Labcon Presentation - Respiratory

Experiment No. 23Experiment No. 23

Effect of Surface Tension on Effect of Surface Tension on ComplianceCompliance

ObjectiveObjective

To determine the effect of surface To determine the effect of surface tension on lung compliancetension on lung compliance

EquipmentEquipment

Two balloonsTwo balloons Tap waterTap water Graduated cylinderGraduated cylinder

MethodologyMethodology

1.1. Fill up one balloon with water. In the Fill up one balloon with water. In the second balloon, pour 10cc. of water and second balloon, pour 10cc. of water and partially inflate it with air until its size is partially inflate it with air until its size is similar to the first balloon.similar to the first balloon.

2.2. After maximal expiration, exhale forcibly After maximal expiration, exhale forcibly into the first balloon.into the first balloon.

3.3. Repeat step 2, with the second balloon Repeat step 2, with the second balloon partially filled with water. partially filled with water.

ResultsResults

MaleMaleBalloon ABalloon A Balloon BBalloon B

Original Original CircumferenceCircumference

16cm16cm 16cm16cm

After Maximal After Maximal ExpirationExpiration

49cm49cm 53cm53cm

ResultsResults

FemaleFemaleBalloon ABalloon A Balloon BBalloon B

Original Original CircumferenceCircumference

16cm16cm 16cm16cm

After Maximal After Maximal ExpirationExpiration

43cm43cm 47cm47cm

ResultsResults

After maximal expiration on both After maximal expiration on both balloons, the balloons, the balloon filled water is balloon filled water is smallersmaller than the balloon with only 10cc. than the balloon with only 10cc. of water.of water.

DiscussionDiscussion

The greater the amount of water, the higher the The greater the amount of water, the higher the surface tension exhibited on a system.surface tension exhibited on a system.

High surface tension in the lungs would High surface tension in the lungs would increase the inspiratory pressure needed for increase the inspiratory pressure needed for the lungs to expand.the lungs to expand.

Elasticity affects lung compliance just like the Elasticity affects lung compliance just like the elasticity of the rubber balloon when inflated.elasticity of the rubber balloon when inflated.

ConclusionConclusion

Based on the result of the Based on the result of the experiment, higher amount of water on a experiment, higher amount of water on a system would increase its surface system would increase its surface tension, and therefore decreasing its tension, and therefore decreasing its compliance.compliance.

QuestionsQuestions

1. Define the following:1. Define the following:

Lung ComplianceLung Compliance

- refers to the distensibility of the lung - refers to the distensibility of the lung and is defined as the change in volume and is defined as the change in volume of that structure produced by a change of that structure produced by a change in pressure across the structure. in pressure across the structure.

QuestionsQuestions

1. Define the following:1. Define the following:Lung ElasticityLung Elasticity- it is the ability of the lung to oppose stress- it is the ability of the lung to oppose stress

The lungs have inward elastic force. The lungs have inward elastic force. The force is larger when the lungs are The force is larger when the lungs are increased in volume. The elastic force of the increased in volume. The elastic force of the lungs is larger when the lungs are increased lungs is larger when the lungs are increased in volume. The elastic force of the lungs is in volume. The elastic force of the lungs is smaller when the lungs are decreased in smaller when the lungs are decreased in volume. volume.

QuestionsQuestions

2. What is the effect of filling up the 2. What is the effect of filling up the balloon with water?balloon with water?

The water increases the surface tension The water increases the surface tension inside the balloon, thus, decreasing the inside the balloon, thus, decreasing the ability of the balloon to expand when a ability of the balloon to expand when a pressure is applied to it.pressure is applied to it.

QuestionsQuestions

3. Explain the effect of surface tension on lung 3. Explain the effect of surface tension on lung compliance.compliance.A high surface tension decreases lung A high surface tension decreases lung compliance. A larger pressure is needed to compliance. A larger pressure is needed to distend the lungs, this is because the distend the lungs, this is because the interaction between the liquid surface must interaction between the liquid surface must first be overcome to lessen the surface first be overcome to lessen the surface tension within the lungs and finally distend tension within the lungs and finally distend the lungs. Thus, to achieve the same volume the lungs. Thus, to achieve the same volume of a lung with normal surface tension a higher of a lung with normal surface tension a higher pressure must be exerted.pressure must be exerted.

QuestionsQuestions

4. Give some conditions that can affect 4. Give some conditions that can affect compliance.compliance.

EmphysemaEmphysema

Cystic FibrosisCystic Fibrosis

Respiratory Distress SyndromeRespiratory Distress Syndrome

QuestionsQuestionsEmphysema-dilation of the alveolar spaces and destruction of the alveolar walls, thus lung elastic recoil is lost-the lung becomes easy to distend but empties slowly, which results in a chronically overinflated lung (high total lung capacity, functional residual capacity, and residual volume), which lessens the curvature of the diaphragm, making it less efficient in generating even the small swings in pleural pressure necessary for breathing - the lung is highly compliant

QuestionsQuestions

Cystic Fibrosis-the lungs become stiff, making a large pressure necessary to maintain a moderate volume. - lung poorly compliant

QuestionsQuestions

Respiratory Distress SyndromeRespiratory Distress Syndrome

- lung surfactant, which is lung surfactant, which is responsible for decreasing responsible for decreasing surface tension in the lungs, surface tension in the lungs, is deficient at birth cause is deficient at birth cause diffuse lung atelectasis diffuse lung atelectasis (failure of lung to expand)(failure of lung to expand)

- the lung has decrease the lung has decrease compliancecompliance

Experiment no. 24Experiment no. 24

Respiratory Movements in ManRespiratory Movements in Man

ObjectivesObjectives

To determine the changes in chest To determine the changes in chest circumference at the level of the axilla circumference at the level of the axilla and xiphoid during inspiration and and xiphoid during inspiration and expirationexpiration

To determine and compare the breaking To determine and compare the breaking points of the subjects at various points of the subjects at various conditionsconditions


Chest MeasurementChest Measurement1.1. Using a tape measure, get the chest Using a tape measure, get the chest

circumference at the level of the axilla circumference at the level of the axilla during:during:a.a. The end of quiet expirationThe end of quiet expiration

b.b. The end of normal inspirationThe end of normal inspiration

c.c. The end of the most forceful expiration possibleThe end of the most forceful expiration possible

d.d. The end of the most forceful inspiration The end of the most forceful inspiration possiblepossible


Chest MeasurementChest Measurement2.2. Using a tape measure, get the chest Using a tape measure, get the chest

circumference at the level of the xiphoid circumference at the level of the xiphoid process during:process during:a.a. The end of quiet expirationThe end of quiet expiration

b.b. The end of normal inspirationThe end of normal inspiration

c.c. The end of the most forceful expiration possibleThe end of the most forceful expiration possible

d.d. The end of the most forceful inspiration The end of the most forceful inspiration possiblepossible


Breaking PointBreaking Point1.1. After normal inspiration, make the subject After normal inspiration, make the subject

hold his breath until he can no longer hold hold his breath until he can no longer hold it. Record the duration.it. Record the duration.

