Cardiorespiratory

It takes blood away from the LV

It returns the blood to the RA from the lower body and viscera

Takes blood away from the RV to the L and R lungs

It returns blood from the L and R lungs to the LA

It returns blood to the RA from the head, neck and arms

It controls blood flow between the RA and the RV

It controls blood flow between the LA and the LV

I controls blood flow between the LV and the aorta

It controls blood flow between the RV and the pulmonary artery

• Expiratory Reserve Volume (ERV)
• Residual Volume (RV)

• Tidal Volume (TV)
• Inspiratory Reserve Volume (IRV)

• Inspiratory Reserve Volume (IRV)
• Tidal Volume (TV)
• Functional Residual Capacity (FRC)
• Residual Volume (RV)

• Inspiratory Reserve Volume (IRV)
• Tidal Volume (TV)
• Expiratory Reserve Volume (ERV)

The volume of air that occupies the non-respiratory conducting airways

The maximal volume of air that can be exhaled  after a normal tidal exhalation (ERV is ~ 15% of total lung volume)

The maximum volume of air exhaled in a  specified period of time (generally the 1sr, 2nd and 3rd second of a forced vital capacity maneuver)

The volume of air expired during a forced maximal expiration after a forced maximal inspiration

The volume of air in the lungs after normal exhalation 

FRC = ERV + RV

FRC is ~ 40% of total lung volume

The maximal volume of air that can be inspired after a normal tidal exhalation 

IC = TV + IRV

IC is ~ 60% of Total Lung Volume

The maximal volume of air that can be inspired after after normal tidal volume inspiration

IRV is  50% of total lung volume

The volume of air expired in one minute

VE = TV x respiratory rate

The maximum flow of air during the beginning of a forced expiratory maneuver

The volume of gas remaining in the lungs at the ends of a maximal expiration

RV is ~ 25% of total lung volume

Total volume inspired and expired with each breath during quiet breathing 

TV is ~ 10% of total lung volume

• The volume of air in the lungs after an maximal inspiration; the sum of all lung volumes 
• TLC = RV + VC
• OR
• TLC = FRC + IC

The volume change that occurs between maximal inspiration and maximal expiration

VC = TV + IRV + ERV

VC is ~ 75% of total lung volume

Sudden respiratory failure d/t fluid accumulation in the alveoli 

• S&S: SOB, laboured and unusually rapid breathing, hypotension, confusion, extreme fatigue, cough, fever
• - S&S vary based on the cause and severity of ARDS

• Treatment: ventilation) ***IMP to determine the cause to guide Rx and predict prognosis***
• Bring O2 to the lungs and organs (supplemental O2 and mechanical + treating underlying condition

A transient precordial sensation of pressure or discomfort resulting from myocardial schema (stabile or unstable). Triggered by exertion or strong emotion. Subsides w/ rest

S&S: pressure, heaviness, fullness, squeezing, burning or aching behind the sternum and/or neck, back, jaw, shoulder and arms. Difficulty breathing, nausea/vomiting, sweating, anxiety

Rx: O2, nitroglycerin, rest

A chronic inflammation of the airways caused by an increased airway hypersensitivity to various stimuli 

• S&S: 
• - Mild attack: wheezing, chest tightness, slight SOB
• - Severe attack: dyspnea, flaring nostrils, diminished wheezing, anxiety, cyanosis, inability to speak

Rx: reduce exposure to known triggers; MEDs (AI agents + bronchodilators); (PT) education, airway clearance, breathing exs, relaxation and endurance/strength training

A condition in which one or more areas of the lung collapse or do not inflate properly

S&S: cyanosis, SOB, increased breathing rate and HR if large area 

Rx: base Rx on underlying cause. Deep breathing, changing position, airway clearance, MEDs, mechanical ventilation assist

An inflammation of the bronchi characterized by hypertrophy of the mucus secreting glands, increased mucus secretion, and insufficient oxygenation d/t mucus blockage 

