Anatomi dan Fisiologi

Jalan Nafas
 The Body’s Need for Oxygen

• Living tissue must have oxygen to survive.

• Brain death in humans occurs within 6 to 10 minutes of
tissue anoxia.
• Rapid and safe airway control is paramount to the
successful management of critically ill and injured
patients.
 Airway Anatomy

Upper airway structures include the:

Mouth Nose
Pharyng Oropharyng

The lower airway structures include the:

Laryng
Trachea Bronchi
Bronchioles Alveoli
Lungs
.
• Nose
• Nasal cavity
• Pharynx
• Larynx conducting zone
• Transport, cleanse, warm and
• Trachea humidify incoming air
• Bronchi • Not involved in gas exchange
• “Anatomical Dead Space”
• Bronchioles
• Respiratory bronchioles
respiratory zone
• Alveolar ducts
Function in gas exchange
• Alveoli
 MOUTH

hard palate

soft palate teeth

lips
tongue
oropharyng

mandible
 NOSE
frontal sinus
sphenoid
sinus Concha superior

Concha medius

Concha inferior
PHARYNG:

- Nasopharyng

- Oropharyng
(throat)

- Laryngopharyng
 frontal sinus

sphenoid hard palate

sinus
concha

eustachian opening
nasopharyng
soft palate
uvula
tongue
tonsilla palatina
oropharyng
epiglottis

laryngopharyng

UPPER
vocal cord
trachea LOWER
LARYNG
(VOICE BOX)

- separates pharyng and trachea

- cartilages, membrane,
ligaments
- ♂ 45 mm long, Ø 35 mm
- ♀ 35 mm long, Ø 25 mm

FUNCTION
- Patent airway

- To act as a switching
mechanism to route air and food
into the proper channels
 Framework of the Larynx

thyrohyoid
ligament
 CRICOTHYROTOMY

- acute, life threatening upper

airway obstruction
- intubation not possible
- conventional airway
management not possible

SELLICK’S MANEUVRE
Used to prevent gastric distention

Technique
Apply slight pressure
anteriorly over
cricoid cartilage
Closes off esophagus
Sellick’s
Manuever
 Movements of Vocal
Cords

The intrinsic muscles of the larynx attach to the

arytenoid cartilage, and allow for movement of the
vocal cords.
Glottis & Epiglottis
epiglottis

glottis
TRACHEA
TRACHEA VIEWED FROM ABOVE
 BRONCHIAL TREE

primary bronchus

secondary bronchus

tertiary
bronchus

bronchiole

terminal
bronchiole

respiratory zone
…hair like projection called cilia line the primary
bronchus to remove microbes and debris from the
interior of the lungs…
Notice that the right is more vertical and fatter than
the left which turns at a bit of an angle.
 Respiratory bronchioles,
alveolar ducts, alveolar sacs
Alveolar sacs Alveoli

• Alveolar sacs
look like clusters
of grapes

• The “individual
grapes” are
alveoli
air-blood barrier
Respiratory Physiology
Breathing
• Pulmonary Ventilation the movement of air into and out of the
lungs
• Gas exchange occurs due to a pressure gradient (partial
pressures of gas)
• Two phases
– Inspiration: Breathing in
• Active process
– Expiration: Breathing out
• Passive process
• Inspiration is initiated by a stimulus in the respiratory
center of the brain.
– The signal is transmitted to the diaphragm via the
phrenic nerve.
– The impulse causes the diaphragm to contract or flatten.
– This causes intrapulmonic pressure to fall below
atmospheric pressure and air is drawn into the lungs like
a vacuum.
– The ribs elevate and expand, the alveoli inflate, and
oxygen and carbon dioxide diffuse across the
membrane.
 Pressure in Thoracic Cavity
• Respiratory pressures are always described relative to
atmospheric pressure
• Boyle’s Law:
– Volume of gas is inversely proportional to pressure (if
temperature constant)

Volume= Constant
Pressure
– So, when the volume of the container increases
(expansion of the lungs), the pressure decreases
 Boyle’s Law

• As the size of
closed container
decreases,
pressure inside is
increase

– Same number
of molecules
striking a
smaller surface
area
 Pressure in Thoracic Cavity
• Atmospheric Pressure (Patm) - pressure exerted by
the air surrounding the body. At sea level its equal
to 760mmHg.
• Intrapulmonary Pressure (Palv) - pressure exerted
by the air within the alveoli. It rises and falls during
inspiration and expiration, but it always equalizes
with atmospheric pressure.
• Intrapleural Pressure (Pip) - pressure within the
pleural cavity. It is always lower than both
atmospheric pressure and intrapulmonary
pressure.
 Patm

pleura parietalis

pleural cavity
Pip pleura visceralis
(attach to the
lung)
Palv
alveoli

• Patm 760 mmHg

• Palv rises and falls during inspiration and expiration, but it
always equalizes with atmospheric pressure
• Pip < Patm or Palv
 Lung Tissue

