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An elderly, 70-year-old, female went to the emergency room for breathing…

- - - - Respiratory failure or death
- - - - Removal of debris is an important part of the immune system protecting the respiratory system from infections.
- - - - HOMEOSTATIS
- - - - Nose and Paranasal Sinuses
        
        Nasal Cavity
        
        Mucus-secreting cells and serous cells
        
        Serous cells secrete watery fluid containing enzymes
        
        Inlet for air
        
        Moistens and warms air
        
        Filters and cleans inspired air
        
        Serves as resonating chamber for speech
        
        Houses olfactory receptors
        
        Nasal conchae
        
        Mucosa-covered projections that protrude medially from lateral wall of nasal cavity
        
        Increase mucosal area
        
        Enhance air turbulence
        
        Filter, heat, and moisten air
      - The Pharynx
        
        Connects nasal cavity and mouth to larynx and esophagus
        
        Skeletal muscle
  - - - The Larynx
        
        Provides patent airway
        
        Routes air and food into proper channels
        
        Voice production
        
        Houses vocal folds
        
        Nine hyaline cartilages (except for epiglottis), connected by membranes and ligaments
        
        Epiglottis
        
        Consists of elastic cartilage
        
        Covers laryngeal inlet during swallowing
      - The Trachea
        
        extends from larynx into mediastinum, where it divides into two main bronchi
        
        Mucosa lined with ciliated pseudostratified epithelium with goblet cells
        
        Submucosa is connective tissue supported by 16–20 C-shaped cartilage rings that prevent collapse of trachea
      - The Bronchi and Subdivisions
        
        Air passages undergo 23 orders of branching (bronchial tree)
        
        Conducting zone structures give rise to respiratory zone structures
        
        Divides to form right and left main (primary) bronchi
        
        Right main bronchus larger and straighter than left
        
        Each main bronchus then divides into secondary (lobar) bronchi
        
        branches into tertiary bronchi and these divide repeatedly, becoming very small
        
        Elastic fibers
        
        Smooth muscle increases
        
        Respiratory zone structures
        
        Feed into respiratory bronchioles, which lead into alveolar ducts and finally into alveolar sacs (saccules)
        
        Alveolar sacs contain clusters of alveoli
        
        Sites of actual gas exchange
        
        Surrounded by fine elastic fibers and pulmonary capillaries
        
        1 more item...
        
        Equalize air pressure throughout lung
        
        Provide alternate routes in case of blockages
        
        1 more item...
        
        2 million dead macrophages/hour carried by cilia to throat and swallowed
        
        Respiratory membrane
        
        Blood air barrier that consists of alveolar and capillary walls along with their fused basement membranes
        
        Single layer of squamous epithelium (type I alveolar cells)
        
        Scattered cuboidal type II alveolar cells secrete surfactant and antimicrobial proteins
      - The Lungs
        
        Hilum
        
        The site for entry/exit of blood vessels, bronchi, lymphatic vessels, and nerves
        
        Cardiac notch
        
        concavity for heart to fit into (left lung)
        
        The Pleurae
        
        Fills slitlike pleural cavity between two parietal and visceral pleurae
        
        Lubrication and surface tension that assists in expansion and recoil of lungs
    - - Cleanses, warms, and humidifies air
        
        larynx, trachea, bronchi
    - - site of gas exchange
        
        respiratory bronchioles, alveolar ducts, and alveoli
  - - - Pressure exerted by air surrounding the body
        
        760 mm Hg at sea level = 1 atmosphere
    - - Pressure in alveoli
      - Fluctuates with breathing
      - Always eventually equalizes with Patm
    - - Pressure in pleural cavity
      - Always a negative pressure
      - Kept free from excess fluid thanks to lymphatics
      - If fluid accumulates, positive Pip pressure develops
      - Lung collapses
    - - inspiration and expiration
      - depends on volume changes in thoracic cavity
        
        Volume changes lead to pressure changes
        
        Pressure changes lead to flow of gases to equalize pressure
      - Boyle’s law
        
        inverse relationship between pressure and volume of a gas
        
        Gases always fill the container they are in
        
        If amount of gas is the same and container size is reduced, pressure will increase
        
        Volume increase = Pressure decrease
      - Inspiration
        
        Active process- contraction of inspiratory muscles (diaphragm and external intercostals)
        
        Chest volume increases, lungs are stretched as they are pulled out with thoracic cage
        
        Causes intrapulmonary pressure to drop by 1 mm Hg
      - Expiration
        
        Quiet expiration normally is passive process
        
        Inspiratory muscles relax, thoracic cavity volume decreases, and lungs recoil
        
        Volume decrease causes intrapulmonary pressure to increase by +1 mm Hg
        
        Forced expiration is an active process that uses oblique, transverse abdominal muscles and internal intercostal muscles
      - Nonrespiratory air movements
        
        Many processes can move air into or out of lungs besides breathing
        
        May modify normal respiratory rhythm
        
        Most result from reflex action, although some are voluntary
        
        Examples: coughing, sneezing, crying, laughing, hiccups, and yawns
    - - External respiration
        
        diffusion of gases between blood and lungs
      - Internal respiration
        
        diffusion of gases between blood and tissues
      - Both processes are subject to:
        
        Basic properties of gases
        
        Composition of alveolar gas
      - Basic Properties of Gases
        
        Dalton’s law of partial pressures
        
        Total pressure exerted by mixture of gases = sum of pressures exerted by each gas
        
        Partial pressure = Pressure exerted by each gas in mixture
      - Carbon Dioxide Transport
        
        Dissolved in plasma
        
        Chemically bound to hemoglobin
        
        As bicarbonate ions in plasma
        
        CO2 + H2O <=> H2Co3 <=> H+ + CO3-
      - C6H12O6 + 6O2 -> 6CO2 + 6 H2O + 36 ATP
        
        THE GOAL OF RESPIRATION IS TO GAIN ENERGY
        
        Henry's Law
        
        When a liquid is exposed to a mixed gas, the partial pressure of each gas at equilibrium is the same in the liquid as in the gas.
        
        The partial pressure response of a gas in alveoli will diffuse into blood the same as it would to air
    - - High altitude conditions always result in lower-than-normal Hb saturation levels
        
        less availability of O2
        
        Decline in blood O2 stimulates kidneys to accelerate production of EPO
        
        RBC numbers increase slowly
    - - Continual bronchial
        irritation and inflammation
        
        Chronic bronchitis
        
        Excess mucus production
        
        Chronic productive cough
        
        Airway obstruction or air trapping
        
        Dyspnea
        
        Frequent infections
      - Asthma
        
        Characterized by coughing, dyspnea, wheezing, and chest tightness
        
        Active inflammation of airways precedes bronchospasms
        
        Airway inflammation is an immune response leading to inflammation
        
        Airways thickened with inflammatory exudate magnify effect of bronchospasms – spasms of smooth muscle