2.2. After a deep expiration, make the subject After a deep expiration, make the subject hold his breath until he can no longer hold hold his breath until he can no longer hold it. Record the duration.it. Record the duration.


Breaking PointBreaking Point3.3. After taking deep breaths from a brown After taking deep breaths from a brown

paper bag, make the subject hold his paper bag, make the subject hold his breath at the end of inspiration until he can breath at the end of inspiration until he can no longer hold it. Record the duration.no longer hold it. Record the duration.

4.4. After a full minute of deep breathing, make After a full minute of deep breathing, make the subject hold his breath at the end of the subject hold his breath at the end of deep inspiration until he can no longer hold deep inspiration until he can no longer hold it. Record the duration.it. Record the duration.

ResultsResults

ConditionCondition Chest measurement (cm)Chest measurement (cm)

Male subjectMale subject Female subjectFemale subject

Axilla levelAxilla level Xiphoid levelXiphoid level Axilla levelAxilla level Xiphoid levelXiphoid level

NormalNormal 9292 8787 73.7573.75 64.7564.75

End of quiet End of quiet expirationexpiration

9090 8585 73.2573.25 65.65.

End of normal End of normal inspirationinspiration

9494 8989 74.574.5 65.2565.25

End of forceful End of forceful expirationexpiration

87.587.5 82.582.5 72.7572.75 63.7563.75

End of forceful End of forceful inspirationinspiration

96.596.5 91.591.5 76.2576.25 67.567.5

Table 1. Chest circumference of the subjects

ResultsResults

Breaking point conditionBreaking point condition Duration (seconds)Duration (seconds)

Male subjectMale subject Female subjectFemale subject

End of normal inspirationEnd of normal inspiration 36.4636.46 2727

End of deep expirationEnd of deep expiration 20.5320.53 2424

End of inspiration after deep End of inspiration after deep breathing from a bagbreathing from a bag

83.8683.86 8787

End of inspiration after deep End of inspiration after deep breathing for 1 minutebreathing for 1 minute

109.13109.13 3737

Table 2. Breaking points of the subjects


Quiet Inspiration

Diaphragm contractsDiaphragm contracts Diaphragm descends into abdomen Diaphragm descends into abdomen Abdominal viscera Abdominal viscera

descend descend Increases vertical diameter of thorax Increases vertical diameter of thorax Elevates lower ribs Elevates lower ribs Elevates body of sternum and upper ribs Elevates body of sternum and upper ribs

Elevation of 3Elevation of 3rdrd, 4, 4thth, 5, 5thth, and 6, and 6thth ribs ribs increase in antero-posterior increase in antero-posterior and transverse diameters of the thoraxand transverse diameters of the thorax

Elevation of 8Elevation of 8thth, 9, 9thth, and 10, and 10thth ribs ribs increase in transverse diameter increase in transverse diameter of upper abdomenof upper abdomen

o 11stst and 2 and 2ndnd ribs ribs fixed by resistance of shoulder girdle fixed by resistance of shoulder girdleo 1111thth and 12 and 12thth ribs ribs fixed by fixed by Quadratus lumborumQuadratus lumborum muscle muscle

External intercostal muscles contractExternal intercostal muscles contract External intercostals elevate rib cage External intercostals elevate rib cage Sternum moves Sternum moves

anteriorlyanteriorly

Quiet Expiration

Diaphragm relaxesDiaphragm relaxes Diaphragm moves superiorly Diaphragm moves superiorly Abdominal viscera ascend Abdominal viscera ascend

Decreases vertical diameter of thoraxDecreases vertical diameter of thorax Returns lower ribs to resting position Returns lower ribs to resting position

External intercostal muscles relaxExternal intercostal muscles relax External intercostals relax External intercostals relax Rib cage and sternum return to Rib cage and sternum return to

resting positionresting position

Muscles of Deep Respiration

Deep Inspiration

All movements of quiet inspiration but to a greater extentAll movements of quiet inspiration but to a greater extent ScalenesScalenes and and sternocleidomastoidssternocleidomastoids draw up the sternum draw up the sternum

and clavicles and clavicles All ribs except 11 All ribs except 11thth and 12 and 12thth are raised to are raised to a higher levela higher level

Anterior abdominal muscles (Anterior abdominal muscles (Rectus abdominis, Internal Rectus abdominis, Internal and external obliques, transversus abdominisand external obliques, transversus abdominis) are ) are stretched stretched Umbilicus is drawn upward Umbilicus is drawn upward Increases Increases transverse diameter of upper abdomentransverse diameter of upper abdomen

Serratus posterior superiorSerratus posterior superior and and sacrospinalessacrospinales straightens thoracic curve of vertebral column straightens thoracic curve of vertebral column Increases antero-posterior diameters of thorax and Increases antero-posterior diameters of thorax and upper abdomen; Widens intercostal spaces upper abdomen; Widens intercostal spaces

Deep Expiration

All movements of quiet expiration but to a greater extentAll movements of quiet expiration but to a greater extent Anterior abdominal muscles contract Anterior abdominal muscles contract Umbilicus Umbilicus

shortens shortens Decreases transverse diameter of upper Decreases transverse diameter of upper abdomenabdomen

