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Welcome to the MCCC Respiratory Therapy Program

Please…
find your name on the roster and sign next to it *if your preferred name if different than name listed please amend the sheet*
Pick up the packets placed on the front table
Place your pagers and cell phones to silent or power them down
We will begin class when everyone is present or 9:05 whichever comes first.

RTH 100:
Respiratory Care Techniques 1

Meeting times:

M & F 10:15-11:55; T 10:30-12:10

Place: Room H157

Instructor: Helen Stripling, BFA, RRT, RRT-ACCS

First day things…

Introductions (Ummm let’s save for Friday!)
Attendance
Paperwork
The syllabus
Course Structure
Expectations

Introduction & Who am I??

Please tell us about yourself!
Name, Pets, Academic history, Favorite Pokestop, Children, Significant other, Your sports team, Your driver, Your golfer, Your skater, If you’re new to MCCC, whatever you’d like to share.

Why did you choose to become a Respiratory Therapist or why did it choose you?

About the program…

Repetition –
Concepts will be often be introduced simultaneously. Concepts will be repeated in multiple courses.
Graphics have been developed over the 30 yrs the program has been around and are used in multiple places
Reality and Theory
This course and other courses in the program will describe the consensus view and approach to Respiratory Therapy as outlined by the NBRC (National Board of Respiratory Care).
Your hospital may adopt different models and procedures. Clinical classes will help differentiate these.

About the program…

Language

Words (terminology, synonyms, homonyms, unpronouncable-onyms)

Symbols

About the program…

Numbers

Averages

Rounding

Formulas, Oh My!

Endless barrage of them

The Syllabus

RTH 100 - Respiratory Care Techniques I

Instructor: Helen Stripling

UNIT 1 - CARDIOPULMONARY

ANATOMY and PHYSIOLOGY

I. Life

A. Good Air In & Bad Air Out

RTH 100 - Respiratory Care Techniques I

Instructor: Helen Stripling

UNIT 1 - CARDIOPULMONARY

ANATOMY and PHYSIOLOGY

I. Life

A. Good Air In & Bad Air Out

1. How Did I Get Here?

SINGLE CELL

MULTICELLULAR, SOLID BODY

SPONGES

TUBULARS: WORMS, SEA CUCUMBERS

ALL VERTEBRATES EXCEPT FISH*

UNIT 1 - CARDIOPULMONARY

ANATOMY and PHYSIOLOGY

I. Life

A. Good Air In & Bad Air Out

1. How Did I Get Here?

2. Birds do it, plants do it,
Pseudomonas aeruginosa do it

Inside ALL human cells:

sugar

oxygen

metabolism

usable body energy

waste products

3. Unless you’re a real low-life (viral level),

a. oxygen (O2) must reach all body cells

b. multicellular creatures, have some kind of body parts that increases body contact with O2, such as gills or lungs

c. if you’re a larger multicellular animal, then you have a special system to pick up O2 at the gills or lungs and rapidly carry the O2 to constantly hungry cells waiting in distant parts of the body; this is the function of the heart and blood

4. Major steps in getting O2 to body cells for all air breathing animals:

cellular

capillary

blood

left

heart

alveolar

capillary

blood

diffusion1

blood transport

diffusion2

ventilation

atmosphere

alveoli

cells

4. Major steps in getting O2 to body cells for all air breathing animals:

a. ventilation from atmosphere to deep inside lungs (pulmonary - mechanical)

b. diffusion from lung gas spaces to blood (pulmonary - passive)

c. blood transport from lungs to cells (cardiovascular - mechanical)

d. diffusion from blood to body cells (vascular - passive)

diffusion1

blood transport

diffusion2

ventilation

cellular

capillary

blood

left

heart

alveolar

capillary

blood

atmosphere

alveoli

cells

B. The Bad Air

2. As long as cells are alive, carbon dioxide (bad air) is being produced.

a. bodies have adapted to tolerate a certain amount of carbon dioxide (CO2)

b. excess CO2 has toxic body effects

c. if you’re a larger multicellular animal, then you have a special system to pick up CO2 from generating cells and rapidly carry the CO2 to distant gills or lungs; this is the function of the heart and blood

