Anatomi dan Fisiologi

Jalan Nafas

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The Bodys Need for

Oxygen

Living tissue must have oxygen to survive.

Brain death in humans occurs within 6 to 10

minutes of tissue anoxia.

Rapid and safe airway control is paramount to

the successful management of critically ill and
injured patients.

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Airway Anatomy
Upper airway structures include the:
Mouth Nose
Pharyng
Oropharyng
The lower airway structures include the:
Laryng
Trachea
Bronchi
Bronchioles Alveoli
Lungs
.

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Nose

Nasal cavity

Pharynx

Larynx

conducting zone

Trachea

Bronchi

Bronchioles

Transport, cleanse, warm and

humidify incoming air
Not involved in gas exchange
Anatomical Dead Space

Respiratory bronchioles

Alveolar ducts

Alveoli

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respiratory
zone
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Function in gas
exchange

MOUTH
hard palate

soft palate

teeth
tongue

lips

oropharyng
mandible

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NOSE
frontal sinus

sphenoid
sinus

Concha superior
Concha medius
Concha inferior

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PHARYNG:
- Nasopharyng
- Oropharyng
(throat)

- Laryngopharyng

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frontal sinus
sphenoid
sinus
eustachian opening

hard palate
conch
a

nasopharyn
g soft palate
uvula

tongue

tonsilla palatina
oropharyng
epiglottis
laryngopharyng

UPPER

vocal cord
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trache
a

LOWER
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LARYNG
(VOICE BOX)
- separates pharyng and
trachea
- cartilages, membrane,
ligaments

45 mm long, 35 mm
- 35 mm long, 25 mm
-

FUNCTION
- Patent airway

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To act as a switching

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to route air and

Framework of the
Larynx

thyrohyoi
d
ligament

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CRICOTHYROTOMY

- acute, life threatening upper

airway obstruction
- intubation not possible
- conventional airway
management not possible

SELLICKS MANEUVRE

Used to prevent gastric distention

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Technique
Apply slight pressure
anteriorly over
cricoid cartilage
Closes off esophagus

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Sellicks
Manuever

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Movements of
Vocal Cords

The intrinsic muscles of the larynx attach to

the arytenoid cartilage, and allow for
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movement
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Glottis &
Epiglottis

epiglottis
glottis

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TRACHEA

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TRACHEA VIEWED FROM ABOVE

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BRONCHIAL TREE
primary bronchus

secondary
bronchus
tertiary
bronchus
bronchiole
terminal
bronchiole

respiratory zone
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hair like projection called cilia line the primary

bronchus to remove microbes and debris from th
interior
of the lungs
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Notice that the right is more vertical and fatter th

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a bit of an angle.
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Respiratory bronchioles,
alveolar ducts, alveolar
sacs

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Alveolar sacs

Alveolar sacs
look like
clusters of
grapes

The individual
grapes are
alveoli

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Alveoli

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air-blood barrier

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Respiratory Physiology
Breathing

Pulmonary Ventilation the movement of air into and out of

the lungs

Gas exchange occurs due to a pressure gradient (partial

pressures of gas)

Two phases

Inspiration: Breathing in

Active process

Expiration: Breathing out

Passive process

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Inspiration is initiated by a stimulus in the

respiratory center of the brain.

The signal is transmitted to the diaphragm via the
phrenic nerve.
The impulse causes the diaphragm to contract or
flatten.
This causes intrapulmonic pressure to fall below
atmospheric pressure and air is drawn into the
lungs like a vacuum.
The ribs elevate and expand, the alveoli inflate,
and oxygen and carbon dioxide diffuse across the
membrane.

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Pressure in Thoracic Cavity

Respiratory pressures are always described relative

to atmospheric pressure

Boyles Law:

Volume of gas is inversely proportional to

pressure (if temperature constant)
Volume= Constant
Pressure

So, when the volume of the container increases

(expansion of the lungs), the pressure decreases

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Boyles Law

As the size of
closed container
decreases,
pressure inside
is increase

Same number
of molecules
striking a
smaller
surface area

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Pressure in Thoracic Cavity

Atmospheric Pressure (Patm) - pressure exerted
by the air surrounding the body. At sea level
its equal to 760mmHg.
Intrapulmonary Pressure (P ) - pressure exerted
alv
by the air within the alveoli. It rises and falls
during inspiration and expiration, but it
always equalizes with atmospheric pressure.
Intrapleural Pressure (P ) - pressure within the
ip
pleural cavity. It is always lower than both
atmospheric pressure and intrapulmonary
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pressure.
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Patm
pleura
parietalis

Pip
Palv

pleural cavity
pleura
visceralis
(attach to the
lung)
alveoli

Patm 760 mmHg

Palv rises and falls during inspiration and expiration, b
always equalizes with atmospheric pressure
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atm or
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Lung Tissue

It is elastic and has a

tendency to recoil
Ribs want to expand
outward
Lungs want to collapse

Since the pressure in the plural space is

lower than in the alveoli, the alveoli do not
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collapse.