Serratus posterior inferiorSerratus posterior inferior and and transversus thoracistransversus thoracis affects thoracic curve of vertebral column affects thoracic curve of vertebral column Decreases Decreases antero-posterior diameters of thorax and upper antero-posterior diameters of thorax and upper abdomen; Intercostal spaces narrowabdomen; Intercostal spaces narrow

Also affected by recoil of thoracic wallsAlso affected by recoil of thoracic walls

Control of VentilationControl of Ventilation

Inc. COInc. CO22 or decreased O or decreased O22 levels induce the levels induce the respiratory center in the brain to induce respiratory center in the brain to induce respirationrespiration

Central chemoreceptors in the medulla are Central chemoreceptors in the medulla are stimulated by Pstimulated by PCO2CO2 and the pH of arterial and the pH of arterial bloodblood

Peripheral chemoreceptors in the aorta Peripheral chemoreceptors in the aorta and external carotid arteries sense Pand external carotid arteries sense PO2O2, , PPCO2CO2 and pH of arterial blood and pH of arterial blood

Control of VentilationControl of Ventilation

Respiratory control center in the medulla Respiratory control center in the medulla controls the pattern of respirationcontrols the pattern of respiration

Voluntary respiration originating in the Voluntary respiration originating in the motor cortex bypasses the medulla, motor cortex bypasses the medulla, impulses travel down the corticospinal impulses travel down the corticospinal directly to respiratory musclesdirectly to respiratory muscles

In breath-holding, voluntary control initially In breath-holding, voluntary control initially predominates, then the RCC overpowers it predominates, then the RCC overpowers it

Breaking PointBreaking Point

Duration that a person could hold his/her Duration that a person could hold his/her breathbreath

Related more to the partial pressure of Related more to the partial pressure of COCO22 than to O than to O22

Lung CapacityLung Capacity

Total lung capacityTotal lung capacity (TLC) = 6 L. The volume of gas contained in the lung at the end of maximal inspiration. (TLC) = 6 L. The volume of gas contained in the lung at the end of maximal inspiration. Vital capacityVital capacity (VC) = 4.8 L. The amount of air that can be forced out of the lungs after a maximal inspiration. (VC) = 4.8 L. The amount of air that can be forced out of the lungs after a maximal inspiration. Tidal volumeTidal volume (TV) = 500 mL. The amount of air breathed in or out during normal respiration. (TV) = 500 mL. The amount of air breathed in or out during normal respiration. Residual volumeResidual volume (RV) = 1.2 L. The amount of air left in the lungs after a maximal exhalation. (RV) = 1.2 L. The amount of air left in the lungs after a maximal exhalation. Expiratory reserve volumeExpiratory reserve volume (ERV) = 1.2 L. The amount of additional air that can be breathed out after normal (ERV) = 1.2 L. The amount of additional air that can be breathed out after normal

expiration. (At the end of a normal breath, the lungs contain the residual volume plus the expiratory reserve expiration. (At the end of a normal breath, the lungs contain the residual volume plus the expiratory reserve volume, or around 2.4 liters. If one then goes on and exhales as much as possible, only the residual volume of volume, or around 2.4 liters. If one then goes on and exhales as much as possible, only the residual volume of 1.2 liters remains). 1.2 liters remains).

Inspiratory reserve volumeInspiratory reserve volume (IRV) = 3.6 L. The additional air that can be inhaled after a normal tidal breath in. (IRV) = 3.6 L. The additional air that can be inhaled after a normal tidal breath in. Functional residual capacityFunctional residual capacity (ERV + RV) = 2.4 L. The amount of air left in the lungs after a tidal breath out. (ERV + RV) = 2.4 L. The amount of air left in the lungs after a tidal breath out. Inspiratory capacityInspiratory capacity (IC) = is the volume that can be inhaled after a tidal breathe-out. (IC) = is the volume that can be inhaled after a tidal breathe-out.

Normal InspirationNormal Inspiration

Respiration involves the tidal volume of Respiration involves the tidal volume of airair

Around 2.9L of air in the lungsAround 2.9L of air in the lungs

Deep expirationDeep expiration

Vital capacity is expelledVital capacity is expelled Only residual volume of air is left, around Only residual volume of air is left, around

1.2L 1.2L Low oxygen in tissues, COLow oxygen in tissues, CO22 is also is also

accumulatingaccumulating Shortest breaking pointShortest breaking point

Deep BreathingDeep Breathing

Tidal volume and IRV are utilized in Tidal volume and IRV are utilized in breathsbreaths

Larger amount of air enters the lungs Larger amount of air enters the lungs (around 3.6L per breath)(around 3.6L per breath)

Longest breaking point due to larger OLongest breaking point due to larger O22

concentration in bloodconcentration in blood

Bag BreathingBag Breathing

Shorter breaking point than normal deep Shorter breaking point than normal deep breathingbreathing

Re-breathing increases the CORe-breathing increases the CO22

concentration in the blood while also concentration in the blood while also lowering the amount of inspired oxygenlowering the amount of inspired oxygen

Low levels of oxygen and/or high levels of Low levels of oxygen and/or high levels of carbon dioxide in the body stimulates carbon dioxide in the body stimulates resumption of breathing and faster, deeper resumption of breathing and faster, deeper breathingbreathing

Arterial COArterial CO22 is the most important is the most important

regulator of ventilationregulator of ventilation PPaO2aO2 levels below 60 mm Hg and P levels below 60 mm Hg and PaCO2aCO2

levels above 40 mm Hg trigger increased levels above 40 mm Hg trigger increased respirationrespiration


There is generally an increase in chest circumference There is generally an increase in chest circumference during inspiration and a decrease in circumference during inspiration and a decrease in circumference

during expiration.during expiration. Greatest increase was during forced inspirationGreatest increase was during forced inspiration Greatest decrease was during forced expirationGreatest decrease was during forced expiration

The fastest breaking point is influenced by the The fastest breaking point is influenced by the concentration of Oconcentration of O22 and CO and CO22 in the body in the body Shortest breaking point is after forced expirationShortest breaking point is after forced expiration Longest breaking point is after forced inspirationLongest breaking point is after forced inspiration

EXPERIMENT NO. EXPERIMENT NO. 2525Examination of the Chest and LungsExamination of the Chest and Lungs

OBJECTIVEOBJECTIVE

To demonstrate the different To demonstrate the different methods and proper techniques of methods and proper techniques of chest examination useful in the chest examination useful in the assessment of respiratory function.assessment of respiratory function.

