pulm
Terms
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- Innervation of the diaprhagm
- C3,C4,C5
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Relationship of vagus and phrenic n.
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phrenic is lateral
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pulm artery and bronchi relationship
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R anterior, L superior
(RALS)
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Which mainstem bronchus is more vertical
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Right
Aspirations go to right side
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Intercostal n. a. v.
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run along BOTTOM of each rib (upside down VAN, but order is right side up)
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Bronchopulmonary segement
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arteries run w/ bronchioles
Vein and lymph run in interstitial septum
- Diaphragm openings
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T8: IVC
T10: Esophagus, vagus
T12: aorta, azygous, thoracic duct
I 8 10 EGGs AT 12
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Internal intercostals
- active expiration
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external intercostals
- active inspiration
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2-3 BPG
- Right shift curve. Get rid of O2 easier
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Diffusion limited states
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O2 in exercise, COPD, fibrosis
CO2 (think DLCO)
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Calculate Vd
- Vd=Vt*[PaCO2-PeCO2)/PaCO2]
- Calculate Pa02
- PaO2=0.21(760-46)-(PCO2/0.8)
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Normal A-a gradient
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<10mmHg
(>30mmHg and there's really a problem)
- decreased FEV1/FVC
- Obstructive
- Blue bloater
- chronic bronchitis
- pink puffer
- emphysema
- decreased lung volumes w/ normal or increased FEV1/FVC
- Restrictive
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chronic bronchitis affects______?
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terminal bronchiole (prox to respiratory unit)
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centroacinar emphysema
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smoking, upper lobes, affects respiratory bronchioles
ALL smokers have increased neutrophils that produce elastace and less a1antitrypsin which normally breaks it down.
- pan-acinar
- a1-antitrypsin. destruction of entire respiratory unit in lower lobes.
- Kartagener's syndrome
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immotile cilia due to dynein arm defect
infertile men and women
sinusitis, bronchiectasis
situs inversus
- Isoproterenol
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Beta adrenergic agonist (non-specific)
- salmeterol
- Long acting B2 agonist used for maintenance.
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methylxanthines (theophyline)
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PDE inhibitors
- ipratropium
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muscarinic antagonist (prevents bronchoconstriction)
- Cromolyn
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mast cell stabilizer (only for phrophylaxis)
- Antileukotrienes
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Zileuton - block 5-lipoxygenase
Zarfirlukast, montelukast - block leukotriene receptors
- theophylline
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PDE antagonist
Cardiotoxic, neurotoxic
- LTB4
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neutrophil chemotactic agent
- LTC4,LTE4,LTD4
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bronchoconstriction, vasoconstriction, increase vascular permeability