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Cardiopulmonary Anatomy & Physiology
Unit 1 Chapter 1 (Test 1)
Conducting airways are divided into ...
Upper and lower airways
The upper third of the nose (bridge) is formed by...
Nasal bones and the frontal process of the maxilla
Conducting airways are....
Passageways between the ambient environment and the gas exchange units of the lungs (the alveoli)
What are the primary functions of the nose?
Filter, humidify and conditioning warm/cool inspired air and to generate a resonance in phonation.
Primary functions of the upper airway
- Act as a conductor of air
- Humidify and warm or cool the inspired air
- Prevent foreign materials from entering the tracheobronchial tree
- Serve as an important area involved in speech and smell
The outer portion of the nose is composed of...
Bone and cartilage
The lower two thirds of the nose consists of...
Lateral nasal cartilage, greater alar cartilage, lesser alar cartilage, septal cartilage, and some ibbrous fatyy tissue
Posteriorly the nasal septum is formed by...
Perpendicular plate of the ethmoid bone and the vomer
Nasal septum
Internal portion of the nose a partition, separates the nasal cavity into two approximately equal chambers
Anteriorly the septum is formed by...
Septal cartilage
The roof of the nasal cavity is formed by...
Nasal bones, frontal process of maxilla and cribriform plate of ethmoid bone
Where is the vestibule located?
The opening of the nose (slightly dilated)
What is the function of the vibrissae?
It functions as a iblter and are the tracheobronchial tree's ibrst line of defense
Hair follicles located in the vestibule
Vibrissae
Three bony protrusions on the lateral walls of the nasal cavity
Superior, middle, and inferior nasal turbinates or conchae
Choanae
Two nasal passageways between the nares and the nasopharynx
Choanalatresia
disrupts baby's ability to breath, bi or unilateral, if baby develops this, they will need a nasogastric tube
What is Epistaxis?
Nosebleed
Oral cavity
Considered an accessory respiratory passage
Tongue
Is composed of interlacing bundles of skeletal muscles and ibbers
Tongues falls back into throat
Common cause of upper airway obstruction
Uvula
Keeps things from entering the sinus cavity
Palatine tonsils
Are lymphoid tissues and are believed to serve certain immunologic defense functions
Pharynx
Divided into 3 parts: nasopharynx, oropharynx, and laryngopharynx
Why is the Barium Swallow test performed?
To test for esophageal malignancy, dysphasia and gastric reflux
Where is the vallecula epiglottica located?
In front of of epiglottis and behind the lingual tonsil, in a lityle valley; it is an important landmark during the insertion of an endowed heal tube into the trachea
Where is the laryngopharynx located?
Lies between the base of the tongue and the entrance of the esophagus
What can be used to bypass a patients upper airway?
Nasal endotracheal tube, an oral endotracheal tube or a tracheostomy tube
When an endotracheal tube is in place....
Ensure the gas being delivered is appropriately warmed and humidiibed, if it isn't the mucosal layer can become thick and risk obstruction
The upper airways consists of...
Nose, oral cavity, pharynx and larynx
Where does the laryngopharyngeal musculature receive its sensory innervation from?
The ninth cranial (glossopharyngeal) nerve and its motor innervation from the tenth cranial (vagus) nerve.
When stimulated together, what do the ninth and tenth cranial nerves produce?
Pharyngeal reflex (gag or swallow reflex)
The larynx is also called the...
Voice box
Where is the larynx located?
Between the base of the tongue and the upper end of the trachea
What is the Larynx three main functions?
- Passageway of air between the pharynx and trachea
- Protective mechanism against aspiration of solids and liquids
- Generated sounds for speech
What are the 3 single cartilages of the larynx?
Thyroid cartilage, cricoid cartilage, and the epiglottis
What is croup syndrome?
Glottic and subglottic swelling (edema) secondary to viral or bacterial infection commonly seen in infants and young children
What is post-extubation laryngeal edema?
Because the endotracheal tube is placed between the vocal cords for extended periods of time, the vocal cords often have some degree of trauma, edema, and swelling.
Early treatment of post-extubation laryngeal edema consists of ...
Aerosolized alpha-adrenergic drug, such as racemic epinephrine (treatment of choice), high humidiibcation (vaporized mist or steam inhalation) and avoidance of any irritants
What is another name for croup?
Inspiratory stridor
What are two major causes of croup?
Laryngotracheobronchitis (LTB) and acute epiglottitis
What is acute epiglottitis?
