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Mechanical Barriers
• Upper Respiratory Tract Mucosa
○ Lining of nose, turbulence in back of throat
○ Regulates temp of air, humidifies air, nose is more effective for
humidification.
• Nasal hair and turbinates
○ Mucosa tracks/removes foreign bodies (bacteria, noxious
gasses, etc)
○ Nasal hairs, turbinates, trap/remove foreign particles/gasses.
• Mucus blanket
○ In trachea/bronchus trap foreign bodies
• Cilia
○ Propel mucus blanket back up to be swallowed or
expectorated.
• Alveolar Macrophages
○ Last level of defense, digest any foreign particles that may
have been able to enter through phagocytosis.
• Irritant Receptors
○ Nares
• Stimulated if there is a foreign object/noxious gas to
sneeze to propel out of sys.
○ Trachea and large airways
• Trigger to cough.
Ventilation vs Respiration
• Ventilation: the mechanical movement of air into and out of the
lungs
○ Ability of chest wall to expand/contract, active and passive.
• Respiration: the exchange of oxygen and carbon dioxide during
cellular metabolism
Mechanics of Breathing
• Major muscles
○ Passive breathing, diaphragm doing the major work.
• Accessory muscles
○ When doing more active forms of breathing, singing, shouting,
difficulty breathing, focused on breathing, more help to
ventilate lung tissue. Sternalcleidal mastoid muscle (sp?) [see
pic below] Scaling muscles, pectoral muscles.
○ No muscles used during expiration. Passive process.
• Elastic properties
○ Of lungs and chest wall, allow lungs to move and ventilate
Screen clipping taken: 7/12/2009, 8:05 PM
Other Determinants
• Alveolar surface tension
○ Ability of alveoli to stay expanded
○ Need surfactant
• Airway Resistance
○ Increased resistance may deter ability to ventilate and
exchange O2 and CO2.
○ Occurs mostly in upper airway (nose, larynx)
• Swelling in nares, obstruction, stuffy nose.
• Work of Breathing
○ Muscular effort it takes for body to ventilate, amount of O2 to
do muscular effort.
○ Normally there's a Low work of Breathing, requires little O2
and energy.
○ WOB increases because of blockages or pulmonary diseases,
requires more O2 and energy to perform work of breathing.
Gas Transport
• Diffusion across alveolar-capillary membrane
○ Oxygen is loaded onto Hemoglobin
○ At tissues oxygen dissociates with hemoglobin and diffuses
across membrane at tissue level.
○ Carbon dioxide more soluble in plasma then O2.
○ CO2 returns to lungs dissolved in plasma as bicarbonate or
bound to hemoglobin
Animations
Video gas transport:
Also in textbook CD.
http://www.youtube.com/watch?v=WXOBJEXxNEo
http://highered.mcgraw-
hill.com/sites/0072495855/student_view0/chapter25/animation__g
as_exchange_during_respiration.html
Hypercapnia
• Increased CO2 in arterial blood (PaCO2)
○ Usually from hypoventilation, may be initially overlooked.
People's respiratory rate may not change initially.
○ Only way to tell is through ABS (arterial blood gas)
○ See in people with respiratory acidosis
○ Decrease in drive to breath
• Caused by depression of resp. center
• Recreational/illicit drugs
• diseases of the medulla or trauma of CNS.
○ diseases of the neuromuscular junction or resp. muscles, eg
muscular dystrophy, mylestinia gravus (sp?)
○ thoracic cage abnormalities
• Chest injury or congenital condition, or deformity.
○ large airway obstruction
• Tumor or real severe sleep apnea.
○ increased work of breathing
• Emphysema
Hypoxemia
• reduced O2 in arterial blood (PaO2)
○ decreased oxygen content in tissues
• Tissue b/c hypoxic
• Decreased O2 in air itself (mountains)
• Most common cause: high altitude.
○ Hypoventilation
○ diffusion abnormalities
•Edema --> inc pressure at capillary level, hard for O2
blood to cross over capillary membrane (pulmonary or
peripheral).
○ abnormal ventilation-perfusion ratios
• Atelectasis, collapsed lung tissue (can't ventilate)
Pneumothorax
○ presence of air or gas in the pleural space
• No more negative pressure, lung tissue collapses.
• Need to insert chest tube to create negative pressure, re-
expands lung.
• Pneumothorax
○ Open
• Stabbed in chest, pleura filled with air, air comes in and
out (communicating pneumothorax)
○ Tension
• Fractured rib, gunshot, etc, flap covers, air cannot get back
out. Need to open air space with a giant needle like in the
movies.
○ Spontaneous
• Sudden pleural pain, HR up, some dyspnea, severity
depends on how much tissue is lost.
• Diminished breath sounds over where tissue develops, see
in thin male athletic individuals.
• May have some hyper resonance over open area during
percussion.
○ Traumatic (secondary)
• Open, tension, spontaneous.
Screen clipping taken: 7/12/2009, 8:12 PM
Pulmonary Disorders
Asthma
Screen clipping taken: 7/12/2009, 8:16 PM
COPD
Emphysema
• Abnormal permanent enlargement of gas-exchange airways and
accompanied by destruction of alveolar walls
○ Airways become distended, alveoli are damaged.
• Obstruction occurs d/t changes in lung tissue
• Loss of elastic recoil
• Leads to hyperinflation (hyperventilation) of alveoli and
development of blebs (pockets of air in tissue, can burst and are
painful, not stable, can break easily)
• Barrel chest appearance (a lot of trapped air in lung tissue)
• Hard for people to exhale air (pink puffers, purse lips to slow down
exhalation)
• Very oxygenated, just can't get extra O2 out. Can have excess CO2
(not always) Don't give high volumes of O2!
• Anything that damages alveolar membrane can lead to
Emphysema.
Emphysema
Pneumonia
• virulent microorganisms overwhelm natural body defenses
• release of multiple inflammatory mediators and activation of
immune response damages bronchial airways and alveolocapillary
membranes
• fill with infectious debris and exudate
• leads to further lung damage
Pneumonia
Screen clipping taken: 7/12/2009, 8:18 PM