S&S: persistent cough w/ production of thick sputum, increased use of accessory myo of breathing, wheezing, dyspnea, cyanosis, and increased pulmonary artery pressure. Cough may be worse in the morning and damp weather

• Rx: focuses on receiving S&S and improving breathing.
• - Acute: rest, fluids, breathing warm and moist air, cough suppressants, acetaminophen or ASA
• - Chronic: antibiotics, anti-inflammatory agents, bronchodilators, life style changes

Hypertrophy of the RV caused by altered structure or function of lung

S&S: progressive SOB, fatigue, palpitation, atypical chest pain, swelling of the LE, dizziness and syncope

Rx: supplemental O2 to maintain SpO2 > 90% and/or PaO2 > 60mmHg

Autosomal recessive genetic disease of the exocrine glands that the primarily affects the lungs, pancreas, liver, intestines, sinuses and sex organs

S&S: slaty tasting skin, persistent and productive coughing, frequent lung infection, wheezing, SOB, poor growth/weight gain (good appetite), frequent greasy/bulky stool

Rx: MEDs, nutritional supplements, pancreatic enzyme replacement. (PT) airway clearance, breathing technique, assisted cough, ventilatory myo training

Inflammation of the endothelium the lines the heart and cardiac valves

S&S: fever, chills, heart murmur, fatigue, SOB, weight loss, blood in urine, skin petechiae

Rx: antibiotics. Surgery may be needed

Inflammation and weakness of of the myocardium --> can cause the myocardium to become thick and swollen which can lead to S&S of heart failure 

S&S: arrhythmias, chest pain, SOB, fatigue and signs of fever

• Rx: focus on underlying cause. Antibiotic, anti-inflammatory, diuretics, beta-blockers, calcium channel blockers 
• ***In severe cases, may require surgical implantation of a ventricular assist or intra-aortic balloon pump

• Occurs when fluids collect in the alveoli within the lungs
• ***ACUTE = MEDICAL EMERGENCY***

S&S: extreme SOB, a feeling of suffocating or drowning, wheezing or gasping for breath, anxiety, restlessness, a sense of apprehension, coughing, frosty/blood-tinged sputum, chest pain, rapid/irregular HB

Rx: supplemental O2 and MEDs...varies w/ underlying cause

22-26 mEq/L

35-45 mmHg

80-100 mmHg

7.35-7.45

>95%

1st heart sound - closure of the mitral and tricuspid (atrioventricular) valves at the onset of ventricular systole

- High frequency sound w/ lower pitch and longer duration than S2

2nd heart sound - closure of the aortic and pulmonary valves at the onset of ventricular diastole

- High frequency sound w/ higher pitch and shorter duration than S1

3rd heart sound - vibration of the distended ventricle walls due to passive flow of blood from the atria during the rapid filling phases of diastole

• - Normal in young children
• - Abnormal in adults : may be associated w/ heart failure

4th heart sound - pathological sound of vibration of the ventricular wall with ventricular filling and atrial contraction 

- May be associated w/ HBP, stenosis, hypertensive heart disease or MI

Vibrations of longer duration than the heart sounds and are often d/t disruption of blood flow past a stenotic or regurgitant valve (backward flow of blood)

Sounds described as soft, blowing or swishing

Continuous, high-pitched popping sound heard during INSPIRATION

Dry, crackling sound heard during both INSPIRATION and  EXPIRATION

continuous, low-pitched sounds resembling snoring or gurgling during INSPIRATION and EXPIRATION

Continuous, high-pitched wheeze heard with INSPIRATION or EXPIRATION

Continuous musical or whistling sound composed of a variety of pitches

Atrial depolarization

Time for the atrial depolarization and conduction from the SA node to the AV node

Normal duration = 0,12-0,20 sec

Ventricular depolarization and atrial depolarization 

Normal duration = 0,06-0,10 sec

Time for both ventricular depolarization and repolarization

Normal duration = 0,20-0,40 sec (depending on HR)

