Term
| Conductive airway structures include: |
|
Definition
| trachea to terminal bronchioles; bulk gas movment, no gas exchange |
|
|
Term
| Transitional airway structures without gas exchange are the: |
|
Definition
| Respirtory bronchioles; bulk gas movement |
|
|
Term
| Transitional airway structures with limited gas exchange: |
|
Definition
|
|
Term
| Respiratory structures where gas exchange occurs: |
|
Definition
|
|
Term
| 2 divisions of conducting airways |
|
Definition
| upper airway & lower airway |
|
|
Term
| Name the primary function of the nose? |
|
Definition
| to filter, humidify and warm inspired air |
|
|
Term
|
Definition
|
|
Term
| The airway consists of what 2 major forms? |
|
Definition
1. Cartilaginous airways (only conduct air between the external environment and the site of gas exchange)
2. Noncartilaginous airways: sites of gas exchange |
|
|
Term
| Cartilaginous airways consist of? |
|
Definition
| trachea, mainstem bronchi, lobar bronchi, segmental bronchi, and subsegmental bronchi |
|
|
Term
| Cartilaginous airways are collectively known as? |
|
Definition
|
|
Term
| Length of trachea in the adult? |
|
Definition
|
|
Term
|
Definition
| T-4 to T5 level posteriorly, anteriorly at the angle of louis on the sternum (articulation of the 2nd rib) |
|
|
Term
| Inadvertent extubation can occur when the neck is? |
|
Definition
|
|
Term
| Neck flexion & movement side to side will affect ETT position how? |
|
Definition
|
|
Term
| True or false: the cartilage rings of the trachea are complete rings? |
|
Definition
| False; C shaped rings, incomplete posteriorly where the trachea and esophagus share a fibro-elastic membrane |
|
|
Term
| In newborns & small children, deep ETT insertion will enter which bronchus? |
|
Definition
| ETT's will often enter either bronchus, both mainstem's have a 55 degree angle |
|
|
Term
| In adults; which mainstem bronchus is most likely to be intubated with deep ETT insertion? |
|
Definition
| Right mainstem inbutation, b/c the Right has a less acute angle(25 degrees), and is shorter and wider than the left bronchus. |
|
|
Term
| Correct ETT placement is? |
|
Definition
|
|
Term
| In the supine pt, aspiration is most likely to occur in what lobe? |
|
Definition
| Right Upper lobe (d/t 90 degree angle from right mainstem bronchus) |
|
|
Term
| Potential complication associated with placement of a double lumen tube in the Right mainstem bronchus? |
|
Definition
| Total atelectasis of right upper lobe |
|
|
Term
| Preferred site for DL ETT placement? |
|
Definition
|
|
Term
| True or False; cilia are present in the respiratory bronchioles? |
|
Definition
| False: Cilia line the epithelial cells from the trachea to terminal bronchioles where they gradually disappear; they are absent in the respiratory bronchioles |
|
|
Term
| Globlet cells or bronchial glands produce? |
|
Definition
|
|
Term
| Bronchial glands are innervated by what nerve? |
|
Definition
| the parasympathetic nervous system via the vagus nerve |
|
|
Term
| Mucociliary escalator/transport mechanism is? |
|
Definition
| the process of moving mucous towards the pharynx by the cilia and the cough reflex. |
|
|
Term
| In an allergic reaction these cells will secrete vasoactive substances producing respiratory smooth muscle vasoconstriction |
|
Definition
|
|
Term
| What type of muscle fibers suround the bronchioles? |
|
Definition
|
|
Term
| What respiratory structures are susceptible to collapse depending on intrapleural and intra-alveolar pressures? |
|
Definition
| Bronchioles (b/c they do NOT contain cartilage) |
|
|
Term
| The conducting portion of the airway ENDs with what? |
|
Definition
|
|
Term
| What structures are located between the terminal bronchioles and adjacent alveoli? |
|
Definition
|
|
Term
| True or False; Collateral air flow through the canals of lambert are not affected by smooth muscle contraction |
|
Definition
|
|
Term
| Structures distal to the terminal bronchioles are termed the ? |
|
Definition
| Respiratory Zone-- this is where gas exchange occurs (respiratory bronchioles, alveaolar ducts & alveoli) |
|
|
Term
| True or False; the velocity of air flow is faster in upper airways compared to lower airways |
|
Definition
| True: as cross section area increases(cross sectional area increases with each level of branching); air velocity decreases |
|
|
Term
| Name the 3 types of cells that make up alveoli: |
|
Definition