H2O & CO2

1. Inside ALL human cells:

sugar

oxygen

metabolism

usable body energy

3. Major steps in getting rid of CO2 created in all body cells by air breathing animals:

diffusion1

blood

transport

diffusion2

ventilation

(dilution)

alveolar right cellular

atmosphere  alveoli  capillary  heart  capillary  cells

blood blood

a. diffusion from body cells to blood (vascular - passive)

b. blood transport from cells to lungs (cardiovascular - mechanical)

c. diffusion from blood to gas space (pulmonary - passive)

d. ventilation from lungs to atmosphere (pulmonary - mechanical)

3. Major steps in getting rid of CO2 created in all body cells by air breathing animals:

diffusion

blood

transport

diffusion

ventilation

(dilution)

alveolar right cellular

atmosphere  alveoli  capillary  heart  capillary  cells

blood blood

C. Impairment of getting the good air in and the bad air out leads to morbidity

D. Failure to get the good air in and the bad air out leads to mortality

E. It’s taken either over 3,000,000,000 years of evolution and/or your own personal god to come up with our present precise, dependable, self-regulating breathing system.

Morbidity – the rate of incidence of disease

Mortality – the rate of failure or lose (death)

II. Pulmonary Anatomy - Upper Airways (a/w)

A. functions

1. gas conduction

2. protection of lower a/w

3. air conditioning

4. miscellaneous including smell and speech

B. structures related to functions

1. gas conduction

Oral Cavity - is also known as the mouth which swallows food and drinks that then go down the esophagus and into the stomach.

2) mouth

1) nare

Upper Airways: Function 1 - Gas Conduction

3) glottis

(separates upper and lower airways)

a. Entrances/Exits

Glottis – the space between the true vocal cords (in the adult – the narrowest point in the larynx.) In the infant, the cricoid cartilage is the narrowest point.

Glottic and subglottic swelling (edema) secondary to viral or bacterial infections are commonly seen in infants and young children and this is known as “croup” or laryngotracheobronchitis and acute epiglottitis. This is characterized by a high pitched crowing sound called stridor during inspiration.

1) choana

2) nasal cavity

Upper Airways: Function 1 - Gas Conduction

3) nasopharynx

b. nasal conduction passages

*Also note:

nasal septum

Choanae - The passageway from the back of one side of the nose to the throat. There are two choanae, one on either side of the nose. The choanae must be open to permit breathing through the nose. The passageway from the back of one side of the nose to the throat. There are two choanae, one on either side of the nose. The choanae must be open to permit breathing through the nose.

Nasal Cavity - is a large air filled space above and behind the nose in the middle of the face.

Nasopharynx– located between the posterior portion of the nasal cavity and the superior portion of the soft palate.

Upper Airways: Function 1 - Gas Conduction

4) eustachian tube opening

b. nasal conduction passages

The eustachian tube connects the middle ear to the throat

Its purpose is to equalize middle ear pressure with environmental pressure. When your ear "pops" on a high-speed elevator or in an airplane, the reason is that the eustachian tube has opened and equalized pressure.

Upper Airways: Function 1 - Gas Conduction

c. oral cavity

Oral Cavity - is also known as the mouth which swallows food and drinks that then go down the esophagus and into the stomach.

Upper Airways: Function 1 - Gas Conduction

1) oropharynx

2) laryngopharynx

d. passageways common to nose and mouth

Oropharynx – lies between soft palate superiorly and the base of the tongue inferiorly

Laryngopharynx – also called the hypopharynx lies between the base of the tongue and the entrance of the esophagus

a) hyoid bone

3) Larynx

Upper Airways: Function 1 - Gas Conduction

d. passageways common to nose and mouth

a) hyoid bone

b) thyroid cartilage

c) cricoid cartilage

(cricoid ring)

d) cricothyroid
membrane

3) Larynx

Upper Airways: Function 1 - Gas Conduction

d. passageways common to nose and mouth

Upper Airways: Function 1 - Gas Conduction

laryngopharynx

a.k.a.

hypo-pharynx.

e. features of the oro- and laryngopharynx

1) tongue

2) epiglottis

3) glottis

a) cuneiform cartilage

b) corniculate cartilage

4) vocal cords

6) esophagus

5) intubation landmarks

Layers of cartilage within the larynx

neutral position

Upper Airways: Function 1 - Gas Conduction

f. effects 2° to neck flexion/extension

hyperflexed position

Try it out

Upper Airways: Function 1 - Gas Conduction

f. effects 2° to neck flexion/extension

Here the neck is back to the neutral position

Upper Airways: Function 1 - Gas Conduction

f. effects 2° to neck flexion/extension

hyperextended position.

intubation!

