Easier to make bond with O2
-
Right Shift (Decreased affinity)
- Harder to make bond with O2
- More unloading of O2
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