Type I: primary epithelial cells
Type II: more granular- produce surfactant
Type III: Alveolar Macrophages |
|
|
Term
| What type of cells in the alveoli are most prone to injury? |
|
Definition
| Type I cells; serious damage to these cells often occurs with ARDS & ALIs |
|
|
Term
| Name 2 alveolar anatomical differences found in infants that makes them more prone to problems with ventilation |
|
Definition
Newborns do NOT have Pores of Kohn
newborns only have 10-25 million alveoli compared to the 300 million that is present when the lung is fully mature |
|
|
Term
| Pulmonary vessels have _______ walls and tend to be ________ in diameter compared to the systemic arteries. This makes the arterial tree very ________ & ________. |
|
Definition
thin
larger
Compliant & distensible |
|
|
Term
| Blood in the pulmonary arterial tree is partially ___________. |
|
Definition
|
|
Term
| Pulmonary veins return _________ blood to the left atria and are very short like the arteries. |
|
Definition
|
|
Term
| Bronchial vessels which carry oxgyenated blood to the tracheobronical tree all the way to the terminal bronchioles arise from where? |
|
Definition
| aorta (systemic circulation) |
|
|
Term
| Where do bronchial vessels merge with pulmonary arteries and capillaries (losing their identity)? |
|
Definition
| at the terminal bronchioles |
|
|
Term
| 1/3 of the bronchial-arterial blood joins the intercostal veins and returns where? |
|
Definition
|
|
Term
| 2/3 of the bronchial-arterial blood drains into the pulmonary circulation AFTER it has left the alveolar capillaries, therefore this blood which is _____________. |
|
Definition
|
|
Term
| The unoxygenated bronchial arterial blood that drains into pulmonary circulation mixes with oxgyenated blood in where? |
|
Definition
| Mixes with oxygenated blood in the pulmonary vein and enters the left atria |
|
|
Term
| Venous admixture explains what discrepancy? |
|
Definition
| it explains why the left atrial volume is 2% greater than the right & why if left atrial blood were to be sampled it would not be 100% saturated. |
|
|
Term
| What muscle is primarily responsible for normal quiet breathing? |
|
Definition
|
|
Term
| Intra abdominal pressure increases and the intrathoracic pressure decreases when the diaphragm? |
|
Definition
|
|
Term
| Exhalation is what type of process normally? |
|
Definition
|
|
Term
| True or False, The paralyze diaphragm will function OPPOSITE the normal |
|
Definition
|
|
Term
| With a paralyzed diaphragm; during inspiration the diaphragm will move ________ and during exhalation it will move ___________. |
|
Definition
|
|
Term
| The Diaphragm is innervated by what nerve? |
|
Definition
| the Phrenic nerve (arises from C3-C5) |
|
|
Term
| Brachial plexus blocks can potentially block what nerve? |
|
Definition
| the phrenic nerve, rendering the ipsilateral diaphragm dysfunctional |
|
|
Term
| The Chest wall is pulled up and out (increased AP diamter)via contraction of what muscles? |
|
Definition
| the EXternal intercostal muscles |
|
|
Term
| The vertical diameter is increased by contracting what? |
|
Definition
|
|
Term
| What chest muscles assist with exhalation by puling the chest down and in? |
|
Definition
Internal intercostal muscles
sternocleidomastoid
anterior serrati
scaleni |
|
|
Term
| External intercostals are muscles of? |
|
Definition
|
|
Term
| True or False; Internal intercostal muscles normally assist in exhalation |
|
Definition
| False; Exhalation is normally a passive process. |
|
|
Term
| Which muscles assist with FORCED expiration? |
|
Definition
| Internal intercostals & abdominal muscles |
|
|
Term
| Retractions are a sign of ? and usually occur when? |
|
Definition
| difficulty inhaling, often occur when the upper airway is obstructed |
|
|
Term
| Name the only fixed point of the lungs? |
|
Definition
|
|
Term
| What keeps the lungs inflated? |
|
Definition
|
|
Term
Pleura is divided into two linings that
__________ and __________ the lungs |
|
Definition
|
|
Term
|
Definition
| lining that covers the lung |
|
|
Term
|
Definition
|
|
Term
| Pleural fluid function is? |
|
Definition
| to lubricate the surface of the linings so that they glide smoothly over eachother |
|
|
Term
|
Definition
| the pressure difference between two pints in a tube (p1-p2) |
|
|
Term
|
Definition
| barometric pressure difference between the mouth and the alveoli |
|
|
Term
|
Definition