METHODOLOGYMETHODOLOGY

InspectionInspection

male subject was made to sit uprightmale subject was made to sit upright

↓↓

configuration and symmetry of the chest on configuration and symmetry of the chest on inspiration observed inspiration observed

↓↓

configuration and symmetry of the chest on configuration and symmetry of the chest on expiration observedexpiration observed


↓↓

rate, depth and pattern of respiration also rate, depth and pattern of respiration also observedobserved

↓↓

presence of abnormal sounds when presence of abnormal sounds when breathing, retractions, use of accessory breathing, retractions, use of accessory

muscles and increased anterior-posterior muscles and increased anterior-posterior diameter or barrel chest noted if presentdiameter or barrel chest noted if present

METHODOLOGYMETHODOLOGY PalpationPalpation

each of the examiner’s thumbs of the hand was each of the examiner’s thumbs of the hand was placed to the side of the spinal processes in placed to the side of the spinal processes in

the mid-thoracic regionthe mid-thoracic region↓↓

fingertips were extended to the mid-axillary line fingertips were extended to the mid-axillary line on both sideson both sides

↓↓ subjects were asked to inhale deeplysubjects were asked to inhale deeply

↓↓degree and symmetry of chest expansion degree and symmetry of chest expansion

evaluatedevaluated


FremitusFremitusexaminer’s hand was examiner’s hand was

placed on the placed on the subjects’ back subjects’ back

↓↓ vibration on the chest vibration on the chest

noted by asking the noted by asking the subjects to say subjects to say

“ninety-nine” or “tres-“ninety-nine” or “tres-tres” tres”


PercussionPercussion

chest was percussed with chest was percussed with the distal parts of the the distal parts of the

middle and index fingers middle and index fingers of one hand pressed of one hand pressed

firmly against the chest firmly against the chest wall and the middle wall and the middle

finger of the other hand finger of the other hand used to strike sharply the used to strike sharply the fingers on the chest wallfingers on the chest wall

↓↓


character of percussion on both sides of the chest, from character of percussion on both sides of the chest, from top to bottom, anteriorly and posteriorly was noted top to bottom, anteriorly and posteriorly was noted

↓↓subject inhaledsubject inhaled

↓↓steps 1 then character of percussion noted steps 1 then character of percussion noted

↓↓subject exhaledsubject exhaled

↓↓steps 1 then character of percussion notedsteps 1 then character of percussion noted

METHODOLOGYMETHODOLOGY AuscultationAuscultation

Using the stethoscope, the lungs was auscultatedUsing the stethoscope, the lungs was auscultated

over the apices of both

lungs then down back

↓


in the axillae

↓

anteriorly on both sides

RESULTS AND RESULTS AND DISCUSSION DISCUSSION

InspectionInspectionDegree Degree

ofofExpansioExpansio

nn

Symmetry Symmetry ofof

ExpansionExpansion

FremitusFremitus

Male SubjectMale Subject Within Within normalnormal

SymmetricalSymmetrical Normal and Normal and equal on both equal on both

sidessides

Female SubjectFemale Subject Within Within normalnormal

SymmetricalSymmetrical Normal and Normal and equal on both equal on both

sidessides

RESULTS AND RESULTS AND DISCUSSIONDISCUSSION

PalpationPalpation

Degree ofDegree ofExpansioExpansio

nn

Symmetry Symmetry ofof

ExpansionExpansion

FremitusFremitus

Male SubjectMale Subject Within Within normalnormal

SymmetricalSymmetrical Normal and Normal and equal on equal on

both both sidessides

Female SubjectFemale Subject Within Within normalnormal

SymmetricalSymmetrical Normal and Normal and equal on equal on

both both sidessides


PercussionPercussion

The base of the lung was located on the The base of the lung was located on the subjects by identifying flatness which subjects by identifying flatness which indicates that the tissue beneath is a indicates that the tissue beneath is a

muscle, the diaphragm next to resonance muscle, the diaphragm next to resonance indicating that the tissue beneath is indicating that the tissue beneath is

hollow, the lungshollow, the lungs↓↓


Inferior angle of the scapula was used as the Inferior angle of the scapula was used as the reference point in measuring the boundaries of reference point in measuring the boundaries of

resonance resonance

Distance from inferior angle of scapulaDistance from inferior angle of scapula

InspirationInspiration decreaseddecreased

ExpirationExpiration increasedincreased


AuscultationAuscultation

Normal breath sounds were appreciated on Normal breath sounds were appreciated on both subjects upon auscultation. both subjects upon auscultation.

The normal breath sounds are:The normal breath sounds are:

BronchovesicularBronchovesicular

Mixture of both Mixture of both tracheobronchial and tracheobronchial and vesicular elements in vesicular elements in certain areas where certain areas where the trachea and the trachea and major bronchi are in major bronchi are in close proximity to the close proximity to the chest wall chest wall

VesicularVesicular

Result of movement Result of movement of air in the of air in the bronchioles and bronchioles and alveoli alveoli

Vesicular vs Vesicular vs BronchovesicularBronchovesicular

SoundSound Duration of Duration of inspiratiinspiration and on and

expiratioexpirationn

PitchPitch IntensitIntensityy

Normal Normal LocationLocation

Abnormal Abnormal LocationLocation

VesicularVesicular Inspiration > Inspiration > expiration expiration

5:25:2

LowLow SoftSoft Peripheral Peripheral lunglung

Over trachea Over trachea and and

sternumsternum

Broncho-Broncho-vesiculavesicula

rr

Inspiration = Inspiration = expiration expiration

1:11:1

ModeratModeratee

ModeratModeratee

First and First and second second

intercostintercostal spaces al spaces

at the at the border border over over

major major bronchibronchi

Peripheral Peripheral lunglung

CONCLUSIONCONCLUSION

There are 4 general steps in chest and lung examination:

INSPECTIONPALPATIONPERCUSSIONAUSCULTATION

ANSWERS to QUESTIONSANSWERS to QUESTIONS

1.1. Give the different percussion sounds and the Give the different percussion sounds and the palpable vibrations arising from the palpable vibrations arising from the respiratory tree.respiratory tree.

