midterm review
Diffusion
Definition: Diffusion refers to the transfer of oxygen from the alveoli in the lungs to the bloodstream.
Ventilation
Definition: The breathing process involving:
Contraction of the diaphragm
Use of accessory muscles
Expansion of the ribs to pull air into the lungs.
Perfusion
Definition: The movement and absorption of oxygen molecules into body tissues, also referred to as oxygenation.
Conditions Affecting the Pleural Cavity
Pneumothorax: Presence of air in the pleural cavity that can collapse the lung and displace mediastinal structures.
Hemothorax: Presence of blood in the pleural cavity that can also lead to lung collapse.
Exudate: Fluid in the pleural space that prevents lung expansion and can lead to full collapse.
Respiratory Conditions
Apnea: Cessation of respiration.
Dyspnea: Difficulty or painful respiration.
Hyperventilation: Abnormally fast rate of respiration.
Hyperpnea: Excessively deep respiration.
Cyanosis: Blush tint to skin due to poor oxygenation.
Pulmonary Function Tests (PFTs)
Purpose: Measure lung function and volume.
Tidal Volume: Volume of air exhaled during normal respiration.
Minute Volume: Amount of air exhaled per minute.
Vital Capacity: Total volume of air exhaled after maximum inspiration.
Total Lung Capacity: Total amount of air in the lungs when fully inflated.
Peak Expiratory Flow Rate (PEFR): Maximum rate of air expelled in forced expiration.
Blood Gas Analysis
ABG’s (Arterial Blood Gases): Analyze levels of oxygen and carbon dioxide in the blood, along with pH levels.
Imaging Techniques
X-ray: Used to view the chambers and structures of the heart and lungs.
CT Scans: Advanced imaging techniques used in pulmonology, often for detecting pulmonary embolism.
Pulmonography: Assessing pulmonary function.
Bronchoscopy Procedures
Flexible Bronchoscopy: A slender, tube-like optic instrument used with local anesthetic for viewing peripheral bronchi and performing biopsies while the patient remains conscious.
Rigid Bronchoscopy: A large, metal tube used with general anesthesia for foreign body removal and larger biopsies.
Advanced Bronchoscopy Techniques
Electromagnetic Navigation: Aligns with CT scans to guide bronchoscopy.
EBUS (Endobronchial Ultrasound): Used for lymph node identification and biopsy during bronchoscopy.
Chest Drainage Systems
Purpose: Allow lungs to expand by re-establishing negative pressure in the pleural cavity, removing air, blood, or fluid.
Pleur-vac: Operates on the water seal principle to prevent air from re-entering the chest.
Chest Tubes: Inserted through a small incision and sutured to the chest wall.
Surgical Procedures
Thoracotomy: Open surgery with a posterolateral incision — access to lung structures.
Retractor for shoulder — scapular retractor
Preventing severe hemorrhage the edges of the wound are covered with laborontomy sponges to protect from bleeding
Lung Volume Reduction Surgery (LVRS): Removal of diseased tissue to enhance function of remaining healthy tissue due to loss of elasticity often from smoking. Pathology: Associated with chronic obstructive pulmonary disease (COPD) and pulmonary emphysema.
Lobectomy: Surgical removal of a lobe of the lung, often performed via video-assisted thoracoscopic surgery (VATS).
Pneumonectomy: Removal of an entire lung often due to extensive tumors or abscesses. — nerves are carefully preserved during pneumonectomy
Lung Transplantation: Involves removing a diseased lung and replacing it with a donor lung, while preserving donor nerves. ( Removal lobe only )
Decortication: Surgical removal of fibrous tissue overlying the lung (pleurectomy retrieves parietal pleura).
Right lung - 3 lobes
Left lung - 2 lobes
Hemoptysis - coughing up blood
Cardiac Anatomy and Physiology
Conduction System of the Heart: Includes the
SA Node (sinoatrial node), which acts as the heart’s pacemaker, and spreads impulses through the AV Node (atrioventricular node) and down the Bundle of His to Purkinje fibers in the ventricles.
