RESPIRATORY SYSTEM

Airway assessment is always the first as it is imperative that the airway is not
obstructed, and that breathing is adequate; Only when problems with airway and
breathing are addressed should the we move onto circulation. At the most simple level,
the function of the human respiratory system is to transport air into the lungs and to
facilitate the diffusion of Oxygen into the blood stream. Its also receives waste Carbon
Dioxide from the blood and exhales it.

Functions:

Inhalation and Exhalation Are Pulmonary Ventilation

External Respiration Exchanges Gases between the Lungs and the Bloodstream

Internal Respiration Exchanges Gases between the Bloodstream and Body Tissues

Air Vibrating the Vocal Cords Creates Sound

Olfaction

Upper Respiratory Tract

The major passages and structures of the upper respiratory tract include the
nostrils, the nasal cavity, the pharynx, the epiglottis, and the larynx.
 The upper respiratory tract is lined a mucous membrane. Mucus helps to trap
smoke, dust and other small particles. The membrane is lined with cilia (hair-like
structures that move the mucous upwards only the upper respiratory tract). The
lining of the tract and the close laying blood vessels (especially in the nose) help
to warm and moisten air as it passes.
The pharynx, commonly called the throat. It serves both the respiratory and
digestive systems by receiving air from the nasal cavity and air, food, and water
from the oral cavity. Inferiorly, it opens into the larynx and esophagus.
The larynx, commonly called the voice box or glottis, is the passageway for air
between the pharynx above and the trachea below. The larynx plays an essential
role in human speech. During sound production, the vocal cords close together
and vibrate as air expelled from the lungs passes between them.
The epiglottis acts like a trap door to keep food and other particles from entering
the larynx.

Lower Respiratory Tract

The major passages and structures of the lower respiratory tract include the
trachea, the right & left bronchus, the bronchioles, and the lungs containing
the alveoli. Deep in the lungs, each bronchus divides into secondary and tertiary
bronchi, which continue to branch to smaller airways called the bronchioles. The
bronchioles end in air sacs called the alveoli. Alveoli are bunched together into
clusters to form alveolar sacs. Gas exchange occurs on the surface of each
alveolus by a network of capillaries carrying blood that has come through veins
from other parts of the body.
The trachea, commonly called the windpipe, is the main airway to the lungs. It
divides into the right and left bronchi at the level of the fifth thoracic vertebra,
channeling air to the right or left lung. The cartilage in the tracheal wall provides
support and keeps the trachea from collapsing. The mucous membrane that lines
the trachea is similar to that in the nasal cavity. Mucus traps airborne particles
and microorganisms, and the cilia propel the mucus upward, where it is either
swallowed or expelled.
The alveoli are grouped together like a lot of interlinked caves, rather than
existing as separate individual sacs. The alveoli have a structure specialised for
efficient gaseous exchange: the alveoli walls are extremely thin; they have a
large surface area in relation to volume, they are fluid lined enabling gases to
dissolve; and they are surrounded by numerous capillaries.
Breathing

During inspiration the dome-shaped muscle of the diaphragm flattens, and the
inter-costal muscles pull the rib cage upwards and outwards. This increases the
volume of the chest cavity and air is drawn into the lungs.
During expiration the diaphragm relaxes and resumes it's dome shape. The
inter-costal muscles also relax and the rib cage falls inwards and downwards.
This reduces the volume of the chest cavity and air is forced out of the lungs.

Inspiration and Expiration

In a normal average adult male, the lungs have a combined capacity of about 6
litres, with about 500 mls of air inspired at each breath. Breathing is normally
very quiet, and without much effort.
During exertion the respiratory rate will increase, and so might the respiratory
effort so that more air is pulled into the lungs and, therefore, more oxygen is
made available to the cells in the body. This also allows the increasing amount of
CO2 to be exhaled. It is easier to breathe when you are sitting or standing, as the
diaphragm can more easily 'push' the contents of the abdomen downwards. Your
age, size, gender, and general health can all affect your respiratory performance.
Gaseous Exchange

Once the inspired air reaches the smallest part of the lungs, the alveoli, gaseous
exchange can take place. This refers to the process of Oxygen and Carbon
Dioxide moving between the lungs and blood.