PERCUSSION SOUNDS:PERCUSSION SOUNDS: ResonanceResonance HyperresonanceHyperresonance TympanyTympany DullnessDullness FlatnessFlatness


SoundsSounds Relative Relative IntensityIntensity

Relative PitchRelative Pitch Relative Relative DurationDuration

ResonanceResonance LoudLoud LowLow LongLong

HyperresonanceHyperresonance Very LoudVery Loud LowerLower LongerLonger

TympanyTympany LoudLoud

DullnessDullness MediumMedium MediumMedium MediumMedium

FlatnessFlatness SoftSoft HighHigh ShortShort

Table 1. Percussion notes and their Characteristics (Bates,1983)


VIBRATIONS during PALPATION:VIBRATIONS during PALPATION:

Vocal FremitusVocal Fremitus Pleural Friction FremitusPleural Friction Fremitus Tussive FremitusTussive Fremitus Ronchal FremitusRonchal Fremitus


2. Give the 2 normal breath sounds. Where are these 2. Give the 2 normal breath sounds. Where are these sounds heard best?sounds heard best?

Vesicular Breath Sounds-Vesicular Breath Sounds- heard normally over most of the lungs heard normally over most of the lungs

Bronchiovesicular Breath Sounds-Bronchiovesicular Breath Sounds- heard normally on each side of the sternum in the heard normally on each side of the sternum in the first and second interspaces, between the scapulae, first and second interspaces, between the scapulae, and over the apices anteriorly and posteriorly, and over the apices anteriorly and posteriorly, but is but is more prominent on the right than on the leftmore prominent on the right than on the left

Experiment no. 26Experiment no. 26

Lung Volumes and CapacitiesLung Volumes and Capacities

Objective:Objective:

To be able to measure the different lung To be able to measure the different lung volumes and lung capacitites using wet volumes and lung capacitites using wet spirometer.spirometer.

MaterialsMaterials

Wet spirometerWet spirometer


Tidal volumeTidal volume

1.1. Set the spirometer at 0 mL.Set the spirometer at 0 mL.

2.2. At the end of a normal inspiration, exhale At the end of a normal inspiration, exhale normally into the spirometer.normally into the spirometer.

3.3. Record the reading obtained.Record the reading obtained.

4.4. Make 3 trials and get the average.Make 3 trials and get the average.


Expiratory Reserve Volume (ERV)Expiratory Reserve Volume (ERV)


2.2. After normal exhalation, exhale forcibly into After normal exhalation, exhale forcibly into the spirometer.the spirometer.




Inspiratory Reserve Volume (IRV)Inspiratory Reserve Volume (IRV)


2.2. After deep inspiration, exhale forcibly into the After deep inspiration, exhale forcibly into the spirometer.spirometer.

3.3. Record the volume obtained.Record the volume obtained.

4.4. Subtract tidal volume from this volume to Subtract tidal volume from this volume to obtain IRV.obtain IRV.



Vital CapacityVital Capacity

1.1. Set the spirometer 0 mL.Set the spirometer 0 mL.

2.2. After deep inhalation, exhale forcibly into After deep inhalation, exhale forcibly into the spirometer.the spirometer.




Inspiratory Capacity (IC)Inspiratory Capacity (IC)


2.2. After normal expiration, inhale deeply into After normal expiration, inhale deeply into the spirometer.the spirometer.



ResultsResults

Lung volume and Lung volume and CapacitiesCapacities

Male Male SubjectSubject

(standing)(standing)(L)(L)

Female Female Subject Subject (sitting)(sitting)

(L)(L)

Tidal VolumeTidal Volume 0.530.53 0.450.45

Expiratory Expiratory Reserved VolumeReserved Volume

1.301.30 1.101.10

Inspiratory RVInspiratory RV 2.832.83 1.921.92

Vital capacityVital capacity 4.134.13 2.702.70

Inspiratory capacityInspiratory capacity 3.933.93 2.472.47


Lung Volumes and Lung Volumes and CapacitiesCapacities

Lung VOLUMESLung VOLUMES Tidal Volume (TV or VT)Tidal Volume (TV or VT)

volume of air moved during either the inspiratory or expiratory phase of volume of air moved during either the inspiratory or expiratory phase of each breath; as in quiet breathingeach breath; as in quiet breathing

Inspiratory Reserve Volume (IRV) Inspiratory Reserve Volume (IRV) volume of air which can be inspired above the inspired tidal volume volume of air which can be inspired above the inspired tidal volume value decreases with increasing age.value decreases with increasing age.

Expiratory Reserve Volume (ERV) Expiratory Reserve Volume (ERV) volume of air which can be expired beyond the expired tidal volumevolume of air which can be expired beyond the expired tidal volume effort-dependent effort-dependent values decreases with increases in age.values decreases with increases in age.

Residual Volume (RV)Residual Volume (RV) The volume of air in lungs after maximum exhalation The volume of air in lungs after maximum exhalation Cannot be exhaled and remains in lung so as lung structures; lungs are Cannot be exhaled and remains in lung so as lung structures; lungs are

never devoid of airnever devoid of air Tends to increase with age Tends to increase with age Cannot be measured directly; indirectly via the helium dilution methodCannot be measured directly; indirectly via the helium dilution method

Theoretical ValuesTheoretical Values


Theoretix Theoretix male male


Theoretical-Theoretical-Female Female


Tidal VolumeTidal Volume 0.45-0.550.45-0.55 0.35-0.500.35-0.50


1.0-1.51.0-1.5 0.9-1.20.9-1.2

Inspiratory RVInspiratory RV 2.5-3.52.5-3.5 1.9-301.9-30

Vital capacityVital capacity 4 - 54 - 5 3 – 43 – 4

Inspiratory capacityInspiratory capacity 3-43-4 2.4-3.22.4-3.2

TLC

RV

VC

TV

FRC

ICIRV

ERV

RV

Can UseSpirometer

Lung CAPACITIESLung CAPACITIES

VITAL CAPACITYVITAL CAPACITY Vital Capacity (VC)Vital Capacity (VC)

The amount of air that can be moved into/out of your lungsThe amount of air that can be moved into/out of your lungs maximum volume of air that can be forcefully expelled from the maximum volume of air that can be forcefully expelled from the

lungs following a maximal inspirationlungs following a maximal inspiration Largest volume that can be measured with a spirometer Largest volume that can be measured with a spirometer VC = IRV + TV + ERV VC = IRV + TV + ERV Values vary considerably with body size and body positions Values vary considerably with body size and body positions

during the measurement. during the measurement. is related to age, height, and genderis related to age, height, and gender

The younger and taller one is the larger the VC The younger and taller one is the larger the VC Men have larger lungs than women which enable men to exhibit Men have larger lungs than women which enable men to exhibit

greater VCgreater VC Average values: Average values:

4 - 5 liters in men4 - 5 liters in men 3 - 4 liters in young women.3 - 4 liters in young women.

