Fast and Furious

Basic Mechanics, Drive to Breath and Pressure Spirometry Gas Transport O2/CO2 Exchange Arterial Blood Gasses! Questions

The Pump Handle, The Bucket Handle and the diaphragm:

Inspiration: ACTIVE movement
Antero-posterior dimension increases (Pump handle) Transverse dimension increases (Bucket handle) Vertical dimension increases (Diaphragm)

Muscles of inspirationgo!
Ext. Intercostals, Diaphragm + Accessory Muscles

Muscles of expirationgo! (expiration can be passive)

Int. intercostals, Innermost Intercostals + abdominals

Diagrammatically

Drive to Breath
***no DIRECT detection of paCO2 but CO2 gives rise to most of the H+ ions

Why does air move in/out? Pressure changes

Pressures during breathing

Dynamic small airway closure

Change of pressure = Resistance x Rate of Flow
Biggest factor of Resistance is Radius of the conducting airway( r4) Increased Resistance = faster drop in air pressure

Normal Expiration:
Equalization pressure point occurs at cartilaginous area

Forced Expiration:
Increased intra-alveolar pressure to push air out faster When intra-alveolar intra-pleural pressure, the small airways shut

Same thing happens in Asthma as Emphysema for different reasonswhat are they?

Why is it easier to INSPIRE than EXPIRE in airway obstruction?

Forced Expiration: working against small dynamic airway closure
closing tendency increased by great positive pressure from abdominals, etc.

Forced Inspiration:
extra negative intrapleural pressure created as inspiration pulls pleura outwards at same time alveoli are being inflated

Spirometery: Wet

Restrictive vs. Obstructive

Restrictive: (Fibrosis or other causes)
Lung volumes low FEV1/FVC ratio >80% why? FVC drops more than FEV1 Fibrosis, severe scoliosis/kyphosis

Obstructive (chronic)
Lung Volumes increased Forced Reserve Capacity increased Residual Volume Increased FEV1/FVC ratio <80% why? normal FVC, low FEV1 Asthma, emphysema (slightly different)

Large Airway Obstruction (lego pieces) is a bit different.

Flow-Volume Spirometry
Peak expiratory flow rate

Volume-time graphs

Volume Time Graph

FEV1 = max air expelled in 1s FVC = forced expiratory vital capacity FEV1/FVC ratio is key FEV1/FVC ratio is a useful finding <70% indicative of obstructive disease

Practice!

This one?

Tricky one?

Gas Exchange
Occurs by diffusion, but aided by carrier Hb (tetramer) Oxygen Carried 98.5% on Hb
Cooperative binding; better O2 binding after 1st is bound

Carbon Dioxide is carried by BLOOD 3 ways

Diffused in blood (5%) As Carbaminohemoglobin (5%) As Bicarbonate Ions (90%)

Bohr and Haldanebrief

Bohr:
Increased CO2 in blood Oxygen displaced from Hb Helps let more O2 off at Tissues

Haldane
Increased O2 binding (as at lungs) displaced CO2 Very important for CO2 off-loading

What 4 factors affect Gas Diffusion?

Surface Area involved (emphysema) Distance of Diffusion (fibrosis/edema) Pressure Gradient (altitude) Diffusion Coefficient

Hemoglobin Oxygen Dissociation Curve

????

Carbon Monoxide Effects

Carbon monoxide binds with 240x affinity of O2 Also, inhibits ability of Hb to offload Oxygen!
Lowers p50 of Hb for oxygen

Ventilation/Perfusion
Ventilation: amount of AIR flow to a region Perfusion: amount of BLOOD flow to a region\ V/Q should hover around 1 or else: V/Q mismatch
(V/Q) > 1 Over Ventilation (Type I Resp Failure)
Poor diffusion (fibrosis, edema), poor blood flow (embolism)

(V/Q) < 1 Over Perfusion (TYPE II Resp failure)

RL Shunt (deoxygenated blood leaves the lungs) Failure to ventilate the lungs (asthma, emphysema, Neuromuscular)

Two-Pump Shakur

Airway and Arteriolar responses to V/Q mismatch

Interpreting an ABG
Look at pH (acidotic or alkalotic) RR = 7.35-7.45 Respiratory or Metabolic?
Check direction of pCO2 and pH
Respiratory Opposite, Metabolic Equal (ROME!)

Compensation occurring?
Increased/Decreased Bicarb for Respiratory issues Increased/Decreased pCO2 for Metabolic issues

If metabolic acidosis; Calculate the Anion Gap

AG = [Na+] ([Cl-]+[HCO3-])

Acidosis/Alkalosis: Is it Resp or Metabolic?

Arterial Blood Gasses