Diffusion occurs when molecules move from an area of high concentration (of
that molecule) to an area of low concentration. This occurs during gaseous
exchange as the blood in the capillaries surrounding the alveoli has a lower
oxygen concentration of Oxygen than the air in the alveoli which has just been
inhaled. Both alveoli and capillaries have walls which are only one cell thick and
allow gases to diffuse across them. The same happens with Carbon Dioxide
(CO2). The blood in the surrounding capillaries has a higher concentration of
CO2 than the inspired air due to it being a waste product of energy production.
Therefore CO2 diffuses the other way, from the capillaries, into the alveoli where
it can then be exhaled. When Oxygen diffuses into the blood it attaches to
haemoglobin in red blood cells to be transported via the circulatory system.
If the circulatory system is inadequate, or there is a reduced amount of
haemoglobin or red blood cells (anaemia or blood loss, for example), then the
respiratory rate and effort might increase to try and compensate.

Abnormal Breathing Patterns

Apnea - Absence of breathing.

Tachypnea – increase in respiratory rate.
Bradypnea – decrease in respiratory rate.
 Eupnea- Normal breathing

Orthopnea- Only able to breathe comfortable in upright position (such as sitting

in chair), unable to breath laying down.

Dyspnea- Subjective sensation related by patient as to breathing difficulty

Paroxysmal nocturnal dyspnea - attacks of severe shortness of breath that

wakes a person from sleep, such that they have to sit up to catch their breath -
common in patient's with congestive heart failure.

Hyperventilation- "Over" ventilation - ventilation in excess of the body's need for

CO2 elimination. Results in a decreased PaCO2, and a respiratory alkalosis.

Hypoventilation- "Under" ventilation - ventilation that is less than needed for

CO2 elimination, and inadequate to maintain normal PaCO2. Results in
respiratory acidosis.

Tachypnea- Increased frequency without blood gas abnormality

Cheyne – Stokes Respiration

Gradual increase in volume and frequency, followed by a gradual decrease in
volume and frequency, with apnea periods of 10 - 30 seconds between cycle.
Described as a crescendo - decrescendo pattern. Characterized by cyclic waxing
and waning ventilation with apnea gradually giving way to hyperpneic breathing.

Breath sounds

Breath sounds come from the lungs when you breathe in and out. These sounds can be
heard using a stethoscope or simply when breathing.

Breath sounds can be normal or abnormal. Abnormal breath sounds can indicate a lung
problem, such as:

 obstruction
 inflammation
 infection
 fluid in the lungs
 asthma
Listening to breath sounds is an important part of diagnosing many different medical
conditions.

Types of breath sounds

A normal breath sound is similar to the sound of air. However, abnormal breath sounds
may include:

 rhonchi (a low-pitched breath sound). Occur when air tries to pass

through bronchial tubes that contain fluid or mucus.
 crackles (a high-pitched breath sound). The air sacs fill with fluid when a person
has pneumonia or heart failure.
 wheezing (a high-pitched whistling sound caused by narrowing of the bronchial
tubes) Occurs when the bronchial tubes become inflamed and narrowed liken in
Asthma.
 stridor (a harsh, vibratory sound caused by narrowing of the upper airway) like
an obstruction in the upper airway by a foreign object.

Your doctor can use a medical instrument called a stethoscope to hear breath sounds.
They can hear the breath sounds by placing the stethoscope on your chest, back, or rib
cage, or under your collarbone.

Cyanosis, a bluish color of skin and mucous membranes due to lack of oxygen, can
occur along with abnormal breath sounds. Cyanosis involving the lips or the face is also
a medical emergency.

Signs of an emergency:

 nasal flaring (an enlargement of the opening of the nostrils when breathing
that’s usually seen in babies and young children)
 abdominal breathing (the use of the abdominal muscles to assist breathing)
 accessory muscle use or retractions (the use of the neck and chest wall
muscles to assist breathing)
 stridor (indicating an upper airway obstruction)