final rcp Flashcards
(249 cards)
1
Q
Ventilation
A
process of moving gas into and out of the lungs
2
Q
Respiration
A
process of moving oxygen and carbon dioxide
3
Q
Respiratory System
A
The upper airways Chest wall respiratory muscle the lower airways pulmonary blood vessels supporting nerves lymphatics
4
Q
Sniffing position
A
extending neck and pulling chin anteriorly
5
Q
Glottis
A
narrowest part of the adult upper airway
6
Q
characteristics of obstructive sleep apnea
A
obesity fatigue snoring short neck daytime sleepiness pharyngeal muscles relax when we sleep
7
Q
imbalance between mucus water content and airway humidity of the mucous sheet
A
thick, dehydrated
infected
immobile
8
Q
impairment of the mucociliary clearnance system
A
air pollution
dehydration
smoking
9
Q
neutrophillic inflammation of the airways
A
cystic fibrosis
COPD
asthma
smokers
10
Q
BTPS
A
body temperature 37C
pressure 760
water saturation at AH 44mg/L
water vapor saturation 47mg/L
11
Q
anatomical shunt
A
deoxygenated blood from the pulmonary arteries mixes with oxygenated blood from the pulmonary veins 1%-2%
12
Q
Purpose of surfactant
A
reduces surface tension
reduces work of breathing
increases lung compliance
13
Q
ACM
A
Type 2 cells Type 1 Cells basement membrane interstitial space capillary endothelial cell plasma erythrocyte
14
Q
impact of anatomical shunt
A
systemic arterial blood can never have the same partial pressure of oxygen as alveolar gas, gives rise to the normal PAO2
15
Q
natural mechanism of brochodilation
A
neurotransmitter: norepinephrine
16
Q
B2 receptors located
A
airway smooth muscle
vascular smooth muscle
submucosal glands
airway epithelium
17
Q
parasympathetic
A
increase viscosity
thick secretions
18
Q
sympathetic
A
thin, watery secretions
19
Q
Phrenic nerve
A
diaphragm innervated by somatic innervation
20
Q
primary muscles of quiet breathing
A
diaphragm
parasternal intercostals
scalenes
21
Q
assessory muscle of inspiration and expiration
A
scalenes - inspiration
sternomastoids - inspiration
pectoralis major - inspiration
abdominals - expiration
22
Q
thoracic cavity enlargement
A
the downward movement of the diaphragm
23
Q
causes the flattening of the diaphragm
A
if the lungs fail to empty normally during exhalation
24
Q
emphysema
A
High compliance low elasticity low recoil force air trapping pursed lip breathing longer expiratory time
25
pulmonary fibrosis
```
Low compliance
high elasticity
high recoil force
rapid, shallow breathing
shorter expiratory time
```
26
pulmonary surfactant
to prevent lung collapse by lowering the surface tension in the alveoli
27
benefits of surfactant
reduces WOB
reduces the distending pressure required to keep small alveoli open
provides a stabilizing influence alveoli of different sizes
28
Laplaw Law
if the collapsing force of alveolar surface tension is opposed by an equal counter pressure, the alveolus remains in an inflated state
29
Poiseuille Law
16 X more work if the airway diameter is cut in half
30
Auto-PEEP
if the lungs do not have enough time to empty, pressure may still be positive in slowly emptying alveoli and still be positive at the end of expiration when the next inspiration begins, air trapping
31
air-trapping
asthma
emphysema
weak lung recoil force
32
Alveolar Ventilation
TV-(dead space per pound)
ex. TV = 700
weight 200 Lb
= 500
slow deep breathing will improve
33
partial pressure of oxygen in atmosphere
21%
| 149 mmHg
34
alveolar pressure
- inspiration
0 rest
+ expiration
35
hysteresis
lung volume is greater during deflation than inflation
36
time constants
compliance and airway resistance is the time constant expressed in seconds, how rapidly the source pressure and lung pressure equalize
time constant less = less compliant
time constant more = more compliant
37
surface tension
70%
38
normal % of the minute ventilation in dead space
30%-40%
39
pressure