Useful in the supine position for

Upper Airways: Function 1 - Gas Conduction

f. effects 2° to neck flexion/extension

Upper Airways: Function 2 - Protection of Lower Airways

1) mouth

2) soft palate, uvula,
& nasopharynx

3) tongue/oropharynx

4) epiglottis

5) glottis

a. Doorways to the Lower Airways

(things that open & close)

The uvula plays a key role in the articulation of the sound of the human voice to form the sounds of speech

Upper Airways: Function 2 - Protection of Lower Airways

1) vibrissae

(filtration)

3) conchae

2) sinuses:

make mucus for nasal cavity

4) ciliated epithelium

b. defense components of the nose

a. conchae: also know as
turbinates

b. designed to create turbulent gas flow.

c. turbulence (swirling of gases) ↑ air/ mucosal epithelium contact → gas:

Upper Airways: Function 3 - Air Conditioning

1) warming

2) humidification

olfactory cells in
superior turbinates

Upper Airways: Function 4 - Air Related Miscellaneous

a. Smell

1) glottis

organic noise maker

2) oral cavity, tongue, lips, oropharynx

phoneme formation (sounds, words)

3) nasal cavity:

sound resonator

b. Speech

III. Pulmonary Anatomy - Lower Airways

A. lower airways defined:

below glottis through terminal bronchioles;

a.k.a…

trachea

R & L mainstem bronchi

lobar “ ”

segmental “ ”

subsegmental “ ”

transitional “ ” through

terminal bronchioles

B. Tracheobronchial Tree Divisions & Generation Numbers

respiratory bronchioles
(partially alveolated)

respiratory bronchioles
(totally alveolated)

alveolar ducts  alveolar sacs

Pg. 24 in Des Jardins has the best layout to follow in regards to the generation numbers…..

C. Components & Classification of Lower Airways

1. cartilaginous airways

a. trachea

b. mainstem bronchi

c. lobar bronchi

trachea

1) physical features

a) beginning point of tracheobronchial tree, therefore

generation 0

b) ave. length 11 - 13 cm

c) ave. diameter 1.5 - 2.5 cm

d) 16-20 “C” shaped cartilages

e) running adjacent to the esophagus,

posterior wall is trachealis muscle

a. trachea

f) carina

1] trachea’s distal end

2] bifurcates to R & L mainstem bronchi

3] rich in cough causing tactile irritant receptors

a. trachea

Cross-Section

connective tissue sheath

cartilage

trachealis muscle

epithelium

blood vessels

parasympathetic nerves

submucosal glands

elastic fibers

b. mainstem bronchi

1) right mainstem bronchus

a) wide & short

b) approx. 25°deflection

c) appears to be extension of trachea

d) most common site of accidental mainstem intubation

2) left mainstem bronchus

a) compared to right, long & narrow

b) angle from vertical is 40-60°

3) enter lung as part of R & L hilum

generation 1; branches to each lung; below angle of Louis
has trachea-like cartilage “C” rings,
but less prominent

Demonstrate how to feel for angle of Louis

C. components and classifications of lower airways

1. cartilaginous airways

a. trachea

b. mainstem bronchi

c. large and medium bronchi: these & all airways > 2 mm ID are the

central airways

1) lobar gen. 2; feed 5 separated lobes

2) segmental gen. 3

3) subsegmental gen. 4-10; smallest a/w c̃ connective tissue sheath

2. non-cartilaginous (small) airways

a. bronchioles

- gen. 11-13;

- < 1 mm dia;

- Ø cartilaginous support
& presence of relatively thick smooth muscle

b. terminal bronchioles

- gen. 14;

- last conducting airways;

- cilia & mucus glands gradually disappear;

- location of interbronchiolar

“Canals of Lambert.”