| the pressure of the air inside the lung alveoli |
|
|
Term
|
Definition
| when the glottis is open, no air is flowing in or out, the pressure is equal in all parts to atm pressure (760mmHg) |
|
|
Term
|
Definition
pressure in the fluid in the pleural space-- same as intrathoracic pressure
Normally -5cm water (d/t lymph pull) |
|
|
Term
| What happens to intra-thoracic pressure with chest wall expansion? |
|
Definition
|
|
Term
| What happens to pleural pressure when the chest wall relaxes and recoils? |
|
Definition
|
|
Term
| Trans-pulmonary pressure (aka recoil pressure) |
|
Definition
| pressure difference between the alveolar pressure and the pleural pressure, measurement of the elastic forces in teh lungs that tend to collapse the lungs |
|
|
Term
|
Definition
| are dependent on the movement of the diaphragm & the chest wall. |
|
|
Term
|
Definition
how willing the lung is to accept a change in volume with a given pressure
Normally 200 ml/cmH20-- for every 1cm of water pressure change, the lung volume increases or decreases by 200ml |
|
|
Term
| Will a compliant or non compliant lung receive more volume at a given pressure? |
|
Definition
|
|
Term
| What happens to the airway pressure if the volume remained the same, but lung compliance decreased? |
|
Definition
|
|
Term
| Pressure required to overcome the attractive forces/surface tension in the collapsed alveoli allowing it to expand |
|
Definition
|
|
Term
| This substance decreases alveolar surface tension thus reducing the effort required to inflate the small radii-alveoli |
|
Definition
|
|
Term
| Surfactant is secreted by what type of cells |
|
Definition
| Type II alveolar epithelial cells |
|
|
Term
|
Definition
| phospholipids (primarily DPPC- which contains a hydrophobic and hydrophilic end), proteins and ions., |
|
|
Term
| General causes of surfactant deficiency: |
|
Definition
| Acidosis, hypoxia, hyperoxia, atelectasis, pulmonary congestion |
|
|
Term
| Specific causes of surfactant deficiency: |
|
Definition
| ARDS, RDS, Pulm edema, PE, Pn, Excessive lavage, Drowning, extracorporeal oxygenation (ECMO) |
|
|
Term
|
Definition
| the ability to resist deformity and the ability to return to the pre-existing shape after deformity (steel is more elastic than a rubber band) |
|
|
Term
|
Definition
| describes elastance (change in pressure over change in volume)- the opposite of compliance. Once the elastic limits of a substance is reached it will break |
|
|
Term
| Energy expenditure during normal respiration? |
|
Definition
| 3-5% of total body energy |
|
|
Term
| 3 components of normal ventilatory patterns |
|
Definition
tidal volume
respiratory rate
I:E ratio |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| 1:2 (includes normal pause at the end of exhalation) |
|
|
Term
|
Definition
Inspired air that does not reach the alveoli. There are 3 types
1. anatomic
2. alveolar
3. physiologic |
|
|
Term
| Blood in the pulmonary artery is? |
|
Definition
|
|
Term
|
Definition
| oxygenated blood to the left atria |
|
|
Term
| Bronchial vessels carry what type of blood? |
|
Definition
|
|
Term
| Where do bronchial vessels arise from? |
|
Definition
| the aorta (systemic circ) |
|
|
Term
| Bronchial vessels follow the tracheobronchial tree as far as the ___________ __________ where they lose their identity & merge with the pulmonary arteries and capillaries |
|
Definition
|
|
Term
| Normal bronchial-arterial flow is what % of CO? |
|
Definition
|
|
Term
| Bronchial arterial flow delivers oxygenated blood to which areas outside of the tracheobronchial tree? |
|
Definition
| mediastinal lymph nodes, pulmonary nerves, and parts of the esophagus |
|
|
Term
| 1/3 of the bronchial-arterial blood joins the intercostal veins and returns where? |
|
Definition
|
|
Term
| 2/3 of the bronchial arterial blood drains into the pulmonary circulation AFTER it has left the alveolar capillaries; thus this blood is ___________. It mixes with the _________ blood in the pulmonary vein and enters the _____ ______. |
|
Definition
unoxygenated
oxygenated
left atria |
|
|
Term
| Discrepancy between right & left atrial volumes (L> R by 2%)is explained by the adding of deoxygenated blood to oxygenated blood is called? |
|
Definition
|
|
Term
| Lungs can expand and contract what 2 ways? |
|
Definition
1. movement of the diaphragm
2. elevation/depression of the rib cage |
|
|
Term
| In normal quiet breathing: the major respiratory muscle is? |
|
Definition