TOTAL LUNG CAPACITYTOTAL LUNG CAPACITY Total Lung CapacityTotal Lung Capacity

The volume of air contained in the lungs at The volume of air contained in the lungs at the end of a maximal inspiration.the end of a maximal inspiration.

Sum of all four basic lung volumesSum of all four basic lung volumes TLC = RV + IRV + TV + ERVTLC = RV + IRV + TV + ERV

Functional Residual Functional Residual CAPACITYCAPACITY Functional Residual Capacity Functional Residual Capacity

The volume of air remaining in the lung at the The volume of air remaining in the lung at the end of a normal expiration.end of a normal expiration.

FRC = RV + ERVFRC = RV + ERV

INSPIRATORY CAPACITYINSPIRATORY CAPACITY Inspiratory Capacity (IC) Inspiratory Capacity (IC)

Maximum volume of air that can be inspired Maximum volume of air that can be inspired from end expiratory position. from end expiratory position.

IC = TV + IRVIC = TV + IRV

On Closer Examination…On Closer Examination…


Theoretix Theoretix male male


Male Male SubjectSubject





(L)(L)

Tidal VolumeTidal Volume 0.45-0.550.45-0.55 0.530.53 0.35-0.500.35-0.50 0.450.45


1.0-1.51.0-1.5 1.301.30 0.9-1.20.9-1.2 1.101.10

Inspiratory RVInspiratory RV 2.5-3.52.5-3.5 2.832.83 1.9-301.9-30 1.921.92

Vital capacityVital capacity 4 - 54 - 5 4.134.13 3 – 43 – 4 2.702.70

Inspiratory Inspiratory capacitycapacity

3-43-4 3.933.93 2.4-3.22.4-3.2 2.472.47

Deviations…Deviations… All values except VC (female) are normalAll values except VC (female) are normal Vital Capacity (IC) Vital Capacity (IC)

For the female subject, the procedures For the female subject, the procedures were done in sitting positionwere done in sitting position

All values are observed to be on the All values are observed to be on the lower limit of the rangelower limit of the range

Vital capacity is affected by Vital capacity is affected by body size and body size and body positions during the measurementbody positions during the measurement

Lung Volume Capacities in Lung Volume Capacities in Male and FemaleMale and Female

Males of a given body size have an Males of a given body size have an approximately 25% greater pulmonary volumes approximately 25% greater pulmonary volumes and capacities than females of equal size (2.5 and capacities than females of equal size (2.5 l/m2 of body surface area vs. 2.0 l/m2)l/m2 of body surface area vs. 2.0 l/m2)

Difference is observed even with exclusion of Difference is observed even with exclusion of height variable: lung growth is not very tightly height variable: lung growth is not very tightly coupled to longitudinal growthcoupled to longitudinal growth

Smaller lung volume Smaller lung volume capacities in females…capacities in females… appears to be established in the first few years of lifeappears to be established in the first few years of life

lower rate of alveolar multiplication in girls than boyslower rate of alveolar multiplication in girls than boys females have disproportionately smaller rib cage females have disproportionately smaller rib cage

dimensions than males.dimensions than males. greater inclination of ribsgreater inclination of ribs

stronger inspiratory rib cage muscle contribution in females stronger inspiratory rib cage muscle contribution in females than malesthan males

improved mechanical advantage conferred to the inspiratory improved mechanical advantage conferred to the inspiratory rib cage musclesrib cage muscles

well suited to accommodate abdominal distension during well suited to accommodate abdominal distension during pregnancypregnancy

compression of the rib cage by the weight of the breastcompression of the rib cage by the weight of the breast shorter diaphragm length shorter diaphragm length smaller lung compliance and lung size in femalesmaller lung compliance and lung size in female

(Bellemare, et al. (2003)(Bellemare, et al. (2003)

Lung Volume and Capacities Lung Volume and Capacities in different body positionsin different body positions





(L)(L)

Tidal VolumeTidal Volume 0.35-0.500.35-0.50 0.450.45


0.9-1.20.9-1.2 1.101.10

Inspiratory RVInspiratory RV 1.9-301.9-30 1.921.92

Vital capacityVital capacity 3 – 43 – 4 2.702.70

Inspiratory capacityInspiratory capacity 2.4-3.22.4-3.2 2.472.47


Standing positionStanding position


Sitting positionSitting position


Supine positionSupine position

CONCLUSIONCONCLUSIONA wet spirometer is an important apparatus A wet spirometer is an important apparatus

in measuring the lung volumes and capacities of in measuring the lung volumes and capacities of an individual. It can be considered as an an individual. It can be considered as an important diagnostic tool in determining important diagnostic tool in determining obstructions in the lungs/airways. There is a obstructions in the lungs/airways. There is a comparable difference of the lung volumes and comparable difference of the lung volumes and capacities between a male and a female subject. capacities between a male and a female subject. Usually, males have greater lung volumes and Usually, males have greater lung volumes and capacities due to their larger built, and taller capacities due to their larger built, and taller height.height.

Anwers to Questions:Anwers to Questions:1.1. The measurement of the different lung volumes and capacities The measurement of the different lung volumes and capacities

should be done with the subject standing. Why?should be done with the subject standing. Why?

Standing enables the chest wall to move freely. The Standing enables the chest wall to move freely. The lungs are enclosed by the chest wall which expands during lungs are enclosed by the chest wall which expands during inspiration. inspiration.

