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Paeds > Cardiorespiratory anatomy > Flashcards

Cardiorespiratory anatomy Flashcards

2
Q

When does lung development begin?

A

In the embryo before lung bud observation

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3
Q

When are the lungs ready for function? When does it start functioning?

A

Just prior to birth

  • formation of alveoli
  • integrated capillary network

AFTER birth (unique)

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4
Q

When is lung development complete?

A

8 years old

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5
Q

What additional tissues and systems do the lungs need to function? (3)

A

Structures

  • ribs (skeletal)
  • diaphragm (musculoskeletal)
  • pulmonary circulation (CV)
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6
Q

Describe lung development histologically (P1-2, P2- 3, P3-2, P4-2 )

A
  1. Embryonic (3-5wks)
    - foregut endoderm begins as a single tube
    - divides into 2 major bronichi (develops until branches)
  2. Pseudoglandular (6-16wks)
    - Branches form trachea to terminal bronchioles
    - Cilia at wk 10
    - blood circulates, cartilage and lymph have developed
  3. Canalicular (17-24wks)
    - Surfactant appears
    - Alveoli are short, simple tubular endings
  4. Alveolar (terminal) sac (24wks-term)
    - Pulmonary circulation continues development
    - Alveoli increase size and number (average = 150M)
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7
Q

Surfactant (description, synthesis-3)

A

Phospholipid preventing alveoli collapse on expiration by reducing surface tension in alveoli.

Begins synthesis at wk19 - present until wk30 - birth and respirations stimulates further production

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8
Q

Name 4 things affecting lung development

A

Hormones
Growth factors
ECM interactions (proteins)
Drugs

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9
Q

Briefly describe prenatal cardiac development (9)

A
  1. Mesoderm tissues becoming heart are evident in tube with neural fold (wk 3)
  2. Tube increases size and becomes central in location
  3. Chambers form
  4. Heart begins to beat (day 22-23)
  5. Blood flow (wk4)
  6. Paired cardiac tubes fuse (ventricles superior to atria)
  7. Tubes grow and rotate into S shape (ventricles below atria).
  8. Septation (tube into 4 chambers)
  9. Separation of cardiac outflow (truncus arteriosus) into pulmonary and aortic arches
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10
Q

Differences with cardiac development to other systems (3)

A

Differences

  • Precedes other system development
  • Independent and different regulatory mechanisms
  • Foetal circulation is different to neonate (foramen ovale between atria closes at birth up to 3yrs)
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11
Q

Foetal cardiac function

A
  1. Oxygenation via placenta

2. Some blood goes to lungs to nourish tissue (10-12%)

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12
Q

Foetal cardiac function — blood blow (2, shunt)

A

Blood flow within foetus

  • right to left heart (parallel)
  • CO is combined from both ventricles
  • Shunting
  • – 1 - foramen ovale (bypass lungs)
  • – 2 - Ductus arteriosus
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13
Q

Child cardiac function (1, steps = 8)

A 
Child = adult-like at/shortly after birth
Steps
1. Placental separation
2. Deep breath (lung ventilation)
3. Lung fluid shift
4. Increased pulmonary blood flow
5. Ductus venous closes (within 2-3wks)
6. Foramen ovale closes (within 2-3 months)
7. Ductus arteriosus closes
8. Ventricles work separately
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14
Q

Ductus arteriosus (1)

A

Connects pulmonary artery to proximal descending aorta

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15
Q

Ductus venous (1)

A

Shunts about a 1/3 of blood from the umbilical vein to the inferior vena cava (avoid liver - preferential to brain)

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16
Q

Child vs adult (HEAD) + implications (4 +1)

A

Head (babies have:)

  • relatively larger
  • short neck
  • large tongue
  • less hair (more heat loss)

PT = no need to tilt head (Ax/Rx)

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17
Q

Child vs adult (NOSE) + implications (2+1)

A

Nose (neonates and infants)

  • mainly breathe through nose
  • nostrils are small and easily obstructed

PT = check nose and clear if needed

18
Q

Child vs adult (INTERNAL AIRWAY) + consequences (3 + 3)