pressure in lungs is above pressure in the atmosphere, this is how we breathe naturally
40
anatomical dead space
150mL
| total volume of the conducting airways from the nose to the terminal bronchioles
41
partial pressure of inspired air
159mmHg
42
partial pressure of conducting airway
149mmHg
43
alveolar air equation
```
PAO2 = (pressure-H2Op) X FiO2 - 40/ 0.8
ex. PAO2 = 760 - 47 X (40) - 0.8
713(.21) - 50
149.73 - 50
=99.73 mmHg
```
44
FICKS LAW
A - surface area
D - diffusion solubility
P1-P2 - diffusion gradient
T - membrane thickness
if membrane thickness increases diffusion through ACM increases
45
DLCOab
diffusion capacity of the lungs for carbon monoxide
normal is 20-30mL/min/mmHg
21
25
46
DLCO
```
What affects it:
body size
age
lung volume
exercise
body position
```
47
oxygen is found
bound to hemoglobin on the erythrocyte
48
oxygen content in blood
Hb carries 20 m/dL of oxygen content = 100mmHg PaO2
Hb concentration of 15 g/dL
49
normal cardiac output
5 L/min
50
oxygen delivery to oxygen consumption
arterial blood deliver 1000 mL/O2/min
tissue consumes 250 mL/O2/min
25%
51
Oxygenated Hb
97% @ 100mmHg
52
mixed venous oxygen saturation
75% @ 40mmHg
53
Hb equillibrium curve
| OHEC
steep 20-60mmHg
small changes in PaO2
flat 60-100mmHg
large changes in PaO2
54
P50 @ 27mmHg
left shift
- lower P50
- lower PCO2
- lower 2,3 DPG
- lower temperature
- higher pH
right shift
- higher P50
- higher PCO2
- higher 2,3 DPG
- higher temperature
- lower pH
55
Hb affinity for oxygen
increase in affinity
- left shift OHEC curve
- decrease P50/PO2
- increase SO2 for every PO2
decrease affinity
- right shift OHEC cruve
- increase P50/PO2
- decrease SO2 for every PO2
56
Bohr effect
the decreased affinity or Hb for oxygen
57
Haldane effect
Hb release of oxygen takes up carbon dioxide
| affinity for carbon dioxide increases
58
widening of (C(a-v)O2)
increase in oxygen extraction, decrease in cardiac output
59
anerobic metabolism
oxidative metabolism in body tissues is the sole source of the blood's CO2
60
DOcrit
blood fails to satisfy the demands of the tissue for oxygen
lactate produced
ion gap increases
low O2 delivery
61
carboxyhemoglobin
carbon monoxide poisoning
62
anemia
low Hb content of 5g/dL
| may not look blue but is hypoxic
63
polycythemia
too much blood volume, thickening of blood, will look blue without being hypoxic
64
treating acute CO2 poisoning
an Fio2 of 1.0 (100%) greatly decreases the half life
| half life = time required to cut COHb blood level in half
65
major forms of carbon dioxide transport
dissolved CO2 = 8%
H2CO3 = 80%
carbamino compounds = 12%
66
reaction between carbon dioxide and H2O
combination
slow reaction in blood plasma
faster reaction in the erythrocyte
67
chloride shift
HCO3 leaves the RBC and leaving the erythrocyte electropositive
68
CO2 transport in blood
HCO3 transports majority of the CO2 in blood
69
ventilation
CO2 is the main stimulus
70
buffers
decrease acidity as it transports CO2
71
10 fold change
a change in 1 pH unit corresponds to a 10 fold change in H+
10X
72
volatile acid
carbonic acid
73
fixed acid - nonvolatile
sulfuric acid
phosphoric acid
lactic acid (anaerobic)
74
20:1
kidneys (20) fixed
| lungs (1) volatile
75
bicarbonate
open system
fixed (nonvolatile)
plasma bicarb
erythrocyte bicarb
76
nonbicarbonate
```
closed system
volatile (carbonic)
fixed
hemoglobin
organic phosphates
inorganic phosphates
plasma protein
```
77
compensations
chronic acidemia
chronic alkalemia
fully compensated - pH normal, HCO3/CO2 not
partially compensated - opposite outside
78
uncompensated
acute acidemia
| acute alkalemia
79
combined
both same outside normal limits
80
metabolic alkalosis
most complicated to treat - electrolyte imbalance
elevated HCO3 may be renal compensation for resp. acidosis
occurs: loss of fixed acid, gain of blood buffer base
```
causes:
vomiting - loss of hydrochloric acid
nasogastric suctioning