Isoelectric period following QRS when the ventricles are depolarized

Ventricular repolarization

Refers to the volume of blood ejected by each contraction of the LV

Refers to the tension in the ventricular wall at the end of diastole

MV = Tidal Volume (TV) x Respiratory Rate (RR)

An ectopic very rapid atrial tachycardia of a rate 250-350 bpm. Ventricular rate depends upon AV node conduction (Saw-tooth shape P wave)

Cause: occurs with valvular disease, ischemic heart disease, cardiomyopathy, HTN, acute MI, chronic obstructive lung disease, PE

S&S: palpitations, lightheadedness and angina (d/t rapid HR)

Occurs when an ectopic focus in the atrium initiate an impulse before the SA node (premature and abnormally shaped P wave)

-> Common and generally benign but may progress to atrial flutter, tachycardia or fibrillation

Cause: may occur with a normal HR (ex. caffeine, stress, smoking, alcohol) or any type of heart disease

A common arrhythmia where the atria are depolarized between 300-600 bpm times/min (ECG show characteristically irregular undulation of ECG baseline without discrete P waves)

Cause: occurs in healthy heart and in patients with CAD, HTN and valvular disease

S&S: palpitation, fatigue, dyspnea, lightheadedness, syncope and chest pain

• 1st degree
• - PR interval is longer than 0.2 sec but relatively constant from beat to beat
• - PR may become prolonged for many reasons including MEDs that suppress AV conduction
• - No S&S or significant change in cardiac function 

• 2nd degree
• - AV conduction disturbance in which impulses between atria and ventricles fail intermittently (2 types: Mobitz I and II)
• - Mobitz I: progressiv prolongation of PR interval until one impulse is not conducted 
• - Mobitz II: consecutive PR interval are the same and normal followed by non-conduction of one or more impulses. If HR is slow, cardiac output will decrease with the blocked impulse 

*** 2nd degree may progress to 3rd degree 

• 3rd degree
• - All impulses are blocked at the AV node and none are transmitted to the ventricles. The atria and ventricles are paced independently; Atrial rate > ventricular rate 

***MEDICAL EMERGENCY***

• - If the ventricular rate is too slow, the cardiac output drops and the pt may faint
• - Causes: degenerative changes of the conduction system, digitalis, heart surgery, acute MI

• Premature depolarization arising in the ventricle d/t an ectopic focus 
• - Unifocal: arise from the same ectopic focus and have the same configuration
• - Multifocal: arise from different ectopic foci and have different configurations 

P wave usually absent and QRS complex wide and aberrant 

Cause: common arrhythmia that occurs in healthy and diseased hearts (ex. anxiety caffeine, stress, smoking, all form of heart disease)

S&S: asymptomatic or palpitations

3 or more consecutive PVCs at a ventricular rate > 150bpm (P wave is absent and QRS complex is wide and aberrant)

***V-Tach longer than 30 sec is a life-threatening arrhythmia and requires immediate medical attention

Cause: MI, cardiomyopathy, valvular disease

***V-Tach may degenerate into ventricular fibrillation causing cardia arrest

Ventricular fibrillate or quiver asynchronously and ineffectively; no cardia output so most pt become unconscious 

Cause: heart disease of any type, MI and cocaine use

Ventricular standstill with no rhythm (flat line)

Cause: acute MI, ventricular rupture, cocaine use, lightning strike and electrical shock 

***Requires IMMEDIATE CPR

ST segment depression of 1-2mm: subendocardial schema, digitalis toxicity, hypokalemia

ST segment elevation 1-2mm: acute transmural infarction or being early repolarization pattern in normal heart

Q wave longer than 0.04 msec and large than 1/3 amplitude of the R wave: MI (loss of positive electrical voltages d/t necrosis)

T wave inversion: occurs hours or days after MI (as the result of delay in repolarization produced by the injury), L bundle branch block, after CVA, normal juvenile T wave in children and some adults

