RT Test 4

What is ventilation?

The process of moving gas (air) in and out of the lungs

Why is ventilation regulated? In disease and respiratory care

To meet the body's need under a wide range of conditioning1. In disease, inadequate ventilation or an increased WOB results2. Respiratory care modalities try to reduce WOB and provide artifical ventalation if neccessary

Define respiration?

Complex physiological process at the blood and cellular levels

What are the 2 phases of ventilation?

Inspiration and expirationDuring each cycle, volume gas moves in and out of the respiratory tract

What is Vt?

Tidal volumeAmount of gas that moves in and out of the respiratory tractNormal Vt refreshes the gas present in the lung removing CO2 and supplying O2

What are the 3 different pressure gradients?

Transrespiratory- Difference in pressure between atmosphere (body surface) and alveoli; causes gas to flow in and out of alveoliTranspulmonary- Difference between alveoli and pleural space; keeps alveoli openTransthoracic- Difference in pressure between pleural space and body surface; total pressure needed to expand or contract the lungs

What are the different kinds of pressures throughout the lungs?

Alveolar pressurePleural pressureMouth pressureBody surface pressure

What is transpulmonary pressure?

Difference between alveoli and pleural space; keeps alveoli open. pressures vary

What is Transrespiratory pressure?

Difference in pressure between atmosphere (body surface) and alveoli; causes gas to flow in and out of alveoli

What is Transthoracic pressure?

Difference in pressure between pleural space and body surface; total pressure needed to expand or contract lungs

What are the 2 forces of lung inflation has to work against?

Elastic forces: the tissues of the lungs and thorax along with the surface tension in the alveoliFrictional forces: resistance caused by gas flow and tissue movement

Without surfactant, what would happen to alveoli?

alveoli collapsewithout surfactant, decrease surface tension, and provide alveoli stability.

What is pleural pressure before inspiration (no gas flow)? alveolar pressure?

-5 cmH2O and 0cmH2O

What is the normal value for compliance?

0.2 L/cmh2O

What does compliance mean?

Measures the distensibility of the lungs"Stretch out"How far a lung can be expanded to

How do we measure good compliance?

Cl = Vt/P

In emphysema, compliance __________ and elastic tissue ___________.

increases, decreases or drops

In fibrosis, compliance __________ and elastic tissue ___________.

decreases, increases or raises

What is elastance?

Property of resisting deformation"Back to original shape

When does airway resistance happen?

It occurs when the system is in motionHas 2 components:1. Tissure viscous resistance: impedance of motion caused by displacement of tissues (lungs, rib cage, diaphragm, abnormal organs) during ventilation (approx 20% of R)2. Airway resistance: impedance to ventilation by movement of gas through the airway

What are 2 factors that affect airways?

1. Laminar flow: gas moves in discrete layers layers or streamlines. Layers near the center of the airway move faster than those close to the wall of airway. Results from the friction between gas molecules and the wall (Poiseulle's Law)2. Turbulent flow: gas flow through a tube changes significantly and gas molecules form irregular currents

What factors are needed for laminar to turbulent flow?

1. Gas density2. Viscosity3. Linear velocity4. Tube radius

What is the flow of small airways?

Laminar

What happens to the lung tissue during inspiration?

Widens transpulmonary pressure gradient and increase the diameter of the airways

What happens when you increase airway diameter and increase lung volume?

Decreases airway resistance

What compliance is less then normal?

Restrictive disease

What compliance is increased?

Obstructive disease

What are some symptoms of PTs with stiff lungs?

Increase elastic WOB - pulmonary fibrosisOften have a rapid, shallow breathing pattern which minimizes the mechanical work of distending the lungs but at the expense of more energy to increase breathing rate

What is Raw and what is the equation?

Resistance airway and equation is P/F

What is the normal value of Raw or airway resistance?

0.5-2.5 cmH2O

What is Poiselles law?

Decreased radius = increased pressurelaw that gives the pressure drop in a fluid flowing through a long cylindrical pipe.P = V / r4

Does it take any energy when we exhale or during expiration?

Yes, its passive but potential energy is used.Potential energy: saved energy, from inflated lungs that want to go back to its original size

In the distribution of ventilation in disease, where does all the blood go through the lungs?

Gets pull down through the apices down to the bases and the periphary of the lungs causing, deadspace

What is the % of wasted deadspace volume?

30% wasted

Deadspace is calculated by?

Modified bohr equationmultiply by 1 if lbsmultiply by 2 if kg

What is the normal value for minute ventilation?

5-10L/min

What is the normal PaCO2 value?

40mmHg

During resting CO2, what is the normal value?

200mL/min

If CO2 goes UP because of slow breathing, its called?Hint: VA decreases

Hypoventilation

If CO2 goes DOWN its called?Hint: VA increases

Hyperventilation (blowing in a bag for CO2)

What happens to PaCO2 if you were to hold your breath?

PaCO2 increases

Where are the DRG and VRG located?

Medulla oblongata

What's in the Pons?

Apneustic centerPneumotaxic center

What controls It? (Inspiration time)

Pneumotaxic center

What is the Hering-Breuer Reflex?

stretch receptors send signals to DRG and vasovagal nerve, stopping further inspiration

What chemoreceptors are found in arch of aorta and carotid sinus?

Peripheral chemoreceptors

Which chemoreceptors are found in the medulla?

Central chemoreceptors

When the PaCO2 level is below 60mmHg which receptors are more sensitive or triggered?

Peripheral Chemoreceptors

Should COPD PTS or O2 induced hypercapnia PTs ever be denied O2?

No, they should never be denied, but never give them 100% O2. Just give them enough, 60-80%Watch pulse oxymetry

What are Cheyne-stokes patterns?

RR and Vt gradually increase and then gradually decrease to complete apnea

Biot's patterns are seen in PTs with?

Occurs in PTs with ICP (intercranial pressure)

What are Biot's patterns?

Similar to cheyne-stokes except Vt are of identical depth.

Anytime there is damage to the pons it will be in the?

Apneuistic pattern - Long gasping breathing pattern

Which kind of PTs get cheyne-stokes patterns?

CHF and brain injury PTS

In CO2 and cerebral blood flow, or closed brain injury what can happen?

Increased CO2Cerebral Vessel dilationIncreased ICP

Air in the lungs that you dont exhale out is called?

Residual Volume

What is the TLC made up of?

IRV + VT+ ERV + RV

What is the Vital Capacity or VC made up of?

TLC - RV

What is the sum of IRV + VT?

Inspiratory Capacity

What is the sum of ERV + RV?

Functional Residual Capacity