FINALL

Nasal Cavity & Nasopharynx

Ciliated / goblet / basal / olfactory receptor / supporting / bowman

Oropharynx & laryngopharynx

Stratified squamous epithelium

Larynx

Respiratory epithelium (Above vocal cords) & stratified Squamous (vocal cord)

Trachea & Bronchi

Ciliated / goblet / basal /

submucosal glands - Neuroendocrine cells

Terminal Bronicholes

Club (dominant) / Few ciliated

Respiratory Bronchioles

Club-some ciliated-alveolar openings

Alveoli

Type 1 pneumocytes / type 2 pneumocytes / alveolar macrophages - endothelial cells-fibroblasts

Nose/Nasal Cavity

Filters, warms, humidifies air, smell (olfaction)

Nostrils (Nares)

Entry of air

Nasal Hair (vibrissae)

Filters out large particles

Nasal septum

Divides cavity into right and left sides

Turbinates (Conchae)

Increase surface area, warm. Humidifies, filters air

Olfactory region

Roof of nasal cavity - smell

Nasopharynx

•  air passage, connects nose to throat, equalizes pressure (eustachian tube)

Oropharynx

shared air/food passage

Laryngopharynx

directs food to esophagus & air to larynx

Larynx

Air way protection / sound production / routes air vs food

Epiglottis

Flap that covers trachea during swallowing that prevents aspiration 

Vocal Cords

Vibrate to produce sound, protect airway

Sinuses (frontal,maxillary,ethmoid, sphenoid)

Lighten skull, mucus production, and voice resonance

Blood vessels

Rich supply - warm incoming air

Hering-Breuer

Pulmonary stretch receptors in bronchi/bronchioles

CN X (vagus afferent)

Inhibits further inspiration, prevents overinflation

obstructive

Air cant get out (narrowed/blocked airways) Inc in resistance

Asthma, Emphysema, chronic bronchitis, bronchiectasis

Prolonged aspiration / barrel chest / dyspnea, accessory muscle use / hypoxemia, hypercapnia

Wheezing (high pitched esp on expiration) / rhonchi (low pitched, snoring, mucus in larger airways) / diminished breath sounds if severe air trapping

WHEEZE & RHONCHI

↓ FEV1/FVC ratio (<70%)

↑ TLC, ↑ RV

restrictive

Air can’t get in , dec in compliance or lung volume

Pulmonary fibrosis, ARDS, Obesity, Neuromuscular disorders

Rapid shallow breathing, dyspnea on exertion, cyanosis if severe, reduced chest expansion

Fine inspiratory crackles (velcro-like) esp at base, fibrosis / possible pleural friction rub / less commonly wheeze (unless mixed pattern)

CRACKLES

Normal or ↑ FEV1/FVC ratio, but ↓ total lung volumes

↓ TLC, ↓ volumes

true ribs 1-7

Attach directly to sternum via costal cartilage

false ribs 8-10

Indirect attachment via rib 7’s cartilage

Floating ribs 11-12

No anterior attachment (end in muscle)

manubrium 

Articulates with the clavicles / 1st rib / contains jugular notch (palpable landmark at base of neck

Ineffective compressions

angle of louis

Junction of manubrium / body of sternum / 2nd rib anteriorly / rib counting starts (2nd rib) / trachea bifurcation (Carina) / aortic arch begins/ends / separates superior and inferior mediastinum

body of sternum

Articulates with ribs 2-7

Main compression site for CPR

xiphoid process

Cartilaginous tip (ossifies later)

Pressure here can fracture leading to liver injury

autonomic

: “automatic” heart, stomach, intestines, parasym & sympathetic, pre and post ganglion

somatic 

 needs effort from the body, skeletal muscle 

sympathetic

fight or flight, vasodilate, pupils dilate / epi or norepi, inc hr and inc bp, adrenergic

parasympathetic

ach to ach, digest and rest, cholinergic, muscarinic, vasoconstrict, pupil constrict, relaxation

M1

Gas stimulation

M2

HR and Force

M3

Smooth muscle constriction and secretion

M4/M5

CNS

PHRENIC NERVES

Controls the diaphragm, C3,C4,C5 keeps the diaphragm alive, travels downward along neck between lung and heart

Intercostal

(T1-T11) helps expand the ribcage, runs along the intercostal spaces between the ribs

Sympathetic (T1-T5 broncho dilation

Vagus nerve

Controls airway muscles, cough reflex, bronchoconstriction

Parasympathetic - bronchoconstriction and secretions

Enters the thorax via jugular foramen, runs along carcoid arteries, behind the lungs

ALPHA 1

Blood vessels (Gi and kidneys) 

Increase in vasoconstriction and bp

ALPHA 2

Presynaptic nerve terminals (CNS) 

• Inhibits Nore. release, decrease sympath. Output

BETA 1

Heart and kidneys

Inc HR, Inc contractility, Inc Renin release and inc bp

BETA 2

Lungs (bronchioles), blood vessels (skeletal muscle), uterus/gi tract/ liver

Bronchodilation and pupil dilation, vasodilation, relax of smooth muscles

B2

Smooth muscle of trachea and bronchi

bronchodilation

ALPHA

Some in airway smooth muscles and vessels

Mild bronchoconstriction and vasoconstriction

Muscarcinic

Airways (parasympathetic)

Bronchoconstriction, increase in mucus

CILIATED EPI CELLS

Trachea - bronchioles

Move mucus via cilia

Helps transport mucus with goblet cells

GOBLET CELLS

Trachea - bronchi

Mucus secretions

Mucin

BASAL CELLS

Airways

Regeneration

CLUB CELLS 

Bronchioles

Detox surfactant repair

Surfactant proteins & enzymes

TYPE 1

Alveoli

Gas exchange

TYPE 2

Alveoli

Surfactant secretion repair

Pulmonary surfactant

Macrophages (scar)