hypochloremia
hypokalemia (low K+) weakness
latrogenic - diuretic, low-salt diet (medically induced)
volume depletion - high urine output
```
compensation:
hypoventilation
-anxiety, pain, infection, fever
correction:
restore fluid/ electrolyte imbalance
-KCL infusion
81
Metabolic acidosis
```
occurs:
accumulation of fixed acid in blood
excessive loss of HCO3 in body
-lack of blood flow
---tissue hypoxia, anaerobic metabolism, lactic acid
severe diarrhea
```
anion gap >16
causes:
severe diarrhea
pancreatic fistules
hyperchloremic acidosis
compensation:
hyperventilation
rapid central chemoreceptor response
```
manifestations:
increase in minute ventilation
- complaint of dyspnea
- extreme: stupor/ coma
- hyperpnea
```
Severe:
diabetic ketoacidosis
- kussmaul breathing
--deep/ gasping
82
Anion Gap
plasma electrolyte
determines if metabolic acidosis is caused by gain of fixed acids or loss of base (HCO3)
ignores K+
High anion gap indicates increase in fixed acid
- lactic acid
- ketoacid
- uremic acid
normal anion gap indicates loss of HCO3
83
Respiratory acidosis
hypoventilation
hypercapnea (inadequate ventilation)
```
causes:
COPD (most common)
drug-induced CNS depression
extreme obesity
neurological disorder
```
compensation:
renal (increase in HCO3)
masks the problem by maintaining normal pH
neuromuscular weakness: shallow, rapid, short breath
CNS depression: slow, shallow, possibly apnea
```
increase in PaCO2:
increase ICP
myoclonus
asterixis
mental confusion
```
abrupt increase of PaCO2 70mmHg = coma
COPD / chronic hypercapnia can tolerate higher CO2 levels
```
correction:
restore ventilation
-secretion mobilization
-bronchodilator drugs
-endotracheal intubation
-mechanical ventilation
```
84
respiratory alkalosis
hyperventilation
decreased PaCO2/ hypocapnia
```
causes:
hypoxia
pulmonary disease
- pneumonia
- edema
CNS disease
high altitude
acute asthma
general anxiety
fever
latrogenically - agressive ventilation (medically induced)
```
anxiety:
panic - vision impaired / speaking difficulty
- rebreather therapy
correction:
remove stimulus causes hyperventilation
- hypoxia O2 therapy
compensation:
slow renal excretion of HCO3
85
rise in HCO3
every 10mmHg rise = 1 mEq/L rise in HCO3
| ex. 40mmHg rises to 70mmHg = increase in 3 mEq/L
86
lab value to indicate tissue hypoxia
lactic acid
87
chronic hypoxemia
increase cardiac output
increase RBC
increase tissue perfusion
88
hypoxic hypoxia
```
increase in PAO2
hypoventilation
shunt
V/Q mismatch
aim to ventilate alveoli
reduces O2 delivery to tissue
```
89
Anemic hypoxia
low Hb concentration
Hb not binding chemically to oxygen
CO poisoning
-reduce O2 delivery to tissue
90
stagnant hypoxia
```
low blood flow, low BP
lung function can be normal
low oxygen delivery rate
-shock
low blood volume
-hemorrhage
-severe dehydration
O2 therapy cardiac arrest = restore blood flow
```
91
histotoxic hypoxia
```
blocked oxidative metabolism
-cyanide poisoning
-smoke inhalation
100% oxygen inhaled
*methemoglobin
```
92
physiological shunt
in bronchial vasculature
bronchial blood flow is only 1%-2% of the cardiac output
93
catheter flow
right atrium (CVP) 2-4
Right ventricle S/D
Pulmonary artery 25/8 systole
PCWP 4-12
94
thermodilution
most useful in evaluating cardiac output
95
what substances are eliminated by the kidneys
```
urea
creatine
uric acid
bilirubin
various toxins
foreign substances
metabolites of assorted hormones
```
96
what structures compose the nephron
```
bowmans capsule
proximal convoluted tubule
loop of henle (ascending, discending)
distal convoluted tubule
collecting duct
```
97
what substance is secreted at the juxatoglomerular apparatus when systemic blood pressure decreases
renin, an enzyme that activates angiostensin, which leads to widespread system arteriole constriction
98
what substances, when excessive, does the nephron clear from the plasma
sodium
potassium
