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what does the resp pump consist of?
  • —Rib cage
  • —Pumping musculature (including intercostal muscles)
  • Diaphragm
  • And accessory muscles of respiration
name 2 types of ventilatory disorders
—restrictive and obstructive
what are flow pump plots?
—Flow-volume loop plots provide an alternative to assess pulmonary function
what is the advantage of flow pump plots?
  • —Flow-volume loop studies are sensitive means of detecting early COPD
  • —Flow-volume loops differentiate the anatomic location of flow obstruction
what is the function of spirometry?
—Spirometry distinguishes restrictive from obstructive
what is normal TV?
—Approx 500 ml (70 kg adult)
what is IRV, and what's the normal value?

—Insp reserve volume (IRV) – inhaled volume over and above normal TV —Approx 3000 ml (70 kg)
what is ERV and what's the normal value?

—Exp reserve volume(ERV) – volume forcibly exhaled beyond relaxed exhalation —Approx 1100 ml (70 kg)
what is RV and what's the normal value?

—Residual volume(RV) – volume of gas remaining in the lungs after maximal exhalation —Approx 1200 ml (70 kg)
what is TLC?

—Total lung capacity (TLC) – volume of air in lungs after maximal inhalation
what is the formula for TLC and what's the normal value?
—Equal to TV + IRV + ERV + RV —Approx 5800 ml (70 kg)
what is VC?

—Vital capacity (VC) – maximal amt of air expired after maximal inhalation
what is the formula for VC and what's the normal value?
—Equal to IRV + TV + ERV —Approx 4500 ml (70 kg)
what is FRC?

—Functional Residual Capacity (FRC) – amt of air left in lungs at end of normal passive exhalation
waht is the formula for FRC and what's the normal value?
—Equal to ERV + RV —Approx 2300 ml (70 kg)
what is IC?

—Inspiratory Capacity (IC) – amt of air moved on maximal inspiration beginning at FRC
what's the formula for IC and what's the normal value?
—Equal to TV + IRV —Approx 3500 ml (70 kg)
what lung volumes and capacities are obtained directly from the spirometric reading?
—Tidal Volume (TV) —Vital Capacity (VC) —Inspiratory capacity (IC) —Inspiratory reserve volume (IRV) —Expiratory reserve volume (ERV)
what lung volumes and capacities are obtained NOT directly from the spirometric reading?

—Functional Residual Capacity (FRC)
—Residual Volume (RV)
—Total Lung Capacity (TLC)

—FRC, RV, and TLC CAN NOT BE MEASURED DIRECTLY WITH SPIROMETRY (true or false)
TRUE (must know!!!!)
what is FEV1?
  • —Forced expiratory volume in one second
  • Volume of gas exhaled within one second of beginning a FORCED expiration
what is FVC?
  • —Forced vital capacity
  • Volume of gas exhaled during forced expiration
what is FEV1/FVC?
—Ratio useful in distinguishing between restrictive and obstructive diseases
what is FEV 25-75?
  • —Rate of flow occurring in forced expiration from point where 25% of FVC has been exhaled to point where 75% has been exhaled
  • Also known as mid-maximal expiratory flow (MMEF)
  • FEF 25-75 is the BEST test for assessing small airway disease
list obstructive pulmonary disease
—Asthma —COPD —-Chronic bronchitis (blue bloater) —-Emphysema (pink puffer)
list restricitve pulmonary disease
—Pulmonary Fibrosis —Pneumothorax —Chest wall disease (scoliosis) —Neuromuscular disease
what is normal FEV1/FVC?

—FEV1/FVC ratio normally is >0.7 (0.8 is normal or 80%)

—if both FEV1 and FVC are low and FEV1/FVC is <0.7, that means........
obstructive disease present

—if both FEV1 and FVC are low and FEV1/FVC is equal to or >0.7, that means....
restrictive disease present
describe how PFT performed

—Pt inhales maximally and then exhales as hard and as completely as they can
what are the causes of ARDS?

—Usually caused by shock or sepsis
what does flow volume loop look like in obstructive disease?
  • —Looks like a baby carriage without wheels
  • Lung volumes are greater
what volume is exhales in the 1st second?

—FEV1 – volume exhaled in 1st second

(In ARDS) —Complement activation may damage pulmonary epithelium and certain drugs may produce _____
pulmonary fibrotic changes
what does flow volume loop look like in restrictive disease?
  • —Looks like a small upside down ice cream cone
  • Lung volumes are smaller
  • —Lungs are restricted = smaller volumes
what is total volume exhales during PFT?

FVC —total volume exhaled
what are the S/Sx of ARDS?

—Progressive tachypnea/CXR – bilat pulm infiltrates (whiteout)/—May have pulm HTN/Decreased lung compliance/—Increased need for more oxygen delivery to maintain satisfactory PaO2/Hypercarbia/—Often assoc with multi-system organ failure, which may lead to death
what happens to the lung during restrictive lung disease?

  • —Disease process which alters elastic properties of the lungs à stiffening
  • —Decrease in total lung capacity (TLC)
what is the treatment for ARDS?

  • —Eliminate cause (if septic…)
  • Mechanical ventilation with PEEP + O2
  • —Inc FRC à  inc alveolar surface exposed to O2
  • —although if in shock may decrease venous return
  • Diuretics (lasix….. not mannitol)
  • Inotropes (dopa or dobut)
  • —Maintain PAWP as low as possible and still produce acceptable CO and BP
  • Steroids
what is normal FEV1?

—Normal – FEV1  is about 80% of FVC
define and describe aspiration pneumonitis

—Inhaled acidic gastric fluid à destruction of surfactant-producing cells and damage to pulmonary capillary endothelium
  • —Atelectasis occurs and fluid leaks into lungs
  • —Producing permeability pulmonary edema and clinical picture like ARDS
what would you see in restrictive disease (in terms of FEV & FVC, increase, decreased and so on)
  • —Both FEV and FVC are reduced
  • —FEV1 / FVC% is normal or increased
  • —FEV 2.8    FVC  3.1  % is 90
what are the S/Sx of aspiration pneumonitis

  • —Arterial hypoxemia
  • —Tachypnea
  • —Bronchospasm
  • Pulmonary vascular vasoconstriction with associated pulm HTN
what are the 2 categories of restricitive lung disease?
pulm edema & chronic restricitive lung disease
what would you see in obstructive disease (in terms of FEV & FVC, increase, decreased and so on)
  • —FEV1 is reduced much more than FVC
  • FEV1 / FVC% is low
  • FEV 1.3   FVC  3.1   % is 42
what is the treatment of aspiration pneumonitis

  • —Place ETT
  • —Saline (5 ml) through tracheal tube
  • Fiberoptic to remove solid materials if indicated
  • Most effective treatment: Supplemental O2, PEEP
  • Nebs with B-agonists release bronchospasm
what is normal values of FEV1/FVC & %?
  • —FEV1 is 4.0
  • —FVC is 5.0
  • % is 80
define pulm edema
—Pulmonary edema – accumulation of water and solutes in interstitial tissues à lung stiffening
define and describe neurogenic pulmonary edema

  • —Assoc with brain injury (medulla)
  • —Occurs minutes to hours after CNS injury —activation of SNS impulses -> generalized vasoconstriction -> shift of blood volume into pulm circulation ->increased pulm capillary pressures -> leakage of fluid into interstitial spaces and alveoli
define chronic restrictive lung disease
—Chronic restrictive lung disease – changes in elastic tissue à lung stiffening
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