Respiratory

Ventilation: Inhalation and Expiration

Inhalation the chest cavity increases intrapleural pressure is negative

Expiration the chest cavity decreases and pressure in chest cavity increases

Hindered Ventilation

Mucus/bronchoconstriction-COPD/Asthma

Loss or poor accessory muscles-ALS

Drug induced-Sedative or Narcotic use

Hindered diffusion

Fluid-Pulmonary edema

Thickining of aleveolar membrane- Pulmonary fibrosis

Alveolar membrane destruction/removal

Lung compliance factors

Elastin fibers and Surfactant

FVC

Total volume of air that can be exhaled forcefully >80% of TLC

FEV1

Air exhaled in 1 second under force ater maximal inhalationn >80% of FVC

FEV1/FVC ratio

Percentage of the FVC expired in 1 second >70%

Obstructive Disorders

Cant get air out

Ex: Asthma, Emphysems, Chronic bronchitis

FVC ✓/↓

FEV1 ↓

FEV1/FVC ↓

TLC ✓/↑

RV ↑

Restrictive Disorders

Cant get air in

Ex: Pulmonary fibrosis, Scoliosis, Obesity, Lung resection, Neuromuscular diseases

FVC ↓

FEV1 ↓

FEV1/FVC ✓

TLC ↓

RV ↓

V/Q Ratio

Ventilation/ Perfusion 0.8

Low V/Q

Less ventilation and more perfusion

Perfusion but no ventilation= shunt

High V/Q

More ventilation and less perfusion

Ventilation but no perfusion= Deadspace

Hypoxemia

Low O2 in blood

Hypoxia

Low O2 in tissue

Hypercapnia

Increase in CO2 in blood

Pneumonia

Inflammation of parenchymal structures of the lung in lower resp tract #2 leading cause of hospitalization

Tuberculosis

highly contagious spread via droplets

Covid-19

Leading cause of hospitalization and death worldwide

Lung inflation disorders

Pleural effusion, Pneumothorax, Atelectasis

Pleaura effusion

abnormal collection of fluid in the pleural cavity can be; transudative- watery due to fluid overload, or exudative- protien rich often from cancer or infectious diseases

Clinical manifestation of pleural effusion

decrease lung’s ability to expand of affected side leading to dyspnea, diminished lung breath sounds, hypoxemia, pleuritic pain, empyema

Pneumothoraxes

Air or gas enters intapleural space between lung and chest wallcause lung collapse

Restrictive lung disorders

Intrinsic-intersitial and Extrinsic-restrictive

Intersitial (Intrinsic)

Problems with the lungs themselves

Inflammation leads to thickining of akveolar walls, fibrotic changes, and increase lung stiffness

ARDS

Poor oxygenation and non-compliant lungs

ARDS Pathway

Injury/infection, lung tissue damage, fluid accumation, surfactant deactivation and inflammation, atelectasis and decreases lung compliance, pulmonary hypertension, poor blood oxygenation, multi-organ failure

Extrinsic Restrictive Lung Disease

Problems outside lungs place pressure on the lungs or breathing is restricted by loss of function

Obstructive airway disorders

Athma, Emphysema, Chronic bronchitis

Asthma charactaristics

Airway inflammation, hyper-responsiveness, obstruction, mucus hypersecretion

Type 1 hypersensitivity

COPD

Consists of emphysema and chronic bronchitis

most common cause is smoking but can also be caused by hereditary deficiency in alpha 1-antitrypsin

Emphysema characteristics

Loss of lung elastisity and abnormal enlargment of the airspaces, leads to increase in TLC

Symptoms of Emphysema

Dyspnea, increased min ventilation/tachypnea, pursed-lip breathing, pink skin, barrel chest, cachexia, decreased breath sounds, accessory muscle use

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Symptoms of chronic bronchitis

Chronic productive cough, purulent sputum, dyspnea, cyanosis, peripheal edema, crackles or wheezes, prolonged expiration time, obesity

Pulmonary circulation disorders

Pulmonary embolism, Pulmonary hypertension, cor pulmonale

Pulmonary embolism

blockage in one of the pulmonary arteries in your lungs

Pulmonary embolism forms

Blood clot that travelled to the lungs, air that has been injected during IV infusion, Fat that has been mobilized from bone marrow after fracture, amniotic fluid that has entered maternal circulation after rupture during delivery

Pulmonary embolism risk factors

Virchow’s triad: Hemodynamic changes/stasis, endothelial injury/dysfunction, hypercoagulability

Cor pulmonale

Right-sided heart failure from a pulmonary cause

Pulmonary hypertension

Pressure in the blood vessels leading from the heart to the lungs is too high