chloride
99
how much of the glomerular filtrate is reabsorbed into the blood
99%
100
gloerular filtrate is the same as plasma except it does not contain what substances
proteins
101
what substances are almost totally reabsorbed from the tubules
sodium
potassium
chloride
bicarbonate
102
what is the most important autoregulatory mechanism of renal blood flow
afferent vasodilator mechanism
103
what part of the nephron is highly impermeable of water
thick portion of the loop of henle
104
assending loop of henle
thin
105
descending loop of henle
thick
106
the hormones inhibit the effects of aldosterone
renin secretion results in angiotensin II formation, which causes the cortex of the adrenal gland to secrete aldosterone -> ANH & BNP -> inhibit aldosterone (promote loss of Na+ in urine
107
what type of urine is excreted by the kidneys, under the influence of ADH
low volume
| high concentration
108
what is the best clinical indicator of perfusion adequacy
urine output
109
osmotic diuretic
mannitol - proximal tubules, elevates osmotic pressure of the filtrate, keeping water inside the tubules to be excreted as urine, decreases ICP in cerebral edema by decreasing brain swelling and ICP
diuretic
110
loop diuretic
furosemide
-lasix
toresimide
-dernadex
ethacynic
-edearin
block Cl- and Na- out of ascending henle loop to promote diuresis (K+ loss)
useful in treating edema related to CHF and can increase urine output by 25Xs
111
diuretic that is effective in treating edema of CHF
loop diuretic
112
categories of acute renal failure
decreased blood supply
- heart failure, hemorrhage
intrarenal failure
- abnormalities within kidney
postrenal failure
- obstruction of urine outflow
113
increased BUN, creatinine, sodium, potassium, fixed acids
renal failure
| metabolic acidosis
114
pulmonary manifestation of nephortic syndrome
interstitial edema
pleural effusion
pericardial effusion
ascites
115
characteristics of goodpasture syndrome
autoimmune disease
hemoptysis
hematuria
targets kidney and lung alveoli
116
normal range for BUN
8-20 mg/dL
117
normal range for creatine
0.6-1.2 mg/dL
118
diseases associated with increased blood creatinine
kidney and muscle disease
| renal failure
119
when BUN and creatinine are elevated in renal failure which acid-base disturbance
metabolic acidosis
120
why is a patient gaining weight on mechanical ventilation
fluid retention
121
causes of pulmonary edema
```
increased hydrostatic pressure
-left ventricular failure (CHF)
-hypervolemia
-mitral stenosis
increased capillary membrane
decreased plasma oncotic pressure
insufficent lymphatic drainage
```
122
edema associated with high PCWP
cardiogenic pulmonary edema
123
major effect of V/Q mismatch
hypoxemia
124
chronic hypercapnia
V/Q mismatch
125
P(a-A)O2 when 100% oxygen is breathed
50-60mmHg
when breathing room aire
7-14mmHg
126
conditions associated with dead space
pulmonary embolism
severe hypotension
alveolar overdistension
Auto-PEEP
127
PaO2/PAO2
most reliable indicator of shunt in stable conditions
128
Qt/Qs
most reliable indicator of shunt in unstable conditions
129
Thiazides
chlorothiazide
inhibit reabsorption of Na+
mild
blood pressure control
130
effects if acute renal failure
- decreased blood supply, heart failure or hemmorrhage
- intrarenal failure, or abnormalities with the kidneys
- postrenal failure, obstruction of urine outflow from the kidneys
131
chronic renal failure
decrease of number of functional nephrons
pyelonephritis - bacteria causes
arteriosclerotic - decreases renal blood flow and ichemiac nephrons
132
physiological effects of chronic renal failure
general edema, salt and water retention
nephrotic syndrome
goodposture syndrome
metabolic acidosis because the kidneys cant excrete fixed acids
high blood concentrations of nitrogenous compounds like urea, creatine, and uric acid (uremia), phenols, sulfates, phosphates, potassium.
