Volume 4 Chapter 10

Structures of the trachea and bronchi

Associated disease process

Union between xiphoid process and body of sternum

• 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

Muscular dome shaped muscle which seperates the thoracic cavity from the abdomen. Muscle of breathing. The aorta, esophagus, inferior vena cava travel through it.

Central medial region of the lung where the bronchi and pulmonary vasculature enter the lung

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)

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.

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

Mechanism that increases respiratory stimulation when PaO2 falls and inhibits respiratory stimulation when PaO2 rises.

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

Collapse of a lung or part of a lung

Large arteries and veins located in the mediastinum that enter and exit the heart

Fibrous sac that surrounds the heart

Serous membrane covering the outer surface of the heart. Visceral pericardium

Muscle tissue of heart

Cordlike remnant of fetal vessel connecting the pulmonary artery to the aorta at the aortic isthmus

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

Defect in chest wall that allows for free movement of a segment. Breathing will cause paradoxical chest wall motion

Air in pleural space

• Trauma to chest
• CP on inspiration
• Hyperinflation of chest
• Diminished breath sounds on affected side

• Penetrating chest trauma
• Sucking chest wound
• Frothy blood at wound site
• Dyspnea
• Hypovolemia

Buildup of air under pressure within the thorax. Resulting compression of the lung severely reduces effectivenss of respirations.

• 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

Blood within pleural space

Blood and air within pleural space

• Blunt or pentrating chest trauma
• S/S of shock
• Dyspnea
• Dull sounds over affect side of chest
• NO JVD

• Blunt or pentrating chest trauma
• Increasing dyspnea
• Hypoxia
• Increasing crackles
• Diminishing breath sounds
• Hemoptysis
• S/S of shock

Coughing of blood that originates in the respiratory tract

• Blunt injury to chest
• Bruising of chest wall
• Rapid HR, maybe irregular
• Severe nagging CP

Area of the chest wall overlying the heart

Damage to the heart caused by an abrupt nonpentrating blow to an adjacent body surface causing ventricular fibrillation.

A restriction to cardiac filling caused by fluid in the pericardial sack

• Penetrating trauma
• Dyspnea
• Cyanosis
• JVD
• Weak, thready pulse
• Decreasing blood pressure
• Shock
• Narrowing pulse pressure

• Signs of pericardial tamponade
• -JVD
• -Distant heart tones
• -Hypotension

Alternating strong and weak pulse

Drop of greater than 10 mmHg in systolic BP during the inspiratory phase of respiration that occurs in patients with pericardial tamponade

Alternating amplitude of complexes on EKG as heart swings in a pendulum like fashion in pericardial tamponade

A weakening or ballooing in the wall of a blood vessel