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Published by: Sidharth Sekhar Patra on Sep 04, 2010
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Respiratory System Anatomy




sternocleidomastoid.  forced inspiration is further assisted by the scalene. and pectoralis muscles.  air rushes in into the lungs to reduce a pressure difference.  . muscles.Pulmonary ventilation  Inspiration is an active process of the diaphragm and the external intercostal muscles.  increased thoracic pressure forces air out of the lungs  forced expiration is an active process of the internal intercostal muscles (latissimus dorsi. quadratus lumborum & abdominals).   Expiration is a passive relaxation of the inspiratory muscles and the lung recoils.

Pulmonary ventilation .

.  It removes carbon dioxide from returning venous blood. It serves two major functions:  It replenishes the blood s oxygen supply which is depleted at the level. where it is used for oxidative energy production.Pulmonary diffusion which is the exchange of oxygen and carbon dioxide between the lungs and the blood.

the capillary wall. 21% (O2). and their basement membranes.  air we breathe = 79% (N2). and . to the red blood cells in the blood of the pulmonary capillaries.  Partial pressure of gases  the individual pressures from each gas in a mixture together create a total pressure.Pulmonary diffusion Respiratory membrane composed of the alveolar wall. gradient.  . through the respiratory membrane.  gas exchange occurs between the air in the alveoli.03% (CO2) = 760mmHg  differences in the partial pressures of the gases in the alveoli and the gases in the blood create a pressure gradient.

Pulmonary diffusion .

hyper- . and cough together with demonstratable bronchial hyper-responsiveness.ASTHMA Asthma is a disease of airway inflammation and airflow obstruction characterized by the presence of intermittent symptoms including wheezing. shortness of breath. chest tightness.

boys > girls Production of IgE antibodies in response to exposure to allergens .Etiology: Common in children.

enzymes. wood dust  . NSAIDs   Allergens Low molecular weight chemicals: penicillin  Organic molecules: animal danders.Proactive factors:  Physiologic and pharmacologic mediators of normal smooth muscle contraction Histamine  Methacholine   Physiochemical agents Exercise: hyperventilation with cold and dry air  Air pollutants: nitrogen dioxide  Viral resp infection: influenza A  Ingestants: aspirin. dust.

Cellular inflammatory events:  Epithelial cells activation or injury  Lymphocytes activation  Mast cells and eosinophils activation .

Pathophysiology:  Increased  Airway airflow resistance due to inflammation  Airway narrowing  Smooth muscle hyper-responsiveness hyper Mucus hyper secretion  Additional broncho-constrictor stimuli broncho Stimulation of bronchial irritant receptors .

Clinical features:  Cough  Wheezing  Dyspnea with chest tightness  Tachypnea and tachycardia  Pulsus paradoxus  Hypoxemia  Respiratory acidosis .

carrying large amounts of shopping Class III Symptoms with mild exertion. running up hills. Class IV Symptoms at rest Class I . breathlessness only occurring with severe exertion. dressing. cross-country skiing crossClass II Symptoms with ordinary activity. showering. fast bicycling.g. walking up stairs. e.g. bathing. making beds.The New York Heart Association classification of breathlessness No symptoms with ordinary activity. e.g. e.

SPUTUM ANALYSIS Description Saliva Mucoid Mucopurulent Purulent Clear watery fluid Opalescent or white Slightly discoloured. tobacco. heroin). vasculitis. mycoplasma Klebsiella Pulmonary oedema Infection (tuberculosis. trauma. cystic fibrosis. infarction. also coagulation disorders. bronchiectasis). but not frank pus Thick. pneumonia Haemophilus Pseudomonas Pneurnococcus. asthma Bronchiectasis. viscous: Yellow Dark green/brown Rusty Red currant jelly Pink or white Ranging from Wood specks to frank blood. coal dust Causes Frothy Haemoptysis Black Black specks in mucoid secretions . old blood (dark brown) Chronic bronchitis without infection. carcinoma. cardiac disease Smoke inhalation (fires.

Diagnosis:  Chest examination Nasal polyps or increased amounts of nasal secretions  Skin changes: atopic dermatitis or eczema  spirometry measures  blood test  chest x ray  .

block inflammation and are extremely effective in relieving symptoms of asthma. which are bronchodilators. Cromolyn and nedocromil are antiantiinflammatory drugs that are often used as initial treatment to prevent asthmatic attacks over the long term in children. are the best choice for relieving bronchodilators. LEUKOTRIENE MODIFIERS.Treatment      METHYLXANTHINES. sudden attacks of asthma and for preventing attacks from being triggered by exercise. . STEROIDS. OTHER DRUGS. The chief methylxanthine drug is theophylline. which resemble natural body hormones. for older children or adults who have a mild degree of asthma that persists. BETABETA-RECEPTOR AGONISTS. Leukotriene modifiers are a new type of drug that can be used in place of steroids. These drugs. These drugs.

PT management:  Relaxation techniques  Breathing exercises  Assisted coughing  Spirometer exercises  Postural drainage  Prevention of exposure to irritants .

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