Chest wall is a term commonly used to describe the Chest wall is a term commonly used to describe the properties of all the structures that are outside of the lungs and properties of all the structures that are outside of the lungs and that move during breathing. These structures include the rib cage, that move during breathing. These structures include the rib cage, diaphragm, abdominal cavity, and anterior abdominal muscles. diaphragm, abdominal cavity, and anterior abdominal muscles. (Berne, 2004). When the subject is standing, there is no (Berne, 2004). When the subject is standing, there is no compression from the abdominal cavity therefore, it allows full compression from the abdominal cavity therefore, it allows full expansion of the chest wall.expansion of the chest wall.

When the subject is sitting, the digestive organs in the When the subject is sitting, the digestive organs in the abdominal cavity compresses the diaphragm therefore limits abdominal cavity compresses the diaphragm therefore limits lengthening of respiratory muscle and lung expansion. lengthening of respiratory muscle and lung expansion.

Anwers to Questions:Anwers to Questions:

2. Compare the lung volumes of male and 2. Compare the lung volumes of male and female subjects. Show tabulated results female subjects. Show tabulated results here.here.

Comparing the average of the lung Comparing the average of the lung volumes obtained from the female and male volumes obtained from the female and male subject, we can see that the male subject has subject, we can see that the male subject has greater volumes. The results obtained are greater volumes. The results obtained are tabulated.tabulated.

Table 1. Lung volumes Table 1. Lung volumes obtained from female obtained from female subject.subject.FEMALE SUBJECTFEMALE SUBJECT Trial 1 Trial 1

(mL)(mL)Trial 2 Trial 2 (mL)(mL)

Trial 3 Trial 3 (mL)(mL)

Average Average (mL)(mL)

Tidal volumeTidal volume 450450 500500 400400 450450

Expiratory Reserve Expiratory Reserve volume (ERV)volume (ERV)

14001400 900900 10001000 11001100

Inspiratory Reserve Inspiratory Reserve Volume (IRV)Volume (IRV)

2300-2300-450450

= 1850= 1850

2400-2400-500500

= 1900= 1900

2400-2400-400400

= 2000= 2000

1916.671916.67

Vital CapacityVital Capacity 27002700 27002700 27002700 27002700

Inspiratory Capacity Inspiratory Capacity (IC)(IC)

24002400 28002800 22002200 2466.672466.67

Table 2. Lung volumes Table 2. Lung volumes obtained from male subject.obtained from male subject.MALE SUBJECTMALE SUBJECT Trial 1 Trial 1

(mL)(mL)Trial 2 Trial 2

(mL)(mL)Trial 3 Trial 3

(mL)(mL)Average Average

(mL)(mL)

Tidal volumeTidal volume 550550 500500 550550 533.33533.33

Expiratory Reserve Expiratory Reserve volume (ERV)volume (ERV)

10001000 16001600 13001300 13001300

Inspiratory Reserve Inspiratory Reserve Volume (IRV)Volume (IRV)

3500-3500-550550

= 2950= 2950

3400-3400-500500

= 2900= 2900

3200-5503200-550= 2650= 2650

2833.332833.33

Vital CapacityVital Capacity 42004200 40004000 42004200 4133.334133.33

Inspiratory Capacity Inspiratory Capacity (IC)(IC)

40004000 40004000 38003800 3933.333933.33

When individuals are matched for height When individuals are matched for height and weight, males normally have larger lungs than and weight, males normally have larger lungs than females. Height is the most important factor influencing females. Height is the most important factor influencing lung size and predicted values. Generally, the taller the lung size and predicted values. Generally, the taller the person, the larger the lung size and predicted lung person, the larger the lung size and predicted lung volumes.volumes.

If a person gains weight by putting on If a person gains weight by putting on muscle, a “muscularity effect” is seen by an increase in muscle, a “muscularity effect” is seen by an increase in lung size. As the weight gain continues because of an lung size. As the weight gain continues because of an increase body fat, there is reduction in lung size, which if increase body fat, there is reduction in lung size, which if allowed to continue, results in the obesity effect and allowed to continue, results in the obesity effect and reduced lung volumes. (Wilkins, 1995)reduced lung volumes. (Wilkins, 1995)


3. Define:3. Define:a.a. Tidal volumeTidal volume

It is the volume of air exhaled or inhaled It is the volume of air exhaled or inhaled during quiet breathing. The average values for healthy during quiet breathing. The average values for healthy adults show considerable variation but usually fall adults show considerable variation but usually fall between 350 and 600 mL. (Wilkins, 1995)between 350 and 600 mL. (Wilkins, 1995)

A decreased VT can occur with both A decreased VT can occur with both restrictive and obstructive disease. A fall in VT without restrictive and obstructive disease. A fall in VT without an increase in rate may result in hypoventilation and an increase in rate may result in hypoventilation and retention of arterial carbon dioxide tension. Restrictive retention of arterial carbon dioxide tension. Restrictive lung disease usually causes the patient to breath with a lung disease usually causes the patient to breath with a smaller VT. smaller VT.

b.b. Expiratory Reserve VolumeExpiratory Reserve Volume

It is the volume of air that can be maximally It is the volume of air that can be maximally exhaled following a passive exhalation. This volume is of exhaled following a passive exhalation. This volume is of limited clinical usefulness. It is reduced in obese persons, in limited clinical usefulness. It is reduced in obese persons, in those making a poor effort to perform the test, and in those those making a poor effort to perform the test, and in those with restrictive disease. Normal value: 1,100 to 1,200 mLwith restrictive disease. Normal value: 1,100 to 1,200 mL

c.c. Inspiratory Reserve VolumeInspiratory Reserve Volume

It is the volume of air that can be inhaled It is the volume of air that can be inhaled after a passive inhalation. This is not widely used in after a passive inhalation. This is not widely used in evaluating pulmonary dysfunction. Normal value: 3,000 to evaluating pulmonary dysfunction. Normal value: 3,000 to 3,200 mL.3,200 mL.

d.d. Vital CapacityVital Capacity

It is measured after the person has It is measured after the person has taken the deepest breath possible. The exhaled taken the deepest breath possible. The exhaled volume should be the maximal amount the patient volume should be the maximal amount the patient can exhale and is measured as the vital capacity. If can exhale and is measured as the vital capacity. If the patient forcefully exhales the volume, it is called the patient forcefully exhales the volume, it is called the forced vital capacity (FVC) and is the usual way the forced vital capacity (FVC) and is the usual way the VC is reported.the VC is reported.