Inspiration

Alveolar pressure falls below

atmospheric pressure.

Contraction of the diaphragm and

external intercostal muscles increases
the size of the thorax (thereby
decreasing the intra-pleural pressure)
and the lungs expand.

Intra-pleural (thoracic) pressure is

always
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Inspiration

Expansion of the lungs decreased

alveolar pressure to 758 mm Hg

Atmospheric pressure is 760 mm Hg

Air flows into the lungs because of this

pressure gradient

Inspiration causes intra-pleural

pressure to decrease to 754 mm Hg

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EXPIRATION

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Air is forced out

of the lungs as
the muscles
relax reducing
the volume of
the chest cavity
and increasing
the pressure
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EXPIRATION

Occurs when alveolar pressure is higher

than atmospheric pressure
762 mm Hg

Elastic recoil of the chest wall and lungs

(main force) and the relaxation of the
diaphragm increases intra-pleural and
alveolar pressure and decreases lung
volume

Air moves out

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Pulmonary Ventilation
3 Major Factors
Alveolar surface tension
Compliance
Airway resistance
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Alveolar surface tension

Surface tension causes the alveoli to

assume the smallest diameter

Major component of lung elastic recoil

Surfactant is a phospholipid produced by

Type II cells in alveolar walls

Alters surface tension below the surface

tension of pure water
Prevents alveolar collapse following expiration
If surface tension is too high, alveoli collapse
and great effort is needed to reopen them

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Compliance
Ratio of volume changes caused by pressure changes V/P

Lung Compliance

Thoracic wall Compliance

Low compliance
To get desired volume there must be higher pressure

High compliance
Low pressure will give high tidal volume
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COMPLIANCE (COMPL)
BALLOON
stiff

Elastis

HIGH
COMPLIANCE

LOW
COMPLIANCE

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P-V LOOP
EKSPIRATION
Vol
NORMAL
500

500

250

250

LOW
COMPLIANCE

500

HIGH
COMPLIANCE

250

P
0

15

30

PEEP 5

15

30

15

30

INSPIRATION

Spontaneus
breathing
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Resistance

The walls of the respiratory passageways

have resistance to the normal flow of air
into the lungs
The smaller the diameter, the greater the
resistance
Any condition that obstructs the air
passageway increases resistance, and more
pressure is need to force air through

Asthma
Inflammation due to infection
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Emphysema

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AIRWAY RESISTANCE
(RAW)

FLOW =

BRONCHOCONSTRICTION:
HISTAMIN

PRESSURE

RESISTANCE

OBSTRUCTION:
MUCUS / SECRET
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AIRWAY
RESISTANCE (RAW)
TOO SMALL
ETT

FLOW =

PRESSURE

RESISTANCE

BRONCHOSPASM
TUMOUR / SECRET

COLLAPSE/ATELECTASIS
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Partial Pressure

Daltons Law: each gas in a mixture of

gases exerts its own pressure as if all
other gases were not present

Air 78% nitrogen, 21% oxygen, 1% other

(CO2)

Partial pressure of a gas is the pressure

of an individual gas in a mixture.
PO2 21% X 760 = 159.6 mm Hg
Total pressure is adding all the partial
pressures
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Exchange of O2 and CO2

O2 and CO2 Diffuse from areas of higher

partial pressures to areas of lower partial
pressure
Results in exchange of O2 and CO2 in the
alveoli

Alveoli: PAO2=105 mm Hg,

PCO2=40 mm Hg

Capillaries: PvO2=40 mm Hg, PVCO2 =45 mm

Hg

Pulmonary vein:PAO2=100

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PCO2=40 mm Hg
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Exchange of O2 and
CO2
O2 and CO2 Diffuse from areas of
higher partial pressures to areas of
lower partial pressure

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RELATIONSHIP BETWEEN VENTILATION (V)

AND PERFUSION (Q)
Normal V/Q = 1

V/Q > 1
V/Q < 1

alveolar dead space

shunt

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TERIMA KASIH

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