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RESPIRATORY 221

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Title: RESPIRATORY 221


1
RESPIRATORY 221
  • CARDIOPULMONARY ANATOMY AND PHYSIOLOGY

2
Chapter 1
  • Main function of lungs bring atmospheric gases
    into contact with the blood
  • Ventilation The process of moving gas in and
    out of the lungs
  • Respiration moving oxygen and carbon dioxide
    between air and blood

3
Upper Airways
  • Most important function
  • warms
  • humidifies
  • filters
  • Consists of
  • nose
  • oral cavity (mouth)
  • pharynx (throat)
  • larynx (voice box)

inspired gas (air)
4
1. Nose
  • Air conditioning and filtering device
  • Nose is more resistant to airflow than mouth
  • Despite that resistance Most adults breathe
    through the nose at times of rest
  • High nasal resistance from swollen mucous and
    rapid breathing from exercise usually cause
    people to switch to mouth breathing.

5
NASAL CAVITYSeptum
  • Cartilage Divides nose
  • Right and Left Nostril
  • Clinically Right and Left NASAL FOSSAE
  • Some deflection occurs slightly to the left
  • Clinical Significance ___________________
  • Difficulty breathing through nose?
  • Deviated Septum? (Next Slide)

6
Nasal Cavity - Anatomical StructuresCONCHAE
  • Three Conchae bones
  • Superior, Middle, Inferior
  • Create Turbulence
  • AKA Turbinates
  • Conchae covered with mucous membranes
  • Main purpose is to filter, humidification, heat
    inhaled air

7
Nasal Fossae
Source mayoclinic.com/health/medical/IM02743
8
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9
3. PharynxGreek throat
  • Comprised of 3 landmarks
  • Where the Nasal Cavity ends all the way down
    right before the Larynx and Trachea- Fig 1-1 page
    3
  • 1. Nasopharynx -behind nasal cavity down to soft
    palate
  • 2. Oropharynx -behind oral cavity from soft
    palate to base of tongue
  • 3. Laryngopharynx aka Hypopharynx - below base of
    tongue and above larynx
  • By the time air reaches the nasopharynx, inspired
    air gains water vapor and heat from the nose and
    humidification

10
Concept Question 1-1, pg. 5
  • Answer
  • Nasal Cannula At what flow rate does the nose
    lose its ability to humidify oxygen?
  • Recommendation

11
Ventilator
  • Artificial Nose or HME
  • Drawback
  • If thick secretions -

12
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13
Back to the Pharynx
  • NASOPHARYNX- pg 5
  • Connected to the middle ear by the Eustachian
    Tubes aka _______________
  • AUDITORY TUBES

Eustachian Tube
Ear Drum
Inner
Outer
Middle
Middle Ear Space behind ear drum
14
Pharynx (cont) pg 6
  • The laryngopharynx (hypopharynx) separates the
    Esophagus and Trachea.
  • (digestive respiratory tracts)
  • Sensory motor nerves effect on pharyngeal
    muscles prevents food and liquid aspiration in
    the trachea
  • PHARYNGEAL REFLEX
  • Stimulation of this nerve Gag Swallow
  • Deeply unconscious patients may lose gag reflex
  • Aspiration risks increase
  • Intubation and mechanical ventilation is necessary

15
Pharyngeal Muscle Tonepg 6
  • Loss in muscle tone
  • Base of tongue may fall back and occlude the
    laryngopharynx
  • Snoring
  • Excessive occlusion/blockage apnea
  • Apnea No air movement No breathing

16
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17
Intubation
  • Often done in patients who need support in
    ventilation
  • Endotrachael Tube is inserted into the trachea
    (Nasally, Orally, Tracheostomy)

18
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19
Pharynx
C Sniffing position. Pulls the tongue forward
out of the way of the airway. Best for intubation
Fig. 1-5
20
Pharynx
21
4. LARYNX
  • Sometimes called the VOICEBOX
  • Vocal cords control the size of the opening of
    the trachea (glottis)
  • Main Cartilage of the Larynx (the middle of neck)
  • is the Thyroid Cartilage, aka ADAMS APPLE
  • Function Speech and __________________

22
Epiglottis Flap Larynx aka Voice
Box Cartilage beneath it Thyroid Cartilage
Adams Apple
23
At the opening of the Larynx
  • Epiglottis
  • The epiglottis does not seal the airway,
    instead, the upward movement of the larynx toward
    the base of the tongue pushes the epiglottis
    down, diverting food away from the glottis.

24
Left No breathing or swallowing Right
Swallow is initiated. Larynx moves up. Forces
the epiglottis to bend down
25
Left Epiglottis bends downward Redirects from
the the larynx and trachea Doesnt seal it just
diverts food to the esophagus Right Food
passes to Esophagus
26
Left After a complete swallow, the Epiglottis
starts lifting up again Right Epiglottis
continues to lift up now as the patient begins to
exhales
27
Left as exhalation continues to the oropharynx,
epiglottis is now nearly shut Right As the air
flows out the mouth, epiglottis is completely shut
28
Epiglottitis
  • Life Threatening
  • Drooling/Difficulty Swallowing/Breathing
  • Intubation

29
Intubation Visual
30
Thyroid and Cricoid
Thyroid is what we refer to as the Adams Apple
It encloses the main cavity of the Larynx
Fig. 1-6
31
Cricoid
  • Narrowest portion of the upper airway in the
    infant
  • Not the narrowest in the adult, however passing
    Endotracheal through may still be difficult