Alveoli

Phagocytes, granulomas, clean up

Cytokines and enzymes

TB, pneumonia, chronic smoker

NEUTROPHILS (CLOG)

Acute inflammation, pus

Pneumonia, ards, copd

EOSINOPHILS (SQUEEZE)

Allergy, parasites

Asthma, abpa

LYMPHOCYTES (STIFF)

Viral defense, chronic inflammation

Viral pneumonia, ILD and sarcoidosis

NITROGEN

78% / 593mmHg

O2

21% / 159mmHg

CO2

0.04% / 0.3mmHg

H2O

47MMHG

NORMAL SUBATMOSPHERIC PRESSURE

Keeps lung expanded

Creates a pressure gradient for airflow

Maintains transpulmonary pressure

Essential for normal ventilation

LOSS OF SUBATMOSPHERIC PRESSURE

Lung collapse

Breathing becomes difficult / impossible

No gradient = alveoli close

Can lead to respiratory failure

PNEUMOTHORX

Air enters the pleural space eliminating the subatmospheric pressure

Inspiratory pressure becomes 0mmHg (equal to atmosphere) which results to lung collapse due to its natural elastic recoil being compromised

Open: trauma enters from the outside

Closed: internal rupture

Tension: air enters but can’t escape - pressure builds - life threatening

PLEURAL EFFUSION

Fluid / blood in pleural space inc pressure

Reduces or eliminates negative pressure

Compression of the lung, reducing elimination

EMPHYSEMA

Alveolar wall destroyed

Loss of recoil

Impaired pressure generation for expiration

TIDAL VOLUME

Air in / out during quiet breath ~500mL / quiet breath volume / Increased VT= increased fresh air = high alveolar O2 partial pressure

INSPIRATORY RESERVE VOLUME

Extra air inhaled after normal inspiration ~3100mL

EXPIRATORY RESERVE VOLUME 

Extra air exhaled after normal expiration ~1200mL

RESIDUAL VOLUME

Air remaining in lungs after forced exhale ~1200mL

ATMOSPHERIC PRESSURE

Inward inspiration, air into lungs, 760mmHg, pressure of air outside of body, controlled by changes in the thoracic volume 

• Treated as baseline (0mmHg) when cal. Pressure changes during breathing, higher to lower

INTRAPULMONARY

Air into lungs, outward expiration, 760mmHg, pressure within the alveoli

Alveoli pressure

Inspiration: drops slightly below ~1mmHg, air flows in

Expiratory: rises slightly above +1mmHg, air flows out

INTRAPLEURAL 

756mmHg

Pulls lungs outward - keeps expansion

Prevents lung collapse

Maintains expansion

Pressure within the pleural cavity, between visceral and parietal pressure

Always negative relative to keep lungs inflated ~4mmHg (i.e. 756mmHg)

During breathing inspiratory becomes more negative -6mmHg, expiratory returns to ~4mmHg

TRANSPULMONARY

+4mmHg

Difference between alveolar pressure and intrapleural pressure

Keep lungs open, the greater in pressure more lung expansion

Normal is 0mmHg, +4mmHg

Must always be positive to keep lungs expanded

REST

0

-4

none

INSPIRATION

-1

-6

Into lungs

EXPIRATORY 

-1

-4

Out of lungs

BOYLE

Pressure / volume

Breathing works by changing thoracic vol to create pressure gradients

Plethysomography

Lung volumes

TLC & RV

CHARLES

Temperature / volume

Warmer air expands - not critical in resp. Physi. But relevant to nasal cavity warming air

Temperature ventilation

Ventilation circuits

DALTONS

Partial pressure

Helps calculate the p.p. In air or alveoli

Drives gas diffusion from high to low pressure

ABG

Hypoxia, altitude

HENRY

Dissolved gas

Amount of gas dissolved in a liquid

O2 in blood

DCS, O2 therapy

FICKS

Diffusion

Surface area x gradient/thickness

DLCO

Emphysema, fibrosis

LAPACE

Surface tension

Small alveoli collapse easier -> surfactant reduces tension to keep them open

Little alveoli collapse

Neonatal rds

POISEUILLE

Tiny airway swelling in kids= huge increase in resistance

Airway resistance

INFANT AIRWAY

Narrow at cricoid ring

Funnel shaped

Large

Long & floppy

Higher c3-c4

Short, narrow

Very compliant, ribs horizontal

Obligated by nose

Diaphragm dependent

High (small, radius, big effect)

Small FRC

ADULT AIRWAY

Cylinder shaped

Glottis and vocal cord

Proportional

Shorter and rigid

Lower c5-c6

Longer, wider

Rigid, ribs angle down

Mouth and nose

Intercostal - diaphragm

Lower resistance

Larger FRC

GOLD 1

Mild

>80

GOLD 2

Moderate

50-79

GOLD 3

Severe

30-49

GOLD 4 

Very severe

<30

DLCO

Normal

Decreases in emphysema, copd, norm in asthma

Dec due to thick membrane

ZONE 1

PA>Pa>PV

None, dead space

Apex

ZONE 2

Pa>PA>PV

Some, water fall

mid-lung

ZONE 3 

Pa>PV>PA

Most, continuation flow

Base

PEAK EXP. FLOW

Fastest flow rate a person can blow air out of the lungs after max inspiration

Normal is 400-700

Asthma monitoring - detects the airway narrowing before symptoms worsen

Helps guide daily management (green and yellow zone)

Variability during the day -> important in asthma diagnosis

Memory hook: peak flow=fastest blows-asthma control tool

GREEN

80-100% of personal best - well controlled

YELLOW

50-79 caution, adjust the treatment

RED

<50 danger, seek help