|
|
Term
| The intra-abdominal pressure increases and intra-thoracic pressure decreases during? |
|
Definition
| inhalation (contraction of the diaphragm) |
|
|
Term
| Exhalation is normally a passive process due to ? |
|
Definition
| The chest recoil as the diaphragm relaxes and the abdominal structures push upward expelling the air |
|
|
Term
| A paralyzed diaphragm will move ________ during inspiration and __________ during expiration; opposite the normal |
|
Definition
|
|
Term
| What nerve controls contraction each side of the diaphragm? |
|
Definition
|
|
Term
| The phrenic nerve arises from ? |
|
Definition
|
|
Term
| Improving ventilation through increasing AP diameter is accomplished through contraction of what muscles? |
|
Definition
| External intercostal muscles (pull the chest wall up and out) |
|
|
Term
| Contraction of the diaphragm increases what diameter? |
|
Definition
|
|
Term
| Which muscles of breathing pull the chest down and in; assisting with (forced)exhalation? |
|
Definition
| internal intercostal muscles |
|
|
Term
| Muscles of inspiration include: |
|
Definition
| External intercostals, sternocleidomastoid, anterior serrati, and scaleni |
|
|
Term
| Muscles of forced expiration: |
|
Definition
| internal intercostals and abdominal recti muscles |
|
|
Term
| A sign of difficulty with inhalation, often occurs when the upper airway is obstructed? (More often seen in children) |
|
Definition
|
|
Term
| During normal respiration a decrease in alveolar pressure by -1 is enough to move how much air how fast? |
|
Definition
| inspiration of 0.5 L (500ml) over 1-2 seconds in the adult |
|
|
Term
| During normal respiration a increase in alveolar pressure by +1 is enough to move how much air how fast? |
|
Definition
| exhale 500ml over 2-3 seconds |
|
|
Term
| True or False: a 5cm H20 change in pressure will generate the SAME volume regardless if it is positive pressure (controlled ventilation) or negative pressure (normal breathing) |
|
Definition
|
|
Term
| Elastic Forces in the lungs are determined by ? |
|
Definition
| Elastin & Collagen fibers (they stretch when the lungs expand) |
|
|
Term
| How does The air: water interface affect lung compliance |
|
Definition
| it reduces the compliance of thelungs |
|
|
Term
| Law of Laplace: the distending pressure (inflation) of a liquid sphere is directly proportional to what? |
|
Definition
| Surface tension (as surface tension increases the pressure required to hold it open increases) |
|
|
Term
| Law of Laplace: the distending pressure is INdirectly related to what? |
|
Definition
| the radius of the sphere (when the size increases, pressure required to hold it open decreases. When size decreases the presssure required to hold it open increases) |
|
|
Term
| Law of Laplace ONLY comes into play when? |
|
Definition
| when Critical opening pressure has been reached |
|
|
Term
| What substance offsets the natural tendancy for small radii alveoli to collapse? |
|
Definition
| surfactant (reduces surface tension) |
|
|
Term
| What type of cells secrete surfactant? |
|
Definition
| Type II alveolar epithelial cells |
|
|
Term
| During Normal inspiration, the decrease in intrapleural pressure causes bronchial airways to? |
|
Definition
| lengthen & increase in diameter (passive process, NOT driven by the ANS) |
|
|
Term
| True or False; inspiration is an active process? |
|
Definition
|
|
Term
| True or False: The normal increase the length and diameter that occurs with inspiration is a passive process |
|
Definition
| True; NOT controlled by the ANS |
|
|
Term
| The passive bronchial shortening and CONSTRICTION that normally occurs with exhalation is normally not an issue, however it may further exacerbate what condition? |
|
Definition
| COPD (resistance in exhalation) |
|
|
Term
| Poiseuille's Law: what is the biggest contributor to flow in a tube? |
|
Definition
|
|
Term
| True or False; a reduction in radius will increase resistance by a factor of 4 |
|
Definition
|
|
Term
| Time constants are the product of? |
|
Definition
| Resistance and Compliance (RxC) |
|
|
Term
| Definition of time constants: |
|
Definition
| time in seconds it takes to inflate a lung region to 60% of its potential filling capacity, can be used to describe normal or pathological conditions and inform adjustments made on the ventilator for inspiration or expiration |
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|