32
Vocal Cords
  • Form triangular opening into trachea
  • narrowest part of adult larynx
  • Can open and close
  • when closed allows pressure generation needed to
    cough
  • Cough important defense mechanism for lung
  • artificial airway removes vocal cords ability to
    seal airway and cough effectively
  • Vocal cord edema (croup - Pediatrics stridor -
    ETT)
  • Laryngospasm during extubation - hoarseness

33
Upper Airway Summary
  • The nose alters inspired air by
  • A. Humidifying, cooling, and reducing flow
    velocity
  • B. Cooling, filtering, and humidifying
  • C. Humidifying, filtering, and warming
  • D. Warming, reducing flow velocity, and filtering

34
Upper Airway Summary
  • The ________ is referred to as the voicebox
  • A. Pharynx
  • B. Larynx
  • C. Trachea
  • D. Cricoid

35
Upper Airway Summary
  • The Adams Apple is the name given to the
  • A. Thyroid
  • B. Larynx
  • C. Trachea
  • D. Cricoid

36
Airways Vs. Alveoli
37
Lower Airwayspg 10
  • Dichotomous branching pattern from trachea
  • Each airway divides into two smaller airways
  • (See next slide)
  • Each bifurcation creates new generation of
    airways
  • Tracheobronchial tree Figure 1-8

38
Lower Airways
Also referred to as
Conducting Airways No gas exchange takes
place This are can be obstructed with secretions
and mucus This is part one of the lung the
other part is the parenchyma where the alveoli
and tissues exist.
Fig. 1-8
39
Trachea and Main Bronchi
  • Trachea
  • 8-20 C-shaped cartilages
  • Begins at 6th cervical vertbra
  • 11 cm long in adults
  • 1.5-2.5 cm in diameter
  • Carina point of division fig-1-8
  • bifurcation of trachea into right and left
    bronchi
  • right bronchus at 20-30 degrees from midline
  • left bronchus at 45-55 degrees from midline
  • smaller in diameter, but twice as long
  • air is 100 saturated and at 37o C at this point
  • ISB (Isothermic Saturation Boundary See Fig.
    1-10)

40
Application
  • During intubation, if the Tube is pushed too far,
    it most likely will enter the
  • ____________________________
  • Chest Auscultation
  • Chest Excursion

41
Carina
Conducting Airways No gas exchange takes
place This area can be obstructed with secretions
and mucus Lung parenchyma where the alveoli and
tissues exist is where gas exchange starts
42
Conducting Airway Anatomy Conduit or passage or
pathway
  • Airways trachea to just before alveolar level
  • no gas exchange
  • conduit for air to reach alveoli
  • 23-27 subdivisions beginning at trachea
  • Right and left mainstem bronchi

43
position patients during PDP.
Fig. 1-12
44
Problem with airway disease
  • Obstruction
  • Airflow resistance

45
Lung Parenchyma
  • ACINUS (pg 14)
  • Functional tissue of the lung
  • Contains elastic fibers
  • surrounds airways
  • Gas Exchange takes place
  • Elastic fibers can be destroyed by disease
  • Emphysema
  • Prevents air from escaping the lung during
    exhalation
  • Air Trapping

46
The Acinus
THE ACINUS IS THE FUNCTIONAL RESPIRATORY UNIT OF
THE LUNGS. ( ALL ALVEOLI ARE CONTAINED IN THE
ACINUS) EACH TERMINAL BRONCHIOLE GIVES RISE TO
AN ACINUS.
Fig. 1-13
47
Alveoli and Capillaries(Alveoli-Capillary
Membrane)
  • Alveoli
  • 300 million (300 x 106) alveoli in adult lungs
  • 100 to 300 microns (?m) in diameter
  • Pulmonary capillaries
  • in contact with alveolar membrane
  • just large enough to allow passage of red blood
    cells
  • facilitate gas exchange

48
Alveoli and Capillaries
Fig. 1-17
49
Problem with Alveolar Disease
  • Compliance
  • Elastance
  • Restriction- where volume is restricted

50
Alveolar Disease
  • Alveolar Collapse
  • Atelectasis ??
  • Clinical focus 1-5

51
  • Resistance
  • Airflow Obstruction
  • Compliance
  • Distending Properties
  • Elastance
  • Recoiling Properties

52
Summary
  • Patients requiring a tracheostomy would benefit
    most from
  • A. High airflows provided to the trachea
  • B. Dehumidified air provided to the airway
  • C. Cool mist for adequate hydration
  • D. Heated, humidified inspired air

53
  • CPR is often done outside the hospital setting.
    An important technique in ventilating the patient
    involves tilting the victims head back and
    thrusting the jaw forward. This is done to
    allow
  • A. Better blood flow to the head
  • B. Air forced into the mouth easier passage to
    the lungs
  • C. Easier mouth alignment
  • D. Reducing the chance of damage to the upper
    airways

54
  • Certain lung diseases impair the A-C membranes
    gas-diffusing capabilities. An important
    consequence of this would be
  • A. A decrease in blood oxygen levels
  • B. A decrease in blood carbon dioxide levels
  • C. An increase in blood oxygen levels
  • D. An increase in blood oxygen levels and carbon
    dioxide levels
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