RCP 110 Pulmonary Vascular System 🌈.docx

**Pulmonary Vascular System 🌈** The pulmonary vascular system consists of 2 pulmonary arteries and 4 pulmonary veins, which make up the pulmonary circuit. **Composition** - **Arteries**: composed of three layers: - Tunica intima (inner layer): endothelium, elastic tissue, and co...

**Pulmonary Vascular System 🌈** The pulmonary vascular system consists of 2 pulmonary arteries and 4 pulmonary veins, which make up the pulmonary circuit. **Composition** - **Arteries**: composed of three layers: - Tunica intima (inner layer): endothelium, elastic tissue, and connective tissue - Tunica media (middle layer): elastic connective tissue and smooth muscle - Tunica externa (outer layer): connective tissue, small vessels - **Arterioles**: supply nutrients to respiratory bronchioles, alveolar ducts, and villi - **Capillaries**: where gas exchange occurs; selective permeable endothelium allows for passive passage of nutrients and electrolytes - **Venules** and **Veins**: move away from bronchi, taking a direct route out of the lungs - 2 large veins coming off the left and right lungs, emptying into the left atrium **Hilum 👀** *\"Hilum is an area where things pass through. It\'s a collection of tissue, mid-brain, that area, and the vessels, nerves have to pass through.\"* **Lymphatic System 💧** The lymphatic system helps remove excess fluid and protein molecules that leak out of pulmonary capillaries. **Characteristics** - **Lymph nodes**: filter out toxins, found superficially around the lungs, just beneath the visceral pleura - **Lymphatic vessels**: more numerous and larger on the left side than the right side, especially near the heart **Importance** - Removes excess fluid that pools in the lower parts of the lungs - Filters out toxins and protein molecules **Neuro Control of Lungs 🧠** The autonomic nervous system controls the balance, tone, and smooth muscle of the lungs. **Divisions** - **Sympathetic Nervous System (Fight or Flight)**: - Releasing neurotransmitters such as epinephrine and norepinephrine - Stimulates beta 2 receptors on bronchial smooth muscle, causing relaxation and increased airflow - Constricts pulmonary vascular system, increasing blood pressure - **Parasympathetic Nervous System (Rest and Digest)**: - Decreases heart rate and contractility - Constricts bronchial smooth muscle, decreasing airflow - Increases bronchial gland secretions **Effects on Vital Signs** **System** **Sympathetic** **Parasympathetic** ------------------------- ----------------- --------------------- Heart Rate ❤️ Increases ❤️ Decreases Respiratory Rate 👅 Increases 👅 Decreases Bronchial Smooth Muscle 💪 Relaxes 💪 Constricts Bronchial Glands 💧 Decreases 💧 Increases Pupils 👀 Dilates 👀 Constricts The autonomic nervous system (ANS) is made up of the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). **Functions of the ANS** The ANS regulates the following organs: - Heart - Bronchial fluid muscle - Bronchial glands **Neurotransmitters and Actions** **Neurotransmitter** **Action** -------------------------- -------------------------------------------------------------- **Epinephrine** (SNS) Causes heart rate and blood pressure to increase **Norepinephrine** (SNS) Constricts blood vessels and increases blood pressure **Acetylcholine** (PNS) Causes constriction of bronchioles and smooth muscle vessels **Medications and Actions** Medications can be used to combat reactions in the ANS. There are two types of medications: - **Sympathomimetic**: Mimics the SNS, relaxing and dilating airways - Acetylcholine antagonists (e.g., Albuterol) - **Anticholinergic**: Blocks the PNS, not allowing signals to go through - Acetylcholine antagonists (e.g., Ipratropium) **Combination Medications** Some medications combine both sympathomimetic and anticholinergic effects: - **Combinant**: Combination of Albuterol and Ipratropium (e.g., DuoNeb) **Anatomy of the Lungs and Thoracic Cage 🏰** **Shape of the Lungs** The lungs are shaped like a cone, with the **apex** at the top. **Divisions of the Lungs** The right lung is divided into **3 lobes**: - Upper lobe - Middle lobe - Lower lobe The left lung is divided into **2 lobes**: - Upper lobe - Lower lobe **Fissures of the Lungs** Fissures are divisions that separate the lobes of the lungs. - **Oblique fissure**: Separates the upper and middle lobes from the lower lobe - **Horizontal fissure**: Separates the middle lobe from the upper lobe (only in the right lung) **Thoracic Cage** The thoracic cage is made up of: - **Rib cage** - **Spine** - **Sternum** It protects the heart and lungs. **Pleura and Pleural Cavity** The pleura is a layer of tissue that surrounds the lungs. There are two layers: - **Parietal pleura**: Outer layer, close to the rib cage - **Visceral pleura**: Inner layer, close to the lungs The pleural cavity is the space between the two layers, containing **pleural fluid**. **Pleural Diseases** - **Pleurisy**: Inflammation of the pleura, causing friction and pain - **Pleural effusion**: Fluid accumulation in the pleural cavity - **Empyema**: Infected fluid accumulation in the pleural cavity **Thoracentesis** Thoracentesis is a procedure to drain fluid from the pleural cavity using a needle or chest tube. It is used to treat pleural effusion and empyema.\#\# Pneumothorax 💉 **What is a Pneumothorax?** A pneumothorax is the introduction of air in the pleural cavity through an opening in the chest wall or a rupture in the lung. **Types of Pneumothorax** **Closed Pneumothorax** - Air has accumulated in the pleural cavity due to a rupture in the lung. - The gas in the interpleural space is not in direct contact with the atmosphere. - Example: Premature baby with no surfactant, internally developed pneumothorax. *\"Air exits the lung and goes into the pleural space, where is it gonna go from there? Spread. It can\'t. It\'s stuck.\"* **Open Pneumothorax** - Air has accumulated in the pleural cavity due to an opening in the chest wall. - The gas in the interpleural space is in direct contact with the atmosphere. - Example: Gunshot wound or stab wound to the chest. **Characteristics of Pneumothorax** **Closed Pneumothorax** **Open Pneumothorax** ----------------------------- ------------------------- --------------------------- **Cause** Rupture in the lung Opening in the chest wall **Contact with Atmosphere** No direct contact Direct contact **Air Origin** From the lung From the atmosphere **Tension Pneumothorax ⚠️** - The pressure inside the pleural cavity is higher than atmospheric pressure. - This can cause the heart and lungs to shift away from the affected area. - *Tension pneumothorax is a life-threatening condition and requires immediate medical attention.* **Treatment** - Chest tube insertion to evacuate air from the pleural cavity. - Positive pressure ventilation to help the patient breathe. **Tension Pneumothorax 🚨** - A medical emergency that requires immediate attention - Occurs when air builds up in the space between the lungs and chest wall, causing pressure on the heart and other organs - Can lead to decreased blood flow and oxygenation, causing damage to the body **Angles of Louis 👀** - The joint that connects the sternum and xyphoid process - Located at the level of the T5 vertebra - Also where the aortic arch ends and the trachea bifurcates into the left and right bronchi **🏃‍♂️ The Diaphragm** **Definition** *The muscle of ventilation, responsible for breathing* **Characteristics** - Dome-shaped and composed of right and left hemidiaphragms - Pierced by the esophagus, aorta, nerves, and inferior vena cava - Innervated by the phrenic nerves, which control the heart and lungs **Function** - Responsible for ventilation and breathing - Can ventilate the body on its own in healthy individuals - Requires accessory muscle use during exercise or with lung disease (COPD, CF, bronchitis) **Accessory Muscles of Ventilation** **Inspiration** **Muscle** **Description** ----------------------- ----------------- Scalene Sternocleidomastoid External intercostals Trapezius **Expiration** **Muscle** **Description** ----------------------- ----------------- Abdominal muscles Internal intercostals **Importance of Accessory Muscles** - Compensatory mechanism that kicks in when the diaphragm is not strong enough - Can be seen in individuals with COPD, who often have pronounced accessory muscles due to long-term disease - Use of accessory muscles is a sign of respiratory distress - Surfactant plays a crucial role in preventing pneumothorax in premature babies. - Research is being conducted on using synthetic surfactants to prevent pneumothorax in adults. - Tension pneumothorax can cause tracheal deviation and paradoxical breathing.\#\# 💊 Tension Pneumothorax and the Diaphragm