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Tracheobronchial Tree
Structures of the trachea and bronchi
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Co-morbidity
Associated disease process
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Xiphisternal Joint
Union between xiphoid process and body of sternum
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Thoracic Skeleton
- 12 pairs of ribs
- - 1-7 true ribs
- - 8-10 join to 7th rib anteriorly
- - 11-12 no anterior attachment
- Sternum
- -manubrium
- -body
- -xiphoid process
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Diaphragm
Muscular dome shaped muscle which seperates the thoracic cavity from the abdomen. Muscle of breathing. The aorta, esophagus, inferior vena cava travel through it.
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Pulmonary Hilum
Central medial region of the lung where the bronchi and pulmonary vasculature enter the lung
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Lung Volumes
Tidal Volume: Volume of air entering and leaving lungs with each breath. (500mL)
Residual Volume: Volume of gas left in the lungs after a forced maximal expiration. (1,200 mL)
Expiratory Reserve Volume: Volume of gas expelled during a forced maximal exhalation starting at the end of normal tidal expiration. (1,200 mL)
Inspiratory Reserve Volume: Volume of gas inhaled into the lungs duing a forced maximal inhalation starting at the end of a normal tidal inspiration. (3,600 mL)
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Standard Lung Capacities
Total Lung Capacity: Volume of air in the lungs after maximal inspiratory effort and is the sum of all four lung volumes. (6,500 mL)
Vital Capacity: Volume of air forcefully exhaled after maximal forced inspiration.
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Other Lung Volumes and Spaces
Minute Volume: Volume of air exhaled in 1 minute. Tidal volume x RR
Anatomical Dead Space: Volume of air that remains in the tracheobronchial tree and does not reach the alveoli for gas exchange
Alveolar Dead Space: Volume of air in the alvoli that is not perfused and has no gas exchange
Physiological Dead Space: Sum of both of above dead spaces
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Hypoxic Drive
Mechanism that increases respiratory stimulation when PaO2 falls and inhibits respiratory stimulation when PaO2 rises.
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Control of Respiration
Medulla Oblongata: CO2 receptors. Sets basic rate and depth of breathing
Pons: Modifies rate and depth of breathing
Internal Carotid Arteries: CO2, O2 and BP receptors
Aorta: CO2, O2 and BP receptors
Lungs: Stretch receptors
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Atelectasis
Collapse of a lung or part of a lung
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Great Vessels
Large arteries and veins located in the mediastinum that enter and exit the heart
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Pericardium
Fibrous sac that surrounds the heart
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Epicardium
Serous membrane covering the outer surface of the heart. Visceral pericardium
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Myocardium
Muscle tissue of heart
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Ligamentum Arteriousum
Cordlike remnant of fetal vessel connecting the pulmonary artery to the aorta at the aortic isthmus
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Signs and Symptoms of Chest Wall Injury
ribs 4-8 most commonly fractured
- Blunt or penetrating trauma to chest
- Erythema
- Ecchymosis
- Dyspnea
- Pain on breathing
- Limited breath sounds
- Hypoventilation
- Crepitus
- Paradoxical chest wall movement
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Flail Chest
Defect in chest wall that allows for free movement of a segment. Breathing will cause paradoxical chest wall motion
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Pneumothorax
Air in pleural space
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S/S of Pneumothorax
- Trauma to chest
- CP on inspiration
- Hyperinflation of chest
- Diminished breath sounds on affected side
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S/S of Open Pneumothorax
- Penetrating chest trauma
- Sucking chest wound
- Frothy blood at wound site
- Dyspnea
- Hypovolemia
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Tension Pneumothorax
Buildup of air under pressure within the thorax. Resulting compression of the lung severely reduces effectivenss of respirations.
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S/S of Tension Pneumothorax
- Chest trauma
- Severe dyspnea
- Ventilation/perfusion mismatch
- Hypoxemia
- Hyperinflation of affected side of chest
- Hyperressonance of affected side
- Dimished/absent breath sounds on affected side
- Cyanosis
- Diaphoresis
- AMS
- JVD
- Hypotension
- Hypovolemia
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Hemothorax
Blood within pleural space
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Hemopneumothorax
Blood and air within pleural space
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S/S of Hemothorax
- Blunt or pentrating chest trauma
- S/S of shock
- Dyspnea
- Dull sounds over affect side of chest
- NO JVD
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S/S of Pulmonary Contusion
- Blunt or pentrating chest trauma
- Increasing dyspnea
- Hypoxia
- Increasing crackles
- Diminishing breath sounds
- Hemoptysis
- S/S of shock
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Hemoptysis
Coughing of blood that originates in the respiratory tract
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S/S of Blunt Cardiac Injury
- Blunt injury to chest
- Bruising of chest wall
- Rapid HR, maybe irregular
- Severe nagging CP
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Precordium
Area of the chest wall overlying the heart
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Commotio Cordis
Damage to the heart caused by an abrupt nonpentrating blow to an adjacent body surface causing ventricular fibrillation.
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Pericardial Tamponade
A restriction to cardiac filling caused by fluid in the pericardial sack
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S/S of Pericardial Tamponade
- Penetrating trauma
- Dyspnea
- Cyanosis
- JVD
- Weak, thready pulse
- Decreasing blood pressure
- Shock
- Narrowing pulse pressure
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Beck's Triad
- Signs of pericardial tamponade
- -JVD
- -Distant heart tones
- -Hypotension
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Pulsus Paradoxus
Alternating strong and weak pulse
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Pulsus Alternans
Drop of greater than 10 mmHg in systolic BP during the inspiratory phase of respiration that occurs in patients with pericardial tamponade
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Electrical Alternans
Alternating amplitude of complexes on EKG as heart swings in a pendulum like fashion in pericardial tamponade
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Aneurysm
A weakening or ballooing in the wall of a blood vessel
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