Cardiac Catheterization: An interventional radiology procedure used to visualize heart chambers and large vessels to assess functionality and pressure.
Right Heart Catheterization (RHC): Assesses pressures in the right atrium, ventricle, and pulmonary artery.
Left Heart Catheterization (LHC): Evaluates systemic resistance and valve function via arterial puncture in the femoral or brachial artery.
Angiography: Process of imaging using a contrast medium injected into an artery.
Sa node known as the hearts pacemaker initiates the cardiac cycle
AV. Node located in the intra atrial spectrum receives impulses from the SA node
Bundle of his conducts impulses from the AV. Junction to the ventricular walls
Punkinje fibers the final pathway in the conduction system that causes the ventricles to contract
Intravascular ultrasound uses a catheter tipped with a transducer to measure blood flow rate inside a vessel
Cardiopulmonary Bypass (CPB)
System: Temporarily replaces the function of the heart and lungs during surgery using a pump and oxygenator.
Components:
Aortic Cannula: Delivers oxygenated blood from the pump.
Venous Cannula: Drains blood back to the pump from the heart.
Transitional Cannula: Used for delivering cardioplegia directly into the coronary sinus.
Cardiac Conditions
Atrial Flutter: Heart rate ranges from 240 to 350 beats per minute.
Cardioplegia: Method of intentionally stopping the heart's pumping action, typically using a potassium chloride solution.
Symptoms of Heart Dysfunction: Ventricular Fibrillation leading to ineffective contractions; Ischemia due to localized inadequate blood supply.
LV Vent Decompresss the left ventricle and removes air
Ejection Fraction Measurement: Assessing the amount of blood pumped from the ventricle.
Antegrade- infuse into the aorta
Retrograde - solution infused into the coronary venous system via the coronary sinus
VL surgical procedures - stenosis constriction or regulation (leaking of the valve) between the left atrium and the left ventricle— median sternotomy - partial or full midline incision
Heart Valve Issues
Stenosis: Constriction of the valve.
Ventricular fibrillation- chaotic disorganized stimulation of one or both ventricles that does not pump the blood
Ventricular angiography- demonstrates the movement of blood through the valves and can be used to measure the ejection fraction and end systolic and diasystolic volumes
Regurgitation: Leaking of the valve, causing undirectional blood flow difficulties.
Aortic Valve Replacement: Replacement occurs when the valve fails to function due to disease or damage.
Layers of the heart— epicardium . Myocardium , inner endocardium
Disease or interference in the conduction system results in uncoordinated electrical activity in the cardiac muscle and may cause ineffective contractions
Atrial fibrillation chaotic disorganized stimulation of one or both that prevents atrial contraction
Heart transplantation may be performed in suitable patients with end-stage cardiac disease
Major structures
Arteries
Veins
Capillaries
Tunica Externa - adventia protect vessels from injury and provides structural strength
Tunica media composed of inner layers of smooth muscle bonded by connective tissue
Tunica intima secrete substance that causes vasodilation or constriction and those that prevent platelet aggravation in the vessels
Blood not pumped through the veins rather milked toward the heart by contractions in skeletal muscle in the peripheral system
Arteries
Thick walls
Elastic
Blood moves through the arteries by pumping action of the heart
No internal valves
Loss function can lead to tissue, injury or death
oxygenated blood
Veins
Thin walls
Deoxygenated blood
Less elastic than arteries
Blood moves through veins by the contraction of skeletal muscles
Internal valves prevent black flow
Bleed slowly when severed
Closer to the skin
Andiography- is the injection of contrast media into a selected artery and it branches to determine the exact location of stricture occusion or malfunction
Endovascular aneurysm repair- expanding stent deployed from the femoral artery either by percutaneous or open technique ( Main body of the stent is separated from the craft limbs which form the bifurcated y)
Arterial venous shunt or arterial venous fistula- is to treat vascular access
Fusiform aneurysm most common bulges outward symmetrically
Saccular aneurysm- protrudes from one way only
Pseudo — ruptures in vessel Wall wear blood is contained by surrounding tissue rather than vessel loops
Fem-Fem bypass - performed for blockage in iliac artery
fem-pop bypass - blockage of femoral artery - restores bloodflow
Brain Structure and Functionality
Cerebrum: Largest part, controlling motor activities and sensory impulses; responsible for thought and behavior.
