Handout 4 - HANDOUT #4 Respmmoyaq ems-EM 7 7M! r f ‘ '...

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Unformatted text preview: HANDOUT #4 Respmmoyaq ems-EM 7 7M! r f ‘ ' we... - ---«,...,...._<..,n END MODEL 9 \W... ‘ gfig A , Aw 5... , .3. .¢ 4% A C .i . 3:3: _. fl afii w. l8 RESPIRATORY PATHOPHYSIOLOCY Bronchial afiel’iES Right upper lobe Le“ RI hr upper lobe middle loslae / Parietal pleura Mediaslinum ‘7 Pleural space Visceral pleura Right ; LeH _ . A " lower lobe lower lOlDe 3 9/98"“: curculohc‘i'n ' 5 3p: 120/80 mm 9 . : i ‘ v the pul- \ : 4 Functional positlon of the lUnSS m BRONCHOPULMONARY SEGMENTS ; FIGURE 35' I RIGHT LUNG SEGMENTS LEFT LUNG SEGMENTS w‘ monary c‘rcula’uon. U er [0176 K U Hebe 1— ice I . . r 2_:‘:ferior b 2 lAplcopaslenor { 3—Anlerior '4 3 Anterior 5 4 , , Middlg lobe a j 5 $1533? ; A—Lareral ' l 5__Med;a| Anterior '5 Lower lobe g nger lobe é—Apical (superior) 6—Apical 7—Meclial basal (cardiacl 7~Medial basal B—Anlerior basal : B—Anlerior basal 9—Laleral basal y 9~laferal basal 10—posleriar basal lO—Posferior basal l y ‘2 Gener— ation Trachea 1 pm H 1 . Epithelium g Endolheliurn a 2 C» Bronchus Basemenl membrane C O . O BTOnCthle Alveolus I I I I Terminal I l - I f Endothelial bronchlole . 4 nudeus Respiratory . 5 bronchiole ’ Alveolar duct —— Cl) C O N > ._ O .. fl} .: D. u) _ ca '63 C .9 "a C (U ; Alveolar sac LUNG vrrAL CAPACITY CAPACH'Y (TLC) (VC) 5 lNSPiR/t/TéilflrMERESERVE [NEWTON 4 (IRV) liters TIDAL VOLUME (TV) EXPIRATORY RESERVE VOLUME (ERv) EXHALATION FUNCTKDNAL RES DUAL CAPAClTY (RV) lnspiratory reserve Inapiratory “ votume capacity \fital capacity Total lung Tidal . capacrty volume Expiratory reserve volume Functional residual capacity Residual volume We m , M Zero lung volume NORMAL 'OBSTRUCTIVE RESTRICTIVE NORMAL ._.T_______ I l FEV T f I ,, Fvc FEV _ g , FEV FVC : I FVC .1 Psec‘l Idseci Lisecf FEV = 4.0 FEV = 1.3 FEV = 2.8 MMFR =5 FVC = 5.0 FVC = 3.1 FVC = 3.1 % = so as = 42 as = 90 ‘ 3-5 "sec FIGURE 36-4 Measurement of the forced expiratory volume (FEV1) and maximum mi— dexpiratory flow rate (MMFR). The patient takes a full inspiration and exhales as hard and as fast as possible. The pen moves down as the patient exhales. The FEVI is the volume ex- haled in 1 second. The MMFR is the mean flow rate over the middle half of the FVC. Note the differences among the normal, obstructive, and restrictive patterns. (From West JB: Dis— turbances in resniratnrv function In Pprmrcrlnrf for” - Harricnn’c nrinr‘inloc nf inmrnal mind- Ventilation 76 L/min 750 . 1000 ml/m'n ml/min of 02 of o2 250 ml/min to tissues Capillaries 7n Oxygen transport 250 ml/min of Oz 100 —20 90 418 80 —16 C E .9 70 E ~i4 ,9 E 8 as g 50 $ —10 a c - _ E 93) .40 E 8 g a“: 30 é’ —6 33 20 _4 10 ‘2 2 O 6 8 lOO l l O 10 O 30 4 50 070 090 110 20130 40 Gaseous pressure of oxygen (mm Hg) (a) 100 100 80 (D O ‘60 03 O 40 .15 O 20 20 Percent saturation of Hb with 02 Percent saturation of l lb with O2 0 20 40 so 80 loo 0 70 40 an n "i Figure 21—3 Scanning