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Anatomi dan Fisiologi

Jalan Nafas

The Bodys 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
Pharynx
Oropharynx
The lower airway structures include the:
Larynx
Trachea
Bronchi
Bronchioles Alveoli
Lungs
.

Nose

Nasal cavity

Pharynx

Larynx

Trachea

Conducting zone
Transport, cleanse, warm and
humidify incoming air
Not involved in gas exchange
Anatomical Dead Space

Bronchi

Bronchioles

Respiratory bronchioles

Alveolar ducts

Alveoli

Respiratory
zone
Function in gas
exchange

MOUTH
hard palate

soft palate

teeth
tongue

lips

oropharyng
mandible

NOSE
sphenoid
sinus

frontal sinus
Concha superior
Concha medius
Concha inferior

PHARYNG:
- Nasopharyng
- Oropharyng
(throat)

- Laryngopharyng

frontal sinus
sphenoid
sinus
eustachian opening

hard palate
conch
a

nasopharyn
g soft palate
uvula

tongue

tonsilla palatina
oropharyng
epiglottis
laryngopharyng

vocal cord

UPPER
trache
a

LOWER

LARYNG
(VOICE BOX)
- separates pharyng and
trachea
- cartilages, membrane,
ligaments

45 mm long, 35 mm
- 35 mm long, 25 mm
-

FUNCTION
- Patent airway

To act as a switching

mechanism to route air and

Framework of the
Larynx

thyrohyoi
d
ligament

CRICOTHYROTOMY

- acute, life threatening upper


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

SELLICKS MANEUVRE

Used to prevent gastric distention


Technique
Apply slight pressure
anteriorly over
cricoid cartilage
Closes off esophagus

Sellicks
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 th
interior of the lungs

Notice that the right is more vertical and fatter th


the left which turns at a bit of an angle.

Respiratory bronchioles,
alveolar ducts, alveolar
sacs

Alveolar sacs

Alveolar sacs
look like
clusters of
grapes

The individual
grapes are
alveoli

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

Boyles 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

Boyles 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

Pip
Palv

pleural cavity
pleura
visceralis
(attach to the
lung)
alveoli

Patm 760 mmHg


Palv rises and falls during inspiration and expiration, b
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

LOW
COMPLIANCE

Elastis

HIGH
COMPLIANCE

P-V LOOP
EKSPIRATION
Vol
NORMAL
500

500

250

250

LOW
COMPLIANCE

500

HIGH
COMPLIANCE

250

P
0

15

30

PEEP 5

Spontaneus
breathing

15

INSPIRATION

30

15

30

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)

FLOW =

BRONCHOCONSTRICTION:
HISTAMIN

PRESSURE

RESISTANCE

OBSTRUCTION:
MUCUS / SECRET

AIRWAY
RESISTANCE (RAW)
TOO SMALL
ETT

FLOW =

PRESSURE

RESISTANCE

BRONCHOSPASM
TUMOUR / SECRET

COLLAPSE/ATELECTASIS

Partial Pressure

Daltons 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
shunt

alveolar dead space

TERIMA KASIH

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