Lobes of the Brain:
Frontal: Forehead and orbits, implicated in reasoning.
Occipital: Back of the skull, controls vision.
Temporal: Both sides of the cranium, regulates memory, sensation, language, and emotions.
Parietal: Sides and roof of the cranium, related to language control.
Brainstem and Circulatory Systems
Components: (brainstem) Includes the pons and medulla oblongata, vital for cardiac and respiratory functions.
Circle of Willis: A circular network of arteries providing redundant blood flow to the brain; crucial since the brain requires a significant amount of oxygen.
Cerebrospinal Fluid (CSF): cushions and nourishes and cleans the brain, with conditions like hydrocephalus leading to excessive CSF, often treated with shunts.
Hydrocephalus - excessive CSF treated with shunts to drain fluid to the abdominal or heart
Hematomas
Epidural - between skull and dura due to trauma
Subdural- between dura and brain
Brain Divided
Cerebrum - forehead
Cerebellum- hindbrain
Brain stem
Procedures
Craniotomy - opening the skull to access tumors or aneurysms
Craniectomy - Bone flap is removed, stored in antibiotic solution
Laminectomy- removing lamina to relieve pressure
Rhizotomy - cut nerves root for pain spasms
Cordotomy- cut nerves fibers in the spinal cord for terminal pain
Brain
Pia mater
The anachnoid
The dura mater
Carnium
Pericranium
Muscle
Galea
Connected tissue
Scalp
Hair
Pericranium posterior layer of the skull
Midbrain
Hypothalamus
Thalamus
Pituitary gland
Cervical -7
Lumbar - 5
Sacral -5
Thoracic - 12
Nerve and Spinal Procedures
Spina Bifida: Incomplete closure of vertebral arches, with the most severe form being myelomeningocele.
Surgical Access: Various procedures for accessing the brain include craniotomy and craniectomy.
Nerve Interventions: Procedures can involve cutting nerve roots or fibers to relieve pain or spasms, termed Rhizotomy and Cordotomy.
Cranial Nerves
Key Functions:
Olfactory: Sense of smell.
Optic: Visual activity.
Oculomotor: Eye movement control (pupil dilation).
Trochlear: Eye movement down and laterally.
Trigeminal: Chewing and facial sensation.
Abducens: Lateral eye movement.
Facial: Facial expressions and sensation.
Vestibulochlear : hearing and balance
Glossopharyngeal: gagging and swallowing
Vagus : stimulates pharyngeal and laryngeal affects the heart pancreas lungs and digestive system
Accessory : helps control pharyngeal and laryngeal also controls the cranial and spinal portion
Hypoglossal: stimulates muscle of the tongue
Peripheral Nervous System
Structure: Composed of small bundles of nerves surrounded by a sheath; includes both the autonomic and somatic nervous
ANS involuntary controls, heart rates, respiration control of fight or flight.
SNS voluntary action can be controlled
Endoneumium - surrounded by sheath
Surgical Techniques and Instruments
Lidocaine and Epinephrine: Lidocaine acts quickly for anesthesia but has a short duration, while epinephrine reduces bleeding by constricting blood vessels.
Various Scissors Functionality:
Metz: Scissors for delicate tissue. Cut vessels , cut subq , small prolene suture
Mayo: Used for tougher tissue, cut uterus
Straight mayo - cut suture cut bandages cut dreams cut umbilical cord
curved mayo - cut tough tissue, cut uterus
Potts - extended station into vessel
lister scissors - cut inner layer of cast cut bandages cut umbilical cord
Straight Iris- cut suture in very small area like finger
Curved Iris - cut tendon or muscle in very small area like finger
Tenatomy - cut delica tissue and very small area