D. tracheobronchial tree components function primarily for gas conduction

E. Airway Diameter vs. Total Cross-sectional Area

1. airway path diameters individually continually narrow

tending to cause increased airway resistance ( RAW)

trachea diameter

bronchiole diameter

E. Airway Diameter vs. Total Cross-sectional Area

2. total airway path cross-sectional area (CSA) at more and more
distal generation levels shows functional a/w diameter ↑’s tending to cause decreased airway resistance ( RAW)

3. design provides

a. adequate number of gas-flow pathways to > 300 million alveoli while

b. minimizing RAW and work of breathing.

total CSA at bronchiole generation

trachea diameter

a. cellular components

1) submucosal glands produce thick mucus of the surface gel layer

2) goblet cells produce thin fluid of the sol layer bathing the cilia

3) ciliated epithelium beating moves gel layer towards glottis

4) basal cells can differentiate into either #2 or #3

F. histology of the tracheobronchial tree’s 3 possible layers

1. outer layer is the cartilaginous layer

2. middle layer is the lamina propria;

contains blood & lymph vessels, vagal nerves, and smooth muscle

3. inner layer is the respiratory mucosal epithelium

Histology of the tracheobronchial tree

Perspective 1

Histology of the tracheobronchial tree

Perspective 2

Histology of the tracheobronchial tree - Perspective 3

b. the above components plus mucus comprise the mucociliary escalator

1) sol-gel layer is 95% water c̅ small amounts of
glycoproteins and carbohydrates

2) normal adult mucus production ≈ 100 mL/day

irritation of airways  big  in mucus production

3) moves toward glottis at about 2 cm/min

normal mucus functions as part of a pulmonary defense mechanism

a) traps dust, bacteria, pollen, etc.

contains macrophages and neutralizing antibodies

c) transports foreign particles out of the lung

b. the above components plus mucus comprise the mucociliary escalator

5) in more distal airways, there’s progressively fewer goblet cells & mucus glands

6) pulmonary mucus, along with nasal secretions and oral saliva, is part of sputum

7) normal function most commonly reduced by

a) cigarette smoke

b) dehydration

IV. Lung Blood Supplies

A. pulmonary circulation: blood going to the alveoli for gas exchange (to be discussed later)

B. bronchial circulation

1. "bronchial" vs. "bronchiole"

nourishes tracheobronchial tree tissues (glucose, amino acids and

O2)

IV. Lung Blood Supplies

V. Pulmonary Anatomy - Lung parenchyma

A. parenchyma: the functional units of an organ

B. the major function of the lungs is gas exchange: O2 and CO2 between body and atmosphere

C. alveolar sacs – a destination for/origin of gases; not an airway, where gas exchange occurs

D. the basic pulmonary parenchymal unit is the primary lobule

1. primary lobule

a. consists of a single respiratory bronchiole, its alveolar ducts, and alveoli

b. respiratory bronchioles are essentially a terminal bronchiole that has some alveoli

c. primary function is gas exchange

d. respiratory bronchioles are gen. 15-18

alveolar ducts are gen. 19-23
alveolar sacs are gen. 24
no ciliated epithelium

2. secondary lobule

a. a single terminal bronchiole and attached respiratory bronchioles (3-5)

b. encased in a thin connective tissue sheath

c. smallest lung unit visible on CXR (1 cm rosette pattern)

3. alveolar epithelium

capillaries

pore of Kohn

Type I

Type II

Type III

a. alveolar type I

1) squamous pneumocytes

2) for alveolar surface area, make up 95%

3) major site of gas exchage

4) sites of pores of Kohn, inter-alveolar communications channels

b. alveolar type II

1) cuboidal pneumocytes

2) only 5% of alveolar surface area, but number > type I pneumocytes

3) produce pulmonary surface active materials (SAM) or surfactant

3. alveolar epithelium

capillaries

pore of Kohn

Type I

Type II

Type III

c. alveolar type III

1) alveolar macrophages

2) highly phagocytic

d. alveolar fluid lining

1) primarily water

2) includes phospholipid SAM to reduce surface tension

3) very permeable to all gases

4) produced primarily by type II pneumocytes and moves out of alveolated areas
to merge with mucous blanket

4. alveolar capillaries

a. blood vessels whose walls are only 1 cell thick

b. walls consist of squamous pulmonary capillary endothelial cells

c. interconnected capillaries nearly cover all

1) alveolar surface areas

2) alveolar septal walls

d. resting diameter slightly smaller than maximum RBC diameter

frog

capillaries

5. alveolar-capillary membrane

a. alveolar fluid lining

b. alv. epithelium

c. alv. basement membrane

d. pulmonary interstitial space

e. pulm. capillary basement membrane

f. pulm. Cap. endothelium

6. pulmonary interstitium

a. space between alv. epithelium and cap. endothelium (the “thick” space)

b. in this space may be found

1) water

2) electrolytes: Na+, K+, Cl¯

3) elastic elements: collagen and elastin

4) nerve fibers

5) lymphatic capillaries

7. lymphatics

a. lymphatic capillaries open ended (like vacuum hose)

b. lymph nodes produce lymphocytes; filter lymphatic fluid

c. thoracic duct major lymph vessel emptying lymphatic fluid into L subclavian vein

