LECTURE-1-AIRWAY-MANAGEMENT-PRECIOUSdocx (1).pdf

HERMANO|AIRWAY MANAGEMENT| DIAMANTE 1 THE UPPER AIRWAY  Nose  Oral Cavity  Pharynx  Larynx THE UPPER AIRWAY: Primary functions of the upper airway are:  to act as a conductor of air  to humidify and warm the inspired air  to prevent foreign materials from en...

HERMANO|AIRWAY MANAGEMENT| DIAMANTE 1 THE UPPER AIRWAY  Nose  Oral Cavity  Pharynx  Larynx THE UPPER AIRWAY: Primary functions of the upper airway are:  to act as a conductor of air  to humidify and warm the inspired air  to prevent foreign materials from entering the tracheobronchial tree  to serve as an important area involved in speech and smell.  NOSE -filter, humidify, and warm inspired air -also important as the site for the sense of smell and to generate resonance in phonation -Stratified squamous epithelium (non ciliated) lines the anterior one-third of the nasal cavity. -Posterior two-thirds of the nasal cavity are lined with pseudostratiied ciliated columnar epithelium. HERMANO|AIRWAY MANAGEMENT| DIAMANTE 2 HERMANO|AIRWAY MANAGEMENT| DIAMANTE 3  ORAL CAVITY -houses the anterior two-thirds of the tongue; posterior one-third of the tongue is attached to the hyoid bone andf the mandible in the pharynx -levator veli palatinum muscle elevates the soft palate, and the palatopharyngeal muscles draw the soft palate forward and downward -nonciliated stratified squamous epithelium HERMANO|AIRWAY MANAGEMENT| DIAMANTE 4  PHARYNX A. Nasopharynx B. Oropharynx C. Laryngopharynx HERMANO|AIRWAY MANAGEMENT| DIAMANTE 5  LARYNX -or voice box is located between the base of the tongue and the upper end of the trachea -serves three functions 1. act as a passageway of air between the pharynx and the trachea 2. serves as a protective mechanism against the aspiration of solids and liquids 3. Generates sound for speech THE LARYNX -thyroid cartilage (commonly called the Adam’s apple) is the largest cartilage of the larynx -epiglottis is a broad, spoon-shaped fibrocartilaginous structure; prevents the aspiration -cricoid cartilage is shaped like a signet ring; attached to the first C-chaped cartilage of the trachea HERMANO|AIRWAY MANAGEMENT| DIAMANTE 6 THE LOWER AIRWAYS  THE CARTILAGINOUS AIRWAYS -Trachea -Main Stem Bronchi -Lobar Bronchi -Segmental Bronchi -Subsegmental Bronchi HERMANO|AIRWAY MANAGEMENT| DIAMANTE 7  THE NON-CARTILAGINOUS AIRWAYS -Bronchioles -Terminal Bronchioles Airways exist in two major forms: 1. Cartilaginous airways- serve only to conduct air between the external environment and the sites of gas exchange 2. Non-cartilaginous airways- serve both as conductors of air and as sites of gas exchange.  The Cartilaginous Layer -outermost layer of the tracheobronchial tree, progressively diminishes in size as the airways extend into the lungs. Cartilage is completely absent in bronchioles less than 1 mm in diameter. HERMANO|AIRWAY MANAGEMENT| DIAMANTE 8  THE CARTILAGINOUS AIRWAYS 1. TRACHEA -extends from the circoid cartilage to the articulation point between the manubrium and body of the sternum (angle of Louis) -Adult trachea (is approximately 12 cm long and has an inner diameter of about 2 cm. -typical adult trachea has 16 to 20 tracheal rings. -posterior wall of the trachea is a thin band tisue, called the trachealis muscle that support the open ends of the tracheal rings. -At the base of the trachea, the last cartilaginous ring that forms the bifurcation for the two bronchi is called the carina (normally at the base of the aortic arch). 2. MAIN STEM BRONCHI -Right main stem bronchus 20 to 30 degrees, wider, more vertical, and about 5cm shorter than the left main stem bronchus. -Left main stem bronchus branches with 45 to 55 degrees -In the newborn, both the right and left main stem bronchi form about a 55-degree angle with the trachea. 