azotemia
patients may progress to a confused mental state that can progress to uremic coma (acidosis)
133
renal clearance blood tests
BUN - blood urea nitrogen
pyelogram
creatinine
134
PMI
point of maximal impact
fifth intercostal space and midclavicular line
repeated impact of heart beat on chest wall
135
sympathetic receptors are mainly
(adrenergic) B1 - they increase myocardial force of contraction and heart rate
136
parasympathetic receptors are mainly
(cholinergic) alpha 1 - they slow heart rate
137
drugs that block Ca++
decrease heart force of contraction
138
clinical indicator of heart attack
troponin 1
139
all or none principle
if one fiber of the syncytium contract then all fibers contract
140
Frank-Starling
the greater the diastolic volume of the heart the greater the force of contraction - increase in sarcomere length
141
when does most of blood perfusion happen
during diastole
142
preload
the precontraction length of the sarcomere
| if preload is good you will contract well
143
overdistended heart stretched
CHF
144
cardiac cycle
0.8 seconds
145
atrial kick
20%
80% passive
146
decrease heart rate
vagal stimulation
147
normal pulse pressure
40 mmHg
148
venous
veins are 64% of total blood volume
149
venous return
- cardiac pumping of large leg muscles
- sympathetic venous contraction
- cardiac pumping action
- thoracic pump
150
blood flow is determined by
- driving pressure
| - vascular resistance
151
mean blood pressure
stroke volume
arterial compliance
arterial resistance
152
High BP
systolic over 135
| diastole over 90
153
detrimental effects of high BP
- high workload on heart, leading to heart failure
| - rupture of blood vessel in brain, stroke, CVA
154
venous blood flow (CVP) increases if
- increased blood volume
- venous tone increases
- arteriolar dilation occurs
155
normal RAP
0-5 mmHg
156
peripheral edema
RAP increases above 6 mmHg and effects PVP
```
JVD
hepatomegaly
ascites
pedal edema
anasarca
enlarged spleen
```
157
adenosine
most important local vasodilator
158
cycling
vasomotion
159
oxygen demand theory
lack of oxygen dilates precapillary sphincters and arterioles, blood flow increases
160
central control
autonomic system
sympathetic division
vasoconstriction/ vasodilation - depends on adrenergic receptors
161
B2
vasodilation
162
A
vasoconstriction
163
baroreceptors
responsive to stretch
when stretched by high BP they send impulses to the glossopharyngeal and vagus nerve and causes vasodilation and slows the heart rate, low BP
164
RAAS
controls low BP
| holds onto fluid and stimulates renin from kidneys
165
renin produces
angiotensin 1
166
angiotensin 1
produces ACE
167
ACE produces
aldosterone
168
aldosterone
causes kidneys to reabsorb water and sodium
169
ADH
low BP
holds onto water / fluid
raises BP
170
BNP
response to high BP
BNP inhibits aldosterone and RAAR secretion
promotes sodium loss and decreases BP
171
diagnostic marker for heart failure
BNP
helps differentiate between cardiac and pulmonary causes of dyspnea
172
P WAVE
arterial depolarization
| positive
173
PR interval
AV node to bundle of His
0.12-0.20
isoelectric
174
QRS
ventricular depolarization
| less than 0.10
175
ST segment
depressed >0.5mm = myocardial ischemia
elevated >2mm = myocardial injury
176
MCV
60 degrees
normal axis 0-90 degrees