A

Trachea

  • short (4cm at birth) with wider carina angle
  • 4-5mm diameter (newborn)
  • right main bronchus has less angle

Consequences

  • intubation trauma common
  • oedema affects greatly (uncuffed ETT tube needed)
  • Tubes/inhaled objects usually into right bronchus
19
Q

Ventilation in infants (anatomy - 3; implications - 3)

A

Infants:

  • almost entirely diaphragmatic
  • rib cage changes over 1st 2 yrs - towards bucket handle action
  • horizontal ribs usually

Implications

  • to incraease lung V, downwards diaphragm needed
  • thoracic expansion potential is limited
  • abdominal distension can affect lung Vs
20
Q

Chest wall movement in infants/young children (implications 3/3, PT 1)

A

Kids

  1. outward recoil is small; inwards is similar to young adult
  2. FRC maintained by other mechs (e.g. active diaphrgmatic and intercostal expiratory tone) but not when asleep
  3. Closing V is greater than FRC until 6-8yrs

Implications

  1. FRC reduced due to recoils
  2. Neonates can rapidly desaturate
  3. Airways close with normal tidal ventilation

PT - ventilation increase with increased RR

21
Q

Ventilation/perfusion (V/Q) - kids vs adults

A

Kids (V/Q mismatch)

  • uppermost areas are btter ventilated
  • lower parts are better perfused

Adults
- preferentially distributed to dependent lung areas

22
Q

Oxygen consumption - kid (2, 1 implication)

A

Kids

  • High consumption
  • Metabolic cost of respiration up to 15%

PT - desaturation occurs quickly (anaesthetic recovery can be quick too)

23
Q

Normal RR values for Pre-term to adult (5)

A 
Pre-term = 40-60
Newborn = 30-50
6ys = 15-30
Adults = 12-16
24
Q

Central control of breathing in babies (4)

A

Not fully matured

  • often apneas (up to 5-6 months)
  • often during REM sleep
  • increased sensitivity to narcotics/smoking
25
Q

Pattern of respiratory distress (4 changes, 2 = 5)

A
  1. Change in chest wall mechanics (not expanding on inspiration)
  2. Change in breathing pattern
    - nasal flaring (get more air in)
    - Tachypnoea
    - Expiratory grunting (expiration against partially occlued glottis - increase FRC)
    - Stridor
    - Head bobbing
  3. Change in ABGs (cyanosis)
  4. Change in auscultation (abnormal breath sounds)
26
Q

Respiratory distress with other symptoms (2 CV, 4 other)

A

CV

  • Brady/tachycardia
  • Hypo/hypertension

Other

  • Neck extension
  • Pallor
  • Releuctant to feed
  • Not crying but irritable
27
Q

Cardiac output (phys, PT)

A

CO

  • high due to high metabolic rate 200ml/kg/min vs 70-80 in adults)
  • 60% heart weight is non-contractile

PT

  • HR increase but no stoke V increase.
  • Can tolerate up to 200bpm without heart failure.
28
Q

HR with age

A 
Preterm = 150 (100-200)
Neonate = 140 (80-200)
2yrs = 80 (60-140)
>6yrs = 75 (60-90)
12yrs = 80 (60-100)
Adult = 70 (50-100)
29
Q

Bradycardia (why, PT)

A

Why

  • Often from hypoxia and vagal stimulation.
  • Cardiac arrest usually 2ndary to extreme bradycardia

PT
- bradycardia may need O2 or atropine

30
Q

Blood pressure in babies (2)

A

BP

  • low at birth due to low stroke volume and peripheral resistance (80/50)
  • increases in 1st month to 90/60 and adult levels by 16yrs
31
Q

Haemoglobin (type and why)

A

HbF has higher affinity for O2 (avoid hyperventilation - respiratory alkalosis)

Decreases from birth. HbA fully estabilished at 6 months

32
Q

Body fluid (ECF:ICF, total body water)

A

ECF exceeds ICF at birth and reverses with age

Total body water decreases in first few days post-birth

Paeds (5 decks)

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