3 phase breathing technique used to assist secretion clearance in pt with asthma 

• Phase 1 Breathing control: gentle, relaxed breathing at tidal volume for 5-10 sec
• Phase 2 Thoracic expansion exs: 3-4 deep, slow, relaxed inhalations to inspiratory reserve with passive exhalation (vibration, percussion or shaking may be combined with exhalation)
• Phase 3 Forced expiratory technique: 1-2 huffs at mid to low lung volume (brisk ADD of the arms may help)

• Precautions/Contraindications:
• - Splinting post-operative incisions to achieve expiratory force
• - Bronchospasm or hyperreactive airways

3 phase breathing technique that uses controlled breathing to mobilize secretions by varying expiratory airflow without using postural drainage 

• Phase 1 Unsticking phase: slowly breathe through the nose at low-lung volumes followed by a 2-3 sec breath hold; then exhale down into the expiratory reserve volume 
• Phase 2 Collecting phase: breathe at tidal volume, interspersed by 2-3 sec breath-holds
• Phase 3 Evacuating phase: deeper inspirations from lo-to-mid inspiratory reserve volume, with breath holding, followed by a huff

• Precaution/Contraindications:
• - Requires motivation and concentration to learn (30-45 min long technique)

• Cough phase: inhale maximally, close the glottis and hold breath for 2-3 seconds. Contact the expiratory myo to produce increased intra-thoracic pressure and cough sharply 2-3 times through open mouth
• Huff phase: inhale deeply though open mouth. Contract the abdominal myo during a rapid exhalation with the glottis open

• Precautions/Contraindications 
• - Post-surgical pt may need to splint the chest
• -Inability to control possible transmission of infection through droplets
• - Elevated ICP or know intracranial aneurysm
• - Reduced coronary artery perfusion
• - Acute unstable head, neck or spine injury
• - Potential for regurgitation/aspiration
• - Acute abdominal pathology, abdominal aortic aneurysm, hiatal hernia or pregnancy
• - Untreated pneumothorax
• - Osteoporosis
• - Flail chest

Handheld device that combine positive expiratory pressure and high frequency airway vibration to mobilize mucus secretions in the airways

Inhale slowly into the device to 75% of a full breath, hold 2-3 sec, exhale through the device 3-4 sec. Repeat 10-20 breaths. Remove the device and perform 2-3 coughs/huffs

• Precautions/Contraindications:
• - Pt tolerance of increased work of breathing (Acute asthma, COPD)
• - ICP > 20mmHg
• - Hemodynamic instability
• - Recent facila, oral or skull surgery or trauma
• - Acute sinusitis
• - Nosebleed
• - Esophageal surgery
• - Active hemoptysis
• - Nausea
• - Known or suspected tympanic membrane rapture or other middle ear pathology
• - Untreated pneumothorax

Consists of positioning the pt so that gravity will help drain bronchial secretions from specific lung segments toward the central airways, where they can be removed by cough or mechanical aspiration

Maintain the appropriate position for 2-3 minutes

• Precautions/Contraindications:
• - ICP > 20 mmHg
• - head and neck surgery until stabilized
• - Active hemorrhage with hemodynamic instability
• - Recent spinal surgery or acute spinal injury
• - Active hemoptysis 
• - Empyema
• - Bronchopleural fistula
• - Pulmonary oedema associate with CHF
• - Large pleural effusion
• - PE
• - Confused or anxious pt who do not tolerate position changes
• - Rib # with or without flail chest
• - Surgical wound or healing tissue

Main : Diaphragm (75% of the work) and external intercostal 

Accessory: SCM, pectoralis minor and major, scalene, trapezius, serratus (anterior, posterior, inferior)

Forced expiration: internal intercostal (T1-T12) and abdominal muscles (T6-L1)

Superior airways: mouth, nose, pharynx, larynx, glottis

Inferior airway: trachea, carina, bronchi, bronchioles, alveoli, pleurae

Cerebral cortex, medulla and pons, peripheral and central chemoreceptors, receptors in the bronchi, intra-pulmonary receptors, cardiac and thoraco-abdominal mechanoreceptors

Secretion in a part of the lung