RESPIRATORY BASICS

Lung volumes
V/P mismatch
O2 and CO2 transport
Restriction - Expiratory
- Bronchioles are restrictive i.e. takes effort to force air out

V P Inspire
Compliance - alveolar-gas exchange (= pressure required to open alveoli)
Surfactant - reduces compliance/decreases surface tension so that the alveoli dont
collapse type 2 pneumocytes
* Surface tension compliance
Graph
Tidal volume
Minimum + Maximum Inspiratory/Expiratory volumes (measured from top/bottom
of tidal wave?)
Residual volume - volume always leftover in normal physiological state so that lungs dont
collapse
Emphysema - low compliance - disruption/destruction of alveolus - sac that doesnt contract any
more - air going in but not able to be expelled - residual volume
- would have more trouble expiring than inspiring as it is an obstructive process
Shunt - when alveoli is so collapsed on itself that it is unable to get proper exchange although it
has proper perfusion
Dead Space - when you have no perfusion
V Q mismatch:
V/Q ratio higher than normal dead space, PE
V/Q ratio lower than normal shunt, pneumothorax, pleural effusion, consolidation,
COPD, asthma, bronchitis
Oxygen Curve
- Sigmoid curve
O2 and CO2 transport
- haemoglobin dissolved
- bicarbonate dissolved
Bohr Effect: shifting affinity of O2 with CO2 levels
EXAMPLE MEQ QUESTIONS
1. 53 yr old male crushing chest pains radiating from left arm and dyspnoea

Underlying cause of chest pain

O 2 supply heart Ischaemia necrosis MI
- release of cytokines and inflammatory mediators e.g. bradykinin,
histamine inflammatory response
no ATP channels working influx of Ca 2+
Why radiation
- Referred pain: carried by same afferent fibres pathways from C7-T4, which
converge at one area in the brain, which is unable to specify/localise/demarcate a
particular area.
Dyspnoea
- pulmonary hypertension
- reduced cardiac output reduced gas exchange buildup of CO 2
dyspnoea on exertion
Testing
- troponin
- creatine kinase - delayed chemical released during tissue death (not specific to
cardiac muscle)
- ECG - STEMI (elevated during a MI) (whereas only depressed ST after a prior
case of acute MI)
- Lead 2, 3, aVF = inferior infarct
- V3, V5 = anterior infarct
- V5, V6 = lower lateral
Treatment
-

GTN
thrombolytics
supplemental oxygen
angioplasty (normally for STEMI as transmural infarct)

Change in hemodynamic state

Stand blood pooling in legs decreased ventricular filling reduction in BP
baroreceptors sympathetic vasoconstriction to increase venous return
* Include changes in dorsal medulla, adrenergic stimulation, beta-adrenergic stimulation,
change in pulse pressure etc.
Pulse Pressure - difference between systolic and diastolic pressure