3. LOBAR BRONCHI -are the tracheobrinchial tree’s second generation -RMSB: upper, middle, and lower lovar bronchi -LMSTB: upper and lower lobar bronchi 4. SEGMENTAL BRONCHI -third generation of bronchi branch off the lobar bronchi to form the segmental bronchi HERMANO|AIRWAY MANAGEMENT| DIAMANTE 9 HERMANO|AIRWAY MANAGEMENT| DIAMANTE 10 5. SUBSEGMENTAL BRONCHI - The tracheobronchial tree continues to subdivide between the fourth and approximately the ninth generation into progressively smaller airways. -range in diameter from 1 to 4 mm. Peribronchial connective tissue containing nerves, lymphatics, and bronchial arteries surrounds the subsegmental bronchi to about 1-mm diameter level. Beyond this point, the connective tissue sheaths disappear. THE NON-CARTILAGINOUS AIRWAYS 1. BRONCHIOLES -less than 1 mm in diameter and are no longer surrounded by connective tissue sheaths -found between the tenth and fifteenth generations 2. TERMINAL BRONCHIOLES -begin about 12 to 15 generations beyond the trachea -where the conducting tubes of TBT ends -Branching gives rise to unique airways “respiratory bronchioles” HERMANO|AIRWAY MANAGEMENT| DIAMANTE 11 Terminal Bronchioles -progressively becomes thinner, small channels called canals of lambert -canals of lambert (begin to appear) -prescence of Clara cells Structures beyond the terminal bronchioles are the sites of gas exchange and, although connected to it, are not considered part of the tracheobronchial tree. THE SITES OF GAS EXCHANGE SINGLE TERMINAL BRONCHIOLE- supplies a cluster of respiratory bronchioles. -collectively, this unit is the “acinus”, or “primary lobule” -each acinus comprises numerous respiratory bronchioles, alveolar ducts, and approximately 10,000 alveoli. -Gas molecule movement in this region is largely via diffusion rather than connective flow, which occurs in larger airways. HERMANO|AIRWAY MANAGEMENT| DIAMANTE 12 ALVEOLAR EPITHELIUM 1. Type I Cell (Squamous Pneumocyte) -form about 95 percent of the alveolar surface -major sites of alveolar gas exchange 2. Type II Cell (Granular Pneuomocyte) -form the remaining 5 percent -have microvilli and are cuboidal in shape -believed to be the primary source of pulmonary surfactant HERMANO|AIRWAY MANAGEMENT| DIAMANTE 13 PORES OF KOHN -small holes in the walls of the interalveolar septa -permit gas to move between adjacent alveoli -Formation may include one or more:  Desquamation (shedding or peeling) of epithelial cells  Normal degeneration of tissue cells as a result of age  Movement of macrophages, which may leave holes in the alveolar walls. ALVEOLAR MACROPHAGES -aka “type III” alveolar cells, play a major role in removing bacteria and other foreign particles INTERSTITIUM -gel-like substance composed of hyaluronic acid molecules that are held together by a web-like network of collagen fibers -Two major compartments:  tight space- area where most gas exchange occurs  Loose space- surrounds the acinus HERMANO|AIRWAY MANAGEMENT| DIAMANTE 14 ADULT CARDIO ANATOMY AND PHYSIOLOGY HERMANO|AIRWAY MANAGEMENT| DIAMANTE 15 HEART The heart is enclosed in a sac called the pericardium. 1. Fibrous pericardium: tough, loose-fitting, and inelastic sac surrounding the heart 2. Serous pericardium: a thin, slippery, serous membrane, consisting of two layers: A. Parietal layer: inner linning of the fibrous pericardium B. Visceral layer or epicardium: covering the outer surface of the heart and great vessels Pericardial fluid seperates the two layers of the serous pericardium. THE WALL OF THE HEART 1. EPICARDIUM 2. MYOCARDIUM 3. ENDOCARDIUM