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metabolism
• Production of speech
Peripheral receptors
Sistim respirasi
The respiratory tract
Alveolus
The lower airways
Respiratory Tract
Trachea
Respiration
O2
CO2
Mechanisms of Ventilation:
1. Inspiration
Active process
- diaphragm contracts and lowers
- external intercostals contract, elevating the ribs
Result
- diameter and longitudinal dimensions of the thorax,
decreasing the intrapulmonic pressure
(now atmospheric pressure > intrapulmonicpressure)
air flows in from the atmosphere until pressures are =
Mechanisms of Ventilation:
2. Expiration
Passive process
- diaphragm relaxes
Diaphragm
Diaphragm
Inspiration Expiration
Spontaneous breathing
Pressure
kPa
Intrapulmonary pressure
-1 Intrapleural pressure
Time
Insp. Exp. Insp. Exp. s
Pressure
Controlled ventilation
kPa
+1
Intrapulmonary pressure
Intrapleural pressure
-1
Time
Insp. Exp. Insp. Exp. s
Pressure
Spontaneous breathing
kPa
Intrapulmonary pressure
0
Intrapleural pressure
s
-1
Time
Insp. Exp. Insp. Exp.
Pressure
IRV IC VC TLC
5
VT
3
ERV
2
FRC
1 RV
Time
0 s
3 Processes:
1. Ventilation - movement of air in & out --
depends on system of open (clear)
airways & movement of respiratory
muscles, primarily the diaphragm which
is innervated by the phrenic nerve.
3. Perfusion
PROSES PERNAFASAN
Gabungan mekanisme yang berperan
dalam suplai oksigen keseluruh sel
dan eliminasi karbon dioksida
= 500 ml x 12 = 6 L/mnt
Ventilasi Alveolar ( VA )
= VE - Vent. Ruang Mati ( VD )
Dipengaruhi oleh :
Patensi jalan nafas
Posisi tubuh
Volume paru
“Dead space”
“Shunting”
Patensi Jalan Nafas :
obstruksi
Infeksi
tumor
Perfusion disorder :
Pulmonary embolism
Sumbatan pada mikrosirkulasi paru
karena agregasi platelet dan granulosit :
• septicemia
• peritonitis
• acute pancreatitis
Extra pulmonary : reduced CO pada gagal
jantung, atau pada kondisi syok
SIRKULASI PULMONER
Sifat :
Tekanan pembuluh darah rendah, MAP 8 - 15
mmHg
Mudah mengembang (distensible)
Resistensi rendah
ANATOMICAL FUNCTIONAL
Bronchial Atelectasis
Pleural Pneumothorax
Thabesian Hematothorax
CHD Pleural effusion
(Congenital Heart Disease) Pulmonary edema
Tumor Paru Pneumonia
Arteriovenous Anastomosis Acute Respiratory
Failure (ARDS)
DEAD SPACE
ANATOMICAL ALVEOLAR
Physiological
Ventilation
dead space
Anatomical
dead space
Circulation - perfusion
Penyebab :
VT or f ( )
Drug
Anesthesia
CNS
Fatigue
….Hypercapnia
Penyebab lain
• Tidak mampu merespon terhadap PaCO2
– Obat-obatan
– Alkalemia
– COPD
• Tidak mampu bernafas ok
– Spinal cord injury
– Neuromuscular blocker
– Guillain-Barre` Syndrome
– Myasthenia Gravis
• Otot pernafasan yang lemah ok
– Fatique, Malnutrition, Dystrophy
…..Hypoxemia
P (A-a) O2 gradient
• Alveolar hypoventilation
• High Altitude
Diffusion
• Transport of gases between the alveoli and
(pulmonary) capillaries and eventually from the
capillaries to the tissues
Pulmonary capillary
Alveolus
Artery
Cell
Tissue capillary
Summary of gas exchange and gas transport
Cell
Tissue capillary
Vein
Alveolus
Pulmonary capillary
Oxygenation
UDARA BEBAS:
PiO2 : 21% x 760 = 160 mmHg
PiCO2 : 0.04 % x 760 = 0.3 mmHg
ALVEOLUS
PiN2 : 78.6 % x 760 = 597mmHg
PiH2O : 0.46 % x 760 = 3.5 mmHg
N2 H2O
KAPILER PARU
PAN2: PAH2O:
PROSES DIFUSI 573 mmHg 47 mmHg
Peripheral receptors
Ventilation
The normal regulation of breathing
PaCO2
Receptors Hyperventilation
The blood Low PaO2
PaCO2 Peripheral
TRAUMA
OTAK NARKOTIKA
DEPRESSANT / ANESTHETIC
INFEKSI , PERDARAHAN
GUILLAIN BARRE
SYARAF POLIOMYELITIS , POLINEUROSIS
MYASTHENIA GRAVIS
TETANUS
OTOT RELAXANT / CURARE