Butterfly Pattern

A. Major lung divisions

1. lungs: 2 (right & left)

2. lobes: 5 - 3 R + 2 L

3. segments: 18 -10 R + 8 L

V. Intrathoracic Structures

B. Lungs, Lobes, & Fissures

RUL

RML

RLL

LLL

LUL

Oblique Fissures

Transverse or

Horizontal Fissure

Cardiac Notch

Left

Lingular

area

of the

LUL

B. Lungs, Lobes, & Fissures

RUL

RML

RLL

LLL

LUL

Oblique Fissures

Transverse or

Horizontal Fissure

Cardiac Notch

Left

Lingular

area

of the

LUL

1. pulmonary lobes defined

a. largest sub-division of lung

b. each surrounded by own visceral pleura

1) isolates some diseases, such as

pneumococcal pneumonia

2) creates fissures between lobes; fissures aren’t normally visible on CXR, but with disease

fluid can accumulate & show on CXR

B. Lungs, Lobes, & Fissures

1. pulmonary lobes defined

a. largest sub-division of lung

b. each surrounded by own visceral pleura

1) isolates some diseases, such as

pneumococcal pneumonia

2) creates fissures between lobes; fissures aren’t normally visible on CXR, but with disease

fluid can accumulate & show on CXR

c. each lobe has its own paired

bronchus, artery, & vein

B. Lungs, Lobes, & Fissures

slightly shorter than L (rests over liver)

a. upper lobe (RUL)

- apex is up to 1-2" above clavicle

- anterior, inferior border 4th rib (horiz. fissure)

- posterior, inferior border mid-scapula

b. middle lobe (RML)

- sup. border 4th rib (horz. fissure)

- inferior border: 6th rib

c. lower lobe (RLL)

- inferior to oblique fissure

2. R lung

a. upper lobe (LUL) including the lingular area

- apex up to 1-2" above clavicle

- anterior, inferior border: 6th rib

- includes lingular (LLing) area (analog to RML)

- includes cardiac notch (PMI) medial @ 4-6th ribs

lower lobe (LLL) mirror of RLL

4. mainstem bronchi, blood & lymph vessels, and nerves, enter/exit each lung at the hilum

3. L lung

R & L Hilum on CXR

Segments

1. apical

2. posterior

3. anterior

4. lateral

5. medial

6. superior

8. anterior
basal

9. lateral
basal

10. posterior
basal

7. medial
basal

11. apicoposterior

12. anterior

13. superior

14. inferior

16. anteromedial
basal

17. lateral
basal

18. posterior
basal

15. superior

4. Segments

1. cavity between right lung, left lung, sternum, & thoracic vertebrae

2. contents: all or part of the following

a. esophagus

b. trachea

c. the great vessels (vena cava & aorta)

d. nerve trunks

e. thymus gland

f. lymph nodes

3. can sometimes be the site of trapped air, this condition is called a pneumomediastinum

C. Mediastinum

1. inside of chest wall is lined with parietal pleural tissue

2. outside of lung lobes are lined with visceral pleural tissue

3. the “potential space” between these two membranes is called the pleural space.

4. normally the pleural space contains a very small amount of lubricating pleural fluid.

5. trauma can lead to introduction and trapping of air or blood in this space (pneumothorax, hemothorax) which can result in

compression of the lungs

D. Pleural Membranes

rib

visceral pleura

parietal pleura

pleural space

lung

A. Bony Thorax - The Walls of a Closed Container

1. sternum - 3 components

a) manubrium

b) sternal body

c) xiphoid process

manubrium

VI. Thoracic Anatomy

clavicle

sternal body

xiphoid process

angle of Louis

(supra) manubrial notch

2. ribs

costal angle

costal margin

a) true ribs

1) 1st rib: attaches to manubrium

2) ribs 2-7: attachment is vertebrosternal

b) false ribs ribs 8-10 attachment is vertebrochondral

c) floating ribs ribs 11-12: attachment is only vertebral

d) sternal angle attachment is rib 2 (I.e., at Angle of Louis)

