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Unit 2: The Airways The Upper Airways

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1 Unit 2: The Airways The Upper Airways
RSPT 1207 Cardio Pulmonary Anatomy & Physiology

2 The Airways Respiratory tract : combination of organs and tissues that have one function – the transfer of gas to be used by the body. This process exposes the respiratory tract to many environmental extremes

3 The Upper Airways Consists of: The nose Oral cavities The pharynx
The larynx

4 The Upper Airways Function: There are 4 Functions Also involved with:
Direct respiratory gases to and from the lung Defense mechanism Humidify inspired air Heat inspired air Also involved with: Speech Eating, drinking Smell

5 The Nose Midline, external and internal structure
Upper third is bone and covered by skin Lower 2/3 is cartilage

6 Functions of the Nose Filters particles prior to entering lower airways Humidify and heat inspired air Provides a location for sensory receptors used in the sense of smell Provides resonance for speech

7 Major Structures of the Nose

8 Major Structures of the Nose

9 Major Structures of the Nose

10 Nasal Cavity Separated by the septum making it into a symmetric bilateral structure Anterior portion formed by the septal cartilage Posterior septum formed ethmoid and vomer bones

11 Nasal Cavity External nares – (nostrils) the openings of the nasal passageway Internally protected from particles by Vibrissae (nose hairs) Immediately behind vibrissae is an open chamber called the vestibule

12 Turbinates/Conchae As incoming gas flow enter posterior to the vestibule it is separated by the turbinates or conchae By having the turbinates, surface area is increased for heat/moisture exchange

13 Turbinates/Conchae Lines the nasal cavity like three walls
Twisted to allow particles to be filtered and air to be heated and humidified Mucous membranes line turbinates, Mucous glands line

14 Choandae Lumen – the space (hole) in a vessel, tube, or intestine
In the nasal passage this is call the Choandae Choanal atresia is a common birth defect found in infants

15 Paranasal Sinuses Consists of the: frontal, maxillary, ethmoid and posterior sphenoid Sinuses Openings are along the nasal passage Paired sinuses contain mucous glands and membranes Helps strengthen the skull

16 Oral Cavity Simply known as the mouth Functions:
Alternate passageway for breathing Start of the alimentary canal Contains major speech structures Facial expressions

17 Oral Cavity Anteriorly begins with lips and mouth
Follows with oral vestibule and teeth and gums Oral cavity begins after the teeth

18 The Palate The palate is the roof of the oral cavity Consists of:
Hard palate – anterior 2/3 of the palate and is bony Soft palate – posterior 1/3 and is made of soft tissue.

19 The Palate Protects the nasal passage from food Aids in swallowing
Hard palate and tongue are used in speech Uvula helps protect the airway from occlusion

20 The Soft Palate Made of soft tissue
This allows for food to be passed out of the oral cavity to the pharynx Two structures form the soft palate: Palatoglossal arch (anterior) Palato-pharyngeal arch (posterior)

21 The Uvula As the arches of the soft palate come together they form the uvula Protects the lower airways by being extremely sensitive to tactile stimulation Can cause violent gagging and possibly vomiting

22 Palatine Tonsils Lies in palato-glossal arch
Lympathic tissue that is part of the immune system

23 The Pharynx Generally known as the throat Divided into three areas:
Nasopharynyx Oropharynx Laryngopharynx

24 Nasopharynx Located behind the nasal cavities Contains:
Adenoids or Pharyngeal tonsils Eustachian tube: Runs between the back of the throat and middle ear Equilibrates pressure in the middle ear Acts like a pop-ff valve to release excess gas behind eardrum

25 Oropharynx Located below soft palate down to base of tongue
Only portion that can be seen without exam tools Contains: Lingual tonsils: at base of the tongue, tactile stimulation will cause gagging

26 Laryngopharynx Also called the hypopharynx
Located from base of the tongue to entrance of the esophagus Contains: Epiglottis structure that protects the opening to the lower airways which is the glottis Strong but flexible fibro-cartilage flap that comes out of the larynx into the laryngopharynx

27 Swallowing The most critical moment is when the food enters the laryngopharynx. Any mishap in coordination can lead to the food being aspirated into the lower airway There are more than 20 muscles that are involved in the act of swallowing The interaction of the tongue, palate and epiglottis in moving the food from the oral cavity to the oropharynx to the laryngopharynx and the esophagus

28 Swallowing Food is broken down and lubricated in the oral cavity
As one swallows the muscles of the tongue and mouth move food up and back Soft palate protects the nasopharynx Gravity moves food into oropharynx

29 Swallowing When the tongue moves up & forward the epiglottis moves down and backward Results in the glottis is covered as the food moves into esophagus Once food is in esophagus, the epiglottis moves back in place to allow gas to enter trachea

30 The Larynx Located immediately below the pharynx Formed by:
Three large external cartilages Epiglottis Thyroid cartilage Cricoid cartilage Three pairs of internal cartilages Arytenoid cartilage Corniculate cartilage Cuneiform cartilage

31 The Larynx

32 Epiglottis

33 External Cartilages All protect the airway
Thyroid cartilage is open in the posterior but it is solid in the anterior to protect the vocal cords inside them Cricoid cartilage is rigid ring and is the only structure that encircles the airway

34 Internal Cartilages Form a three sided pyramid of ligaments and muscles to control the movement of the vocal cords Pitch of the voice is controlled by tightening and loosening the cords Volume or loudness is controlled by the amount of air forced through the cords

35 Interior of Larynx Viewing the glottis from above a clinician will see the base of the tongue on top Below the tongue will be the epiglottis & between these two will stretch the 3 ligaments of the vallecula Egan’s page 173, figure 7-35

36 Interior of Larynx The base of the glottal triangle is opposite from the base of the tongue Surrounding the true vocal cords are tissue folds that are called the vestibular fold or the false cords Vallecula – space betweent the tongue & epiglottis Important landmark in intubation

37 Vocal Cords The vocal cords come together and separate during quiet breathing so that the glottis is always slightly open. A Valsalva maneuver or laryngospasm are the only time the glottis closed completely To close the glottis completely, not only requires bringing the vocal cords together but the person tightens all laryngeal muscles at the same time

38 Valsalva Maneuver Purpose: When the body requires positive pressure for expulsion Examples: urination, defecation, birth, vomiting, coughing, sneezing Person must exhale forcefully against a closed glottis, building pressure in the abdomen and thorax Side effects: Increase thoracic pressure decreases output of heart Increased pressure in head

39 Coughing Cough reflex is triggered when there is an irritant in the tracheal bronchial tree Deep breath: mL/kg IBW, Inspiratory hold: 3 seconds for air to get behind irritant Compression: Valsalva maneuver. True cords close for 0.2 seconds, resulting intrathoracic pressure is cm H2O pressure Expulsion: Glottis opens and velocity can reach LPM

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