A supraglottic airway obstruction resulting from inflammation of the epiglottitis, aryepiglottic folds and false vocal folds and is life threatening.
What is the primary function of the larynx?
To ensure a free flow of air to and from the lungs.
What is another vital function of the larynx?
Effort closure during exhalation also known as Valsalva's maneuver.
What almost always causes acute epiglottitis?
Bacterial infection of Haemophilus influenza type B
What is commonly used to treat LTB (laryngotracheobronchitis)?
Aerosolized racemic epinephrine
What are the primary functions of the nose?
Primary functions are to iblter, humidify and condition (warm or cool) inspired air. It is also important as the site for sense of smell and to generate resonance in phonation.
A severe maxilla injury may require an endotracheal tube (nasal ET)
They are located in the conducting zone, generations 10- 15
Where is mucus produced?
Goblet cell and submucosal gland
What does the parasympathetic nerve do in the tracheobronchial tree?
what is the epithelial lining composed of?
predominantly composed of pseudostatiibed ciliated columnar epithelium interspersed with numerous mucous glands and separated from the lamina propia by a basement membrane
how far does the pseudostatiibed ciliated columnar epithelium extend?
it extends from the trachea to the respiratory bronchioles
a mucous layer, commonly referred to as the mucous blanket covers what?
it covers the epithelial lining of the tracheobronchial tree
what is the mucous blanket composed of?
it is composed of 95% water, with the remaining 5% consisting of glycoproteins, carbs, lipids, DNA, some cellular debris and foreign particles.
Mucous is produced by...
goblet cells and the submucosal or bronchial glands
the submucosal glands...
are numerous in the medium sized bronchi and disappear in the distal terminal bronchials
what are the submucosal glands innervated by?
vagal parasympathetic nerve ibbers, 10th cranial nerve, and produce about 100mL of bronchial secretions per day.
increased sympathetic activity decreases glandular secretions
how much is considered normal for bronchial mucous secretions?
100 mL a day
what is considered abnormal mucous secretions?
more than 25mL a day from coughing
what angle does the left stem bronchus form?
a 40-60 degree angle with the trachea
the right stem bronchus is wider and more vertical and about 5cm shorter
what are endotracheal tube cuffs used for?
to seal the airway to adequately apply positive pressure mechanical ventilation and to prevent aspiration
what range must the cuff range between?
between 25 and 30 mmHg under normal conditions
what is the clinal safe range for a endotracheal tube cuff?
20 - 25 mmHg
what can prolonged and excessive cuff pressure lead to?
tracheal mucosal ischemia, inflammation, necrosis, ulceration, and destruction of the tracheal wall cartilage
what is a ibstula?
an abnormal communication between the trachea and a nearby structure
what are the common ibstula associated with tracheal cuff erosions?
innominate artery and the esophaguswhat artery is the most common artery involved in massive hemorrhage associated with a tracheostomy?
innominate artery
what is ischemia?
an inadequate blood supply to an organ or part of the body, especially the heart muscles
what is tracheomalacia?
a condition characterized by flaccidity of the tracheal support cartilage, which leads to tracheal collapse especially when increased air flow is in demand
the brachiocephalic artery in also called the innominate artery
when inserting an endotracheal tube where should the end be located?
about 4-6 cm above the carina
8 in the left
what are noncartilaginous airways composed of?
the bronchioles and the terminal bronchioles
when the bronchi decrease to less than 1 mm in diameter and are no longer surrounded by connective tissue sheaths, what are they called?
bronchioles
where are bronchioles found?
between the 10th and 15th generations
between the 10th and 15th generation, cartilage is absent and the lamina propia is directly connected with what?
lung parenchyma
the conducting tubes of the tracheobronchial tree end with the terminal bronchioles between what generations?
16th and 19th generation
what is the average diameter of the terminal bronchioles?
about 0.5 mm
what are the canals of lambert?
they are small channels, it is believed that these tiny pathways may be important secondary avenues for collateral ventilation in patients with certain respiratory disorders.
the structures beyond the terminal bronchioles are the sites of gas exchange and although directly connected to it, are not considered part of the tracheobronchial tree
what is the mixing of venous blood and freshly oxygenated blood known as?
venous mixture; which is the cause of hypoxemia and tachycardia
alveolar pores of kohn allow what?
allows the alveoli to communicate
where does most gas exchange take place?
at the alveolar capillary membrane
approximately how many alveoli are there in an adult males lungs?
480 - 500 million