normal range -30 - 120 degrees
177
MCV deviations
change in heart position
hypertrophy in one ventricle
myocardial infarction
bundle branch conduction block
178
right axis deviation
COPD
| cor pulmonale
179
left axis deviation
CHF
180
reading heart rate on ECG
```
# of large squares between 2 QRS intervals
divide number of squares by 300
```
181
12 lead ECG
bipolar limb leads - anterior / posterior view
uniploar limb leads - anterior / posterior view
chest leads - horizontal / sagittal view
182
bipolar limb leads
lead 1 right arm to left arm
lead 2 right arm to left leg
lead 3 left arm to left leg
183
unipolar limb leads
aVr right arm
aVL left arm
aVf left leg/ foot
184
extreme right axis deviation
lead 1 negative
| aVf negative
185
aVf
90 degrees
186
right axis deviation
lead 1 negative
| aVf postive
187
left axis deviation
lead 1 positive
| aVf negative
188
normal
lead 1 positive
| aVf positive
189
V1
fourth intercostal , right of sternum
190
V2
fourth intercostal, left of sternum
191
V4
fifth intercostal, midclavicular
192
V3
between V2, V4 centered
193
V5
fifth intercostal
194
V6
fifth intercostal, midaxillary
195
high amplitude P WAVE
enlarged atrium
pulmonary valve stenosis
cor pulmonale
COPD
196
O2 content of 100mL of apical blood
20.5 mL
PO2 130 mmHg @ 100%
197
O2 content of 100mL of basal blood
19.1
PO2 85 mmHg @ 94%
198
absolute shunt
40 mmHg PAO2
45 mmHg PACO2
Low V/Q
zone 3 basal
199
normal
PAO2 80-100 mmHg
PACO2 35-45 mmHg
V/Q 1:1
zone 2
200
absolute dead space
PAO2 150 mmHg
PACO2 0
High V/Q
zone 1
201
MAP
110 mmHg
202
intrapulmonary/ physiological shunt
pneumonia
pneumothorax
pulmonary edema
bronchial occlusion
203
hallmark of intrapulmonary shunt
refractory hypoxemia
204
shunted blood
can not take up oxygen or release carbon dioxide
205
supraventricular (atrial) (base) arrythmias
sinus tachycardia
atrial fibrillation
atrial flutter
PAC
206
ventricular arrythmias
ventricular tachycardia
torsades de pointes
ventricular fibrillation
PVC
207
Brady arrythmias
sinus bradycardia
| 1,2,3 degree block
208
Tachycardia
HR >100
```
Causes:
exercise
fever
anxiety
pain
smoking
b-anergenic drugs
hypoxia
anemia
shock
```
treatment:
b-blocker drugs
vagal stimulation (decrease HR)
209
bradycardia
HR < 60
causes:
normal in physically fit, or sleeping individuals
vagal stimulation
- pharynx , trachea instrumentation
```
symptoms:
hypotension
weakness
sweating
synscope
```
treatment:
atropine
pacemaker
210
abnormal sinus arrythmia
bradycardia - expiration
tachycardia - inspiration
no treatment
non pathological
211
1st degree AV block
conduction time is slow
| PR interval >0.2 seconds
212
2nd degree AV block
MOBITZ 1 - treated with drugs
| MOBITZ 2 - pacemaker
213
3rd degree AV block
pacemaker 15 bpm
stokes adams syndrome
- heart block, fainting, loss of consciousness
214
PAC
compensatory pause
PWAVE close to SA +
PWAVE close to AV -
```
causes:
stress
alcohol
tobacco
electrolyte imbalance
sympathetic stimulation
```
treatment:
quinidine
verapamil
215
Atrial conditions
CHF
mitral valve stenosis
pulmonary vascular resistance
216
atrial fibrillation
300-600 bpm
loss of atrial kick 20%
fine F waves
```
causes:
increased atrial pressure
enlarged atrium
thromboembolism
longer depolarization time
```
treatment:
anticoagulant (do first)
Ca++ blocker
electrical cardioversion
217
T wave
vetricular repolarization
218
QT interval
<0.40 seconds
219
atrial flutter
F waves saw toothed
200-350 bpm
```
symptoms:
palpitations
nervousness
anxiety
synscope
```
treatment:
Ca++ blocker
electrical cardioversion
220
PVC
>0.12 seconds and bizzare
single life threatening arrhythmia
```
causes:
stress
tobacco
caffeine
sympathetic stimulation
```
```
diseases:
hypoxia
acidosis
hypokalemia
myocardial irritability
MULTI focal
```
treatment:
lidocaine
amiodarone
221
VT
runs of PVC
110-250 bpm
may not feel a pulse - pulse deficit
treat as emergency can progress to VF
treatment:
lidocaine
amiodarone
electrical cardioversion
222
torsades de pointes " twisting of the points "
```
causes:
electrolyte imbalance
antiarrhythmic drugs
low Ca++
Low Mg++
```
223
VF
most lethal
cardiac arrest
code blue
no drugs can treat
circus reentry mechanism
shock
CPR
224
junctional escape rhythm
if the SA node fails to generate impulses the AV junction may assume the role of the pacemaker
225
DRG
inspiratory neurons
| primary stimulus for inspiration
226
VRG
expiratory
227
inspiration ramp signal
neurons that switch off
- pneumotaxic center
- pulmonary stretch receptors
228
apneustic breathing
prolonged inspiratory gasps interrupted by occasional expirations
damage to pons
229
pneumotaxic center
controls the length of inspiration
230
hering-breurer deflation reflex
hyperpnea
| increase RR
231
hering-breurer inflation relflex
slowing adapting receptors
stretch receptors
stops further inspiration when stretched
activated by large tidal volumes of 800-1000mL
232
heads paradoxical reflex
rapidly adapting receptors
maintains large tidal volume during exercise
prevents atelectasis
first breath of newborn
**periodic deep sighs during quiet breathing
233
rapidly adapting irritant receptors
```
vagocagel reflex
- ETT
- airway suctioning
- bronchoscopy
inhaled irritants
```
234
sensory reflex
laryngospasm
bronchospasm
coughing
decrease HR
235
motor reflex
```
bronchoconstriction
coughing
sneezing
tachypnea
narrow glottis
```
236
central chemoreceptors
repsonds to H+
arrises from the reaction between dissolved CO2 and H2O in the CSF
CO2 diffuses from blood brain barrier to CSF to form H+
237
CO2 diffusion
ventilation increases 2-3L/min for every mmHg in PaCO2 rise
238
maximal hyperventilation
PaO2 can not rise over 130 mmHg
239
peripheral chemoreceptors
20%-30% of ventilation responds to PaCO2 rise 5X quicker than central
240
carotid bodies
exert much more influence over the respiratory center than aortic - high blood flow rate
glossopharyngeal - carotid
vagus - aortic
241
hypoxia
doesnt stimulate ventilation until PaO2 decreases less than 60 mmHg or less
242
normal ICP
<10mmHg
243
normal CBF`
60 mmHg
244
exercise
onset
period of adjustment
steady state
245
J receptors
rapid-slow breathing , sensation of dyspnea
246
cheyne-stokes
increase RR and volume by gradual decrease in RR to complete apnea
CHF
247
biot
RR and tidal volume increase with volume at the same depth
lesions of the PONS
248
central reflex hypernea
continuous deep breathing
249
central reflex hypopnea
respiratory centers do not respond to appropriate ventilation stimuli such as CO2 - hypoventilation
brain trauma
narcotic depression