Boney Thorax

e) intercostal arteries, veins, and nerves are located in a groove at

2. ribs

a) true ribs

b) false ribs

c) floating ribs

d) Angle of Louis

the bottom of each rib.

vein

artery

nerve

e) intercostal arteries, veins, and nerves are located in a groove at

2. ribs

a) true ribs

b) false ribs

c) floating ribs

d) Angle of Louis

the bottom of each rib.

vein

artery

nerve

thoracentesis needle inserted at TOP of rib to avoid arteries, veins, & nerves

3. vertebrae

a) number

1) total of 12 (T1  T12)

2) 2nd prominent spinal process palpated at base of neck is

b) respiratory functions

1) support ribs via articulated joints that allow both

a] rotation and

b] lift

2) landmarks for physical and CXR assessment

c) standard A-P CXR anatomic landmarks

1) carina 5th thoracic vertebrae (T5) by A-P CXR

2) lower lung (diaphragm) margins on A-P CXR

a] @ FRC (end of resting exhalation) (T10)

b] @ TLC (end of deep inspiration) (T12)

cervical

thoracic

lumbar

sacral

coccyx

thoracic

B. Muscles of Ventilation

1. normal inspiration

a. diaphragm – the primary muscle of resting, tidal inspirations

the chest wall plus the diaphragm make up the sides of the thoracic container

right

hemi-diaphragm

left

hemi-diaphragm

right

phrenic nerve

left

phrenic nerve

B. Muscles of Ventilation

1. normal inspiration

a. diaphragm – the primary muscle of resting, tidal inspirations

1) for the thoracic “container”, is the floor

2) separates lungs/heart from abdominal cavity

3) 2 (left & right) domed shaped hemidiaphragms

B. Muscles of Ventilation

1. normal inspiration

a. diaphragm

4) innervation by phrenic nerve

a) under autonomic (automatic) &/or cerebral cortex (conscious) control

b) initial nerve fibers course out of spinal column at C3 through C5

1] spinal cord transection above C5 up to C3 

 diaphragm function

2] spinal cord transection above C3 

total loss of diaphragm function

5) contraction  flattening downward movement

6) from resting to deep breathing, center of domes can drop

1.5 to 8 cm

7) lateral borders with rib cage create CXR costophrenic angles

Costophrenic Angles

Chest X-Ray Landmarks

B. Muscles of Ventilation

1. normal inspiration

a. diaphragms

b. external intercostals

1) innervation from T1 through T12

2) contraction

a) rotates ribs up and out (bucket handle effect)

b)  thoracic A-P diameter and \ volume

3) important for deep, forced inspirations

B. Muscles of Ventilation

1. normal inspiration

2. passive expiration

a. the significant muscle for normal resting expiration is NONE

b. assisting normal transition from I to E phase comes from internal intercostals

3. forced expiration

a. abdominals: contraction  pushing of abdominal contents up against bottom of diaphragm forcing diaphragm upward \

 thoracic sup.inf. diameter & volume

b. internal intercostals: contraction  pulling ribs down and in

( A-P diameter)

B. Muscles of Ventilation

1. normal inspiration

2. passive expiration

3. forced expiration

4. accessory muscles of ventilation

a. inspiratory

1) accessory muscles

a) external intercostal

b) scalene

c) sternocleidomastoid

1] SCM

2] in distressed, short of breath patients, usage easy to see

3] with chronic pulmonary disease patients, may hypertrophy

the scalenes

SCM muscles

B. Muscles of Ventilation

1. normal inspiration

2. passive expiration

3. forced expiration

4. accessory muscles of ventilation

a. inspiratory

1) accessory muscles

a) external intercostal

b) scalene

c) sternocleidomastoid

1] SCM

2] in distressed, short of breath patients, usage easy to see

3] with chronic pulmonary disease patients, may hypertrophy

d) pectoralis major

e) trapezius

pectoralis major

trapezius

B. Muscles of Ventilation

1. normal inspiration

2. passive expiration

3. forced expiration

4. accessory muscles of ventilation

a. inspiratory

1) accessory muscles

function: mostly to raise the

anterior thorax (pump handle effect)

b. expiratory

1) accessory muscles

a) innervated by T6 – L1: abdominals

b) innervated by T1 – T12: internal intercostals

2) function: mostly to compress abdomen  pushing diaphragm up

VII. Cardiovascular Anatomy

A. Content, Cor, Conduit

1. Content = blood and its components

2. Cor = heart

3. Conduit = blood vessels (vasculature)

B. Blood (content)

1. functions

a. transport to all cells: nutrients

1) O2

2) carbohydrates, including glucose

3) fats

4) proteins & amino acids

5) electrolytes & water

b. transport away from all cells: metabolic wastes

1) CO2

2) H+

3) lactate

4) urea

5) water

B. Blood (content)

1. functions

c. communicate chemical messages

1) hormones

2) chemoreceptor stimulants (O2, CO2, H+)

d. transport medium for immune system & vascular repair

1) antibodies

2) leukocytes (WBCs)

