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SPINE

INTERNAL. EXTERNAL. SPINE. RIBCAGE. SPINE. Outside pressure. Inside pressure. P = atmospheric pressure. P . P. P = 0. P = 0. P = 0. P = 0. P = -5. NORMAL. PNEUMOTHORAX. flat thoracic wall spring. flat thoracic wall spring. coiled lung spring. coiled lung spring.

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SPINE

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  1. INTERNAL EXTERNAL SPINE

  2. RIBCAGE SPINE

  3. Outside pressure Inside pressure

  4. P = atmospheric pressure P P

  5. P = 0 P = 0 P = 0 P = 0 P = -5 NORMAL PNEUMOTHORAX

  6. flat thoracic wall spring flat thoracic wall spring coiled lung spring coiled lung spring minimum volume V1 FRC NORMAL PNEUMOTHORAX

  7. VOLUME 100 100 % TLC % VC 75 50 50 25 lung 0 pump 0 -40 -20 0 cm H2O INTRAPLEURAL PRESSURE

  8. P varies with T T varies inversely with r So P varies inversely with r Surfactant reduces T more if r ↓ r Fluid lining So T now does not vary with r and neither does P P T ↓ T r ↑ Surface tension

  9. 200 150 100 50 0 0 5 10 15 20 SALINE VOLUME ml AIR INFLATION PRESSURE cm H2O

  10. VOLUME 100 100 % TLC 75 V1 50 50 25 lung 0 pump 0 -20 0 20 cm H2O INTRAPLEURAL PRESSURE

  11. V1 Inspiratory muscles FRC Volume Min Vol -’ve Intrapleural Pressure

  12. 100 100 % TLC % VC 75 V1 50 50 FRC 25 0 0 -20 0 20 cm H2O

  13. 100 100 % TLC % VC 75 V1 50 50 FRC FRC 25 0 0 -20 0 20 cm H2O

  14. Laminar Flow Turbulent Flow Airway Flow

  15. TLC 16 12 glottis CROSS-SECTIONAL AREA (square cm) 8 4 RV 0 0 12 24 36 42 80 DISTANCE FROM MOUTH (cm)

  16. 52 48 pressure to overcome elastic recoil 44 40 36 32 pressure to overcome tissue movement resistance pressure to overcome airway resistance INSPIRATION thorax wall lung % VC -10 -8 -6 -4 -2 0 Intrapleural Pressure cm H2O

  17. 52 48 recoil pressure 44 40 pressure to overcome airway resistance 36 pressure to overcome tissue movement resistance 32 pressure to overcome persistent inspiratory muscle activity EXPIRATION thorax wall lung % VC -10 -8 -6 -4 -2 0 Intrapleural Pressure cm H2O

  18. 52 Work done by the inspiratory muscles overcoming airway resistance lost as heat 48 44 40 36 32 INSPIRATION % VC thorax wall lung Work done by the inspiratory muscles overcoming tissue movement resistance lost as heat Work done by the inspiratory muscles overcoming system compliance stored as potential energy in the lung compliance Potential energy yielded by the thoracic wall compliance stored as potential energy in the lung compliance -10 -8 -6 -4 -2 0 Intrapleural Pressure cm H2O

  19. 52 48 44 40 36 32 EXPIRATION % VC Work done by the stored potential energy overcoming airway resistance lost as heat thorax wall lung Work done by the lung compliance stored potential energy overcoming tissue movement resistance lost as heat Work done by the lung compliance stored potential energy overcoming the persistent activity of the inspiratory muscles Potential energy yielded by the lung compliance stored as potential energy in the thoracic wall compliance -8 -6 -4 -2 0 Intrapleural Pressure cm H2O

  20. total work of breathing resistive work against airway & tissue movement resistance WORK OF BREATHING elastic work against compliance BREATHING FREQUENCY (breaths/minute)

  21. 0 52 48 44 40 36 32 % VC End Expiration thorax wall lung 0 Airway opening pressure = 5 PI = -5 PA = 0 5 5 -5 -10 -8 -6 -4 -2 0 PM = 0 Intrapleural Pressure cm H2O

  22. 0 52 48 44 40 36 32 % VC During Inspiration thorax wall lung -1 Airway opening pressure = 7 PI = -8 PM PA = -2 6 4-1=3 -3 -10 -8 -6 -4 -2 0 PM = 5 Intrapleural Pressure cm H2O

  23. 0 52 48 44 40 36 32 % VC End Inspiration thorax wall lung 0 PM Airway opening pressure = 7 PI = -7 PA = 0 7 3 -7 -3 -10 -8 -6 -4 -2 0 PM = 4 Intrapleural Pressure cm H2O

  24. 0 52 48 44 40 36 32 % VC During Expiration thorax wall lung 0.5 Airway opening pressure = 5.5 PI = -5 PA = 1 6 4+1=5 -5 -10 -8 -6 -4 -2 0 PM = 0 Intrapleural Pressure cm H2O

  25. Airway closing pressure = 10 % VC 52 thorax wall lung 48 44 40 36 32 -5 -10 -8 -6 -4 -2 0 Intrapleural Pressure cm H2O During Forced Expiration 0 16 PI = 26 PA = 32 6 4 PM = 30

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