electron micrograph of the alveolar capillary bed shows an incompletely fused double network that offers the red cells a very large array of paths. r, 21392 -=PCO'2 ' hPHao ‘ ENz‘ I. ». P‘t’oztal g en atised level (760 tort). : H etytoyt‘él attfioepfieric pressure at £02 in' inspired and alveolar gas is well-below valee‘s for’male's at sea level. jtT I is an app-teximzit v ue andiho‘ s_ ainprqxghat'elyk, ohIEy - or Denver or Salt Lake. Cityjs about QiO’torr, ahdtheparzfial rpressufrf ._ p—‘rv pa p4 "1UJP-fi| “NW”. -W Pulmonary Function During Anesthesia 215 CEREBRAL AFFERENT CORTEX WPUT PERthRAL CHEMORBSEFTORS CiNTRAL --a o'ECEFTORS LUNG lNFLATlON lNTERCOSTALS FIG 7-5. Schematic depiction of the complex interconnection of afferent. efferent, and central com- ponents of ventilatory control. Input comes not only from mechanoreceptors and chemore- ceptors but also from higher centers mediating sensory and psychologic activity. Major integrative centers exist in the pneumotaxic center (PNC), apneustic center (APC), reticu— lar formation (RF), and the dorsal and ventral respiratory neuron groups (ORG, VRG) ot the medulla and the pons‘ ln addition. there are also little-understood integrative centers within the medulla and spinal cord that synchronize reciprocal inhibition of the muscles of the abdominal wall (dashed lines). iliary inspiratory muscles during exhalation. The intercostal muscles, however, appear to be under direct medullary control.18 Reflex relax- ation of abdominal and paravertebral musculature during slow, quiet breathing facilitates abdominal examination and lumbar puncture, a clinically evident phenomenon frequently utilized to facilitate these maneuvers. Contractions of the intercostal muscles during inspiration elevate *vwlulm—alu—n‘ Jawwum l.q.:“\ypnwl‘“ «mmun,t.www .mw vn.;«~'uuf.hn»llhn.n . Il|flflum€w .«am.~.~m=.cuuann Lama - ~— “albums-u:- «mam-u.» u“. ..'-u-._—~\...:;,..4-,u.,. ’ A, - nay-wire: 3M.mMn-:a_rfidfr'mwm 1 a n H. I: q.)- nva: w my 4...: I go»- EXP/I‘M TORY FLOW /N5P//?A TORY FLOW Um EEFORT DEPENDENT ‘2 ‘ ,-—~EFFoaT INDEPENDENT I TIDAL VOLUME l . . _ . ., O l l l l 10 ‘ *- VITAL CAPAClTY~ —'l‘— "r l—TOTALLin CAPAOTY--fi Obstructive lung disease Normal / Trocheol stenosis EXP/RA T/O/V ‘g Restrictive ‘; defect Q o \ l i Q S \J \ K 2: E P— l m 8“— S 8 6 4 2 O LUNG VOLUME {L/ FlC. 33-2. Flow volume loops relative to lung volumes (1) in a normal subject, (2) in a patient with COPD, (3) in a patient with fixed obstruc- tion (tracheal stenosis), and (4) in a patient with pulmonary fibrosis Note the concave expiratory form in the patient with COPD and the flat inspiratory curve in the patient with a fixed obstruction (Goud— souzian :\‘, Karamanian A: Physiology for the Anesthesiologist: 2nd ed. Norwalla', Appleton-Century-Crofts, 1984‘ Reproduced by per— mission) ...
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Handout 4 - HANDOUT #4 Respmmoyaq ems-EM 7 7M! r f ‘ '...

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