3) platelets

B. Blood (content)

1. functions

2. components

a. cellular (formed elements)

1) erythrocytes (RBCs) – transport O2 and CO2

2) leukocytes (WBCs)

a) produce antibodies and/or

b) phagocytize foreign antigens

3) platelets: participate in thrombogenesis

b. liquid

1) blood minus all formed elements is a pale yellow liquid called

plasma

2) 90% water

3) remainder includes dissolved plasma proteins & electrolytes

4) plasma minus clotting factors (including fibrinogen) is called

blood serum

c. a volume comparison of plasma to RBCs is called

hematocrit

1) RBCs and plasma can be separated by centrifuge

2) normal hematocrit values are

a) RBCs 45%

b) plasma 55%

B. Blood (content)

1. functions

2. components

C. Heart (cor)

1. functions as 2 pumps to move blood around the vascular system

C. Heart (cor)

1. functions as 2 pumps to move blood around the vascular system

2. cardiac tissues – from outside to inside across ventricular wall

a. pericardium double walled fibrous sack enclosing the heart

b. epicardium same as visceral layer of serous pericardium

c. myocardium contractile tissue

d. endocardium continuous with cell lining of vascular system

a. chambers: all chambers include myocardial walls that are

contractile

1) atria

a) thin walled & stretches easily

( compliance)

b) receives blood from veins

c) contracts to pump blood to ventricles

2) ventricles

a) myocardial layers

1] much thicker than atrial myocardium

2] L myocardium thicker than
R myocardium

b) receives blood from atria

c) contracts to pump blood to arteries

3. pump construction

a. chambers: all chambers include myocardial walls that are

contractile

3) R & L atria and R & L ventricles separated by septal walls

4) fibrous skeleton of A-V valves electrically separates atria from ventricles.

3. pump construction

b. the 2 “hearts” (2 pumps)

1) right heart

a) R atrium receives venous blood from the body then

pumps blood through the

b) R A-V valve into the AKA: tricuspid valve

c) R ventricle which then pumps blood through the

d) pulmonary semi-lunar valve then the blood passes into the

e) pulmonary artery

b. the 2 “hearts” (2 pumps)

2) left heart

a) L atrium receives venous blood from the pulmonary system

pumps blood through the

b) L A-V valve into the AKA: bicuspid valve or mitral valve

c) L ventricle which then pumps blood through the

d) aortic semi-lunar valve then the blood passes into the

e) aorta (systemic artery)

3) to control the A-V valves during contraction, there are

a) chordae tendonae

b) papillary muscles

4. Electrical Conduction Through the Heart

resting, polarized cell membrane)

Na+ Na+ Na+ Na+ Na+ Na+ Na+ Na+

K+ K+ K+ K+ K+ K+ K+ K+

4. Electrical Conduction Through the Heart

a. Depolarization (along a cell membrane)

Na+ Na+ Na+ Na+ Na+ Na+ Na+ Na+

K+ K+ K+ K+ K+ K+ K+ K+

Na+ Na+ Na+ Na+ Na+ Na+ Na+ Na+

K+ K+ K+ K+ K+ K+ K+ K+

Na+ Na+ Na+ Na+ Na+ Na+ Na+ Na+

repolarizing cell membrane

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

K+

Na+

4. Electrical Conduction Through the Heart

a. Depolarization (along a cell membrane)

b. structures

SA node

Purkinje fibers

L A-V valve

R A-V valve

inter-atrial tracts

inter-nodal tracts

AV node

bundles of His

bundle branches

B. Electrical Conduction Through the Heart

a. Depolarization (along a cell membrane)

b. structures

SA node

Purkinje fibers

AV node

bundles of His

bundle branches

B. Electrical Conduction Through the Heart

a. Depolarization (along a cell membrane)

b. structures

c. ECG - normal

CLASSICAL EKG PATTERN DEVELOPMENT

P wave

R wave

T wave

S wave

atrial depolarization

bundle of His & bundle branch depolarization

Purkinje & ventricular myocardial depolarization

Purkinje & ventricular myocardial repolarization

Q wave ?