• It is elastic and has a

tendency to recoil
• Ribs want to expand
outward
• Lungs want to collapse

• Since the pressure in the plural space is lower

than in the alveoli, the alveoli do not collapse.
 Inspiration
• Alveolar pressure falls below atmospheric
pressure.
• Contraction of the diaphragm and external
intercostal muscles increases the size of the
thorax (thereby decreasing the intra-pleural
pressure) and the lungs expand.
• Intra-pleural (thoracic) pressure is always 4
mmHg less than the atmospheric pressure
just before inhalation (756 mm Hg)
 Inspiration
• Expansion of the lungs decreased alveolar
pressure to 758 mm Hg
• Atmospheric pressure is 760 mm Hg
• Air flows into the lungs because of this
pressure gradient
• Inspiration causes intra-pleural pressure to
decrease to 754 mm Hg
EXPIRATION

• Air is forced out of

the lungs as the
muscles relax
reducing the
volume of the
chest cavity and
increasing the
pressure
 EXPIRATION
• Occurs when alveolar pressure is higher than
atmospheric pressure
762 mm Hg
• Elastic recoil of the chest wall and lungs (main
force) and the relaxation of the diaphragm
increases intra-pleural and alveolar pressure and
decreases lung volume
• Air moves out
• Quiet breathing does not take any effort (no
muscles are being contracted)
 Pulmonary Ventilation

3 Major Factors
• Alveolar surface tension
• Compliance
• Airway resistance
 Alveolar surface tension

• Surface tension causes the alveoli to

assume the smallest diameter
– Major component of lung elastic recoil
• Surfactant is a phospholipid produced by
Type II cells in alveolar walls
– Alters surface tension below the surface tension
of pure water
– Prevents alveolar collapse following expiration
– If surface tension is too high, alveoli collapse
and great effort is needed to reopen them
 Compliance
Ratio of volume changes caused by pressure changes  V/P

• Lung Compliance
• Thoracic wall Compliance

Low compliance
To get desired volume there must be higher pressure

High compliance
Low pressure will give high tidal volume
COMPLIANCE (COMPL)

BALLOON

stiff Elastis

LOW HIGH
COMPLIANCE COMPLIANCE
 P-V LOOP
EKSPIRATION

Vol
LOW HIGH
NORMAL
COMPLIANCE COMPLIANCE
500 500 500

250 250 250

0 15 30 15 30 15 30

PEEP 5
INSPIRATION

Spontaneus
breathing
 Resistance
• The walls of the respiratory passageways have
resistance to the normal flow of air into the lungs
• The smaller the diameter, the greater the
resistance
• Any condition that obstructs the air passageway
increases resistance, and more pressure is need
to force air through
– Asthma
– Inflammation due to infection
– Emphysema
AIRWAY RESISTANCE
(RAW)
BRONCHOCONSTRICTION:
 HISTAMIN

PRESSURE
FLOW =
RESISTANCE

OBSTRUCTION:
 MUCUS / SECRET
 AIRWAY
RESISTANCE (RAW)
PRESSURE
TOO SMALL FLOW =
ETT
RESISTANCE

BRONCHOSPASM
TUMOUR / SECRET

COLLAPSE/ATELECTASIS
 Partial Pressure
• Dalton’s Law: each gas in a mixture of
gases exerts its own pressure as if all other
gases were not present
– Air 78% nitrogen, 21% oxygen, 1% other (CO2)
• Partial pressure of a gas is the pressure of
an individual gas in a mixture.
• PO2 21% X 760 = 159.6 mm Hg
• Total pressure is adding all the partial
pressures
 Exchange of O2 and CO2

• O2 and CO2 Diffuse from areas of higher

partial pressures to areas of lower partial
pressure
• Results in exchange of O2 and CO2 in the
alveoli
– Alveoli: PAO2=105 mm Hg, PCO2=40 mm Hg
– Capillaries: PvO2=40 mm Hg, PVCO2 =45 mm Hg
– Pulmonary vein:PAO2=100 PCO2=40 mm Hg
Exchange of O2 and
CO2

O2 and CO2 Diffuse from areas of

higher partial pressures to areas of
lower partial pressure
RELATIONSHIP BETWEEN VENTILATION (V)
AND PERFUSION (Q)
Normal V/Q = 1

V/Q > 1
V/Q < 1
alveolar dead space

shunt
TERIMA KASIH