VC is also reported as slow vital VC is also reported as slow vital capacity (SVC). It is performed by having the patient capacity (SVC). It is performed by having the patient completely exhale, slowly, following a maximal completely exhale, slowly, following a maximal inspiration.inspiration.

VC is an important preoperative assessment VC is an important preoperative assessment factor. Significant reduction in VC (less than 20 mL/ Kg of factor. Significant reduction in VC (less than 20 mL/ Kg of ideal body weight) indicates that a patient is at high risk for ideal body weight) indicates that a patient is at high risk for post operative respiratory complications. It is also useful in post operative respiratory complications. It is also useful in evaluating the patient’s need for mechanical ventilation. A evaluating the patient’s need for mechanical ventilation. A VC of less than 10 to 15 mL/ Kg indicates that the VC of less than 10 to 15 mL/ Kg indicates that the patient’s ventilatory reserve is decreased significantly.patient’s ventilatory reserve is decreased significantly.

d.d. Inspiratory CapacityInspiratory Capacity

It is the total volume of air in the It is the total volume of air in the lungs during inspiration. This includes the lungs during inspiration. This includes the volume of air during normal inhalation and the volume of air during normal inhalation and the volume of air after deep inspiration. Normally volume of air after deep inspiration. Normally ranges from 3,500 to 3,600 mL. IRV and IC are ranges from 3,500 to 3,600 mL. IRV and IC are not used widely in evaluating pulmonary not used widely in evaluating pulmonary dysfunction. Both of these measurements can dysfunction. Both of these measurements can be normal in restrictive and obstructive be normal in restrictive and obstructive diseases.diseases.


4.4. What lung volume was not measured in this What lung volume was not measured in this exercise? Why not?exercise? Why not?

The residual volume was not measured. RV is The residual volume was not measured. RV is the amount of gas left in the lung after exhaling all the amount of gas left in the lung after exhaling all that is physically possible. It cannot be obtained from that is physically possible. It cannot be obtained from the routine spirogram. It is obtained however in one the routine spirogram. It is obtained however in one of the three ways:of the three ways:

(a.) body plethysmograph (body box), (b.) open (a.) body plethysmograph (body box), (b.) open circuit nitrogen, or (c.) closed circuit helium dilution.circuit nitrogen, or (c.) closed circuit helium dilution.

Experiment No. 27Experiment No. 27

Peak Expiratory Flow Peak Expiratory Flow Rate (PEFR)Rate (PEFR)

ObjectivesObjectives

To determine the peak expiratory flow To determine the peak expiratory flow rate using the peak flow meter.rate using the peak flow meter.

MaterialMaterial

Mini-Wright peak flow meterMini-Wright peak flow meter

ProcedureProcedure

The subject while standing, was asked to The subject while standing, was asked to take a deep breath and blow as hard and take a deep breath and blow as hard and as fast as he can into the mouthpiece of as fast as he can into the mouthpiece of the peak flow meterthe peak flow meter

Values obtained were recorded and Values obtained were recorded and tabulated.tabulated.

The test was repeated twice more to get The test was repeated twice more to get the average.the average.

Get the subjects Get the subjects height and plot the height and plot the highest value of highest value of PEFR in the peak PEFR in the peak flow rate nomogram.flow rate nomogram.

ResultsResults

SubjectSubject AgeAge Ht. in cmHt. in cm Trial 1Trial 1 Trial 2Trial 2 Trial 3Trial 3 Ave.Ave. Expected Expected ValueValue

DivineDivine 2222 157157 440440 420420 440440 433 433 LPMLPM

410410

PatPat 2121 183 183 550550 500500 530530 526 526 LPMLPM

545545

ResultResult

0

100

200

300

400

500

600

Divine

Pat


High or Low Reading is dependent on the High or Low Reading is dependent on the subject’s sex, height, age and severity of subject’s sex, height, age and severity of disease.disease.

The male subject obtained higher PEFR The male subject obtained higher PEFR than the female.than the female.

High peak flow reading means air is High peak flow reading means air is moving easily through the lungs.moving easily through the lungs.


The peak expiratory flow rate of The peak expiratory flow rate of subjects A & B were obtained following the subjects A & B were obtained following the proper procedures. In comparison with the proper procedures. In comparison with the standard values with respect to each of the standard values with respect to each of the subject’s height, both have a normal peak subject’s height, both have a normal peak expiratory flow rate.expiratory flow rate.

Questions and AnswersQuestions and Answers

1.1. What is measured by the peak flow meter?What is measured by the peak flow meter?

Peak flow meter measures the Peak flow meter measures the Peak Peak Expiratory Flow RateExpiratory Flow Rate, which is the highest , which is the highest speed that you can blow air out of the lungs speed that you can blow air out of the lungs after taking in as big a breath as possible.after taking in as big a breath as possible.

It indicates the airflow speed in It indicates the airflow speed in liters per liters per minuteminute..

2.2. Give some uses of peak flow meter.Give some uses of peak flow meter.

To detect changes in your peak flow To detect changes in your peak flow which will tell you what is happening w/ which will tell you what is happening w/ your lungs, how quickly it is occurring, your lungs, how quickly it is occurring, and how severe the change is.and how severe the change is.

Useful in determination of treatment plan.Useful in determination of treatment plan.


3.3. What is the significance of the peak What is the significance of the peak expiratory flow rate?expiratory flow rate?

It is important in monitoring and It is important in monitoring and diagnosing lung diseases.diagnosing lung diseases.

It measures how well the airways of a It measures how well the airways of a person works.person works.


It is helpful in distinguishing between It is helpful in distinguishing between constrictive (TB, silicosis) and obstructive constrictive (TB, silicosis) and obstructive (asthma) lung disease. In asymptomatic (asthma) lung disease. In asymptomatic cases, it may be the only means of cases, it may be the only means of diagnosis.diagnosis.

It can point out specific trigger factors for It can point out specific trigger factors for asthma and can help judge the response asthma and can help judge the response to medication. to medication.

Documents

Labcon Presentation - Respiratory