“Sylvia’s out of Breath”

Anatomy of the thoracic Cavity
1. Consists of
  1. Sternum
    1. Consists of:
      1. Body
      2. Xiphoid process
        Origin of Diaphragm
        ITA branching
      3. Manubrium
    2. Manubriosternal joint
      1. Land Marks of
        T4 and T5
        Bifurcation of trachea
        Beginning and end of aortic arch
        Reference to JVP measurement
  2. vertebrate
    1. Ribs' Facets articulation
      1. 1 facet
        Ribs 1,10,11,12
      2. 2 facets
        Corresponding vertebra and superior
  3. Ribs
    1. 12 ribs
      1. true
        (1-7)
        Characteristics of rib 1
        two grooves
        Subclavian artery & vein
        Scalenus insertion
      2. false
        (8-10)
      3. floating
        (11,12
2. Blood Supply
  1. Anterior ICS arteries
    1. ITA
      1. First 6 ICS
    2. musculophrenic
      1. Lower 5 ICS
  2. Posterior ICS arteries
    1. Thoracic Aorta
  3. Veins
    1. drainage by azygous to superior vena cava
COPD
1. Emphysema
  1. Pathology
  2. Clinical Features
    1. Barrel chest
    2. Tachypnea
    3. Dyspnea
    4. no cyanosis
  3. Distal terminal bronchioles
2. Chronic bronchitis
  1. cough for more that 3 months
  2. Pathology
    1. Hyperplasia pf goblet cells
  3. Clinical Features
    1. cyanosis "blue bloaters"
3. Common cause
  1. smoking
4. Risk factors
  1. Aging population > 50
  2. genes
  3. recurrent infection
5. Irreversable
6. Complications
  1. Core pulmonale
    1. hypoxia induced vasospasm
      1. Pulmonary HTN
        RHF
  2. Pneumothorax
    1. rupture of bullae
7. Management
  1. Oxygen Mask
COPD Investigations
1. Spirometry test
  1. decreased FEV1/FVC ratio
    1. no response to b-2 aganosits
  2. increased TLC
2. Radiology
  1. Hypelucsent
  2. Barrel shaped
  3. flat diaphragm
  4. decreased mediastinal transverse diameter
Physiology
1. Respiration Regulation
  1. central chemoreceptors
    1. sensitive to H+ in CSF
  2. peripheral chemoreceptors
    1. sensitive to O2 in
      1. Carotid & aortic bodies
  3. Respiratory center
    1. dorsal group
      1. controls inspiration
    2. Ventral
      1. active expiration
    3. PC
      1. inhibitory
    4. AC
      1. increases RR
2. CO2 transportation
  1. 3 pathways
    1. 7% dissolved
    2. 70% HCO3-
      1. Cl- shift in the lungs
    3. 23% Carbamin-hemoglobin
  2. Haldane vs Bohr effect
3. Ventilation/perfusion ratio
  1. Normal
    1. Zones
      1. one (Apex)
        > 0.8
      2. two
        0.8
      3. three (base)
        < 0.8
  2. Abnormal
    1. no profusion
      1. pulmonary embolism
    2. no ventilation
      1. atelectasis
        blood shunting
4. Pulmonary blood flow
  1. gravity
    1. increased perfusion in basal zone
  2. increased CO
    1. increases blood supply to branched pulmonary capillaries
Restrictive vs Obstructive
Respiratory failure
1. Types
  1. Hypoxemic
    1. PaO2 < 60 mmHg
  2. Hypercapnic
    1. PaCO2 > 50 mmHg
2. Causes
  1. COPD
  2. Asthma
  3. Pulmonary edema
Burden of COPD
1. increasing morbidity & mortality
Quitting smoking
1. Addiction symptoms
  1. Craving
  2. Withdrawal
2. Stages of cessation

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“Sylvia’s out of Breath”

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	Created by Ibrahim Andelhafez almost 7 years ago