D. Vascular System (conduit)

1. histology of arteries, arterioles, capillaries, and veins

a. possible vessel tissue layers (tunics)

1) adventitia (external) protective;

2) media (middle) thickest layer, smooth muscle, nerves

3) intima (inner) endothelium selectively permeable

1) arteries (large to small)

thick muscle layer

conduction vessels

some control of blood distribution

D. Vascular System (conduit)

1. histology of arteries, arterioles, capillaries, and veins

a. possible vessel tissue layers (tunics)

b. vessel types

2) arterioles

resistance vessels

help control

- BP

- distribution of blood

3) capillaries

NO muscle

single cell layer

exchange vessels

4) veins

thin media layer ( muscle)

stretches easily ( compliance)

capacitance vessels

contains 70% of blood volume

E. Blood flow: structures

pulmonary
capillaries

pulmonary venules

left
heart

aorta

medium & small
systemic arteries

systemic arterioles

systemic capillaries

systemic venules

medium & small
systemic veins

vena cava

right
heart

pulmonary
arteries

pulmonary arterioles

pulmonary
veins

pre-capillary sphincters

E. Blood flow: structures

diastole

E. Blood flow: structures

systole

E. Blood flow: structures

diastole

with inflated Swan-Ganz line

E. Blood flow: structures

systole

with inflated Swan-Ganz line

E. Blood flow: structures

diastole

with deflated Swan-Ganz line

E. Blood flow: structures

systole

with deflated Swan-Ganz line

F. systemic vs. pulmonary vasculature

2. systemic

a. low compliance

b. high volume

c. high pressure

when exposed to low lung O2 conditions, arterioles & precapillary sphincters

relax (dilate)

1. pulmonary

a. high compliance

b. low volume

c. low pressure

d. when exposed to low lung O2 conditions,

arterioles & precapillary sphincters

contract (constrict)

LV OUTPUT

syst vasc:

PAP

25/15 mmHg

RV after-load

SAP

120/80 mmHg

LV after-load

RV OUTPUT

F. Systemic vs Pulmonary
vasculature

pulm vasc:

 R &  C

 R &  C

5 L/min

G. Autonomic Nervous System Effects of the Cardiovascular System

sympathetic



parasympathetic



source of stimulation

heart rate

contraction strength

cardiac output

vasomotor tone

H. Myocardial perfusion

1. blood supplied to mycardial tissue by the coronary arteries

2. opening to coronary arteries is near base of aortic valve

and, by this valve, gets partially blocked during systole

3. \ myocardial perfusion occurs primarily during diastole

4. deoxygenated blood flows out of the myocardial tissue to

a. coronary sinus in right atrium then to lungs (normal)

b. thebesian veins then in to left ventricle which mixes deoxygenated blood with already oxygenated blood from the lungs (anatomic shunt)

I. Elements of Arterial Blood Pressure (BP)

1. normal systolic values are 120 mmHg or 120 or 120/80
diastolic 80 mmHg 80

2. Total BP = static BP + dynamic BP

a. static BP is due to:

1) total blood volume

2) vasomotor tone

b. dynamic BP is due to:

1) cardiac output

2) vascular resistance

3. Total BP = static BP + dynamic BP

Total BP = (fluid volume x container stretchiness) + (flow rate x resistance)

Total BP = (total blood volume x vasomotor tone) + (C.O. x vascular resistance)

Total BP =

(total blood volume

venomotor tone)

(C.O.

SVR)

4. abnormal blood pressure conditions

a. hypertension: BP > 140/90

b. hypotension: BP < 90/60

5. abnormal blood volume conditions

a. low blood volume is hypovolemia

b. high blood volume is hypervolemia

6. NOTE: C.O. µ HR \ BP µ HR

a. normal HR range = 60 to 100 B/min

b. bradycardia if HR < 60 B/min

c. tachycardia if HR > 100 B/min

End

RTH 100

Content/Exam Unit 1

sou rce of stimulation

heart rate

contraction strength

cardiac output

vasomotor tone BP

source of

stimulation

heart

rate

contraction

strength

cardiac

output

vasomotor

tone