1. RT 21 Exam 1 Review

2. According to the law of conservation of energy, energy cannot be created or destroyed: energy can only be transferred.
All matter is comprised of molecules that are in constant motion. The degree of this motion differs among three states of matter (solid, liquid and gas) and their intermolecular forces

3. Kinetic Theory
States that the atoms & molecules that make up matter are in constant motion.
Temperature influences movement of molecules. Hot objects move more than cold objects. Increasing kinetic energy increases temperature
Thermal energy = molecular Kinetic Energy + Potential Energy

4. The 3 states of matter http://www.youtube.com/watch?v=guoU_cuR8EE

5. States of Matter
Solids – have a high degree of internal order; their atoms have a strong mutual attractive force
Liquids – atoms exhibit less degree of mutual attraction compared with solids, they take the shape of their container, are difficult to compress, exhibit the phenomenon of flow
Gases – weak molecular attractive forces; gas molecules exhibit rapid, random motion with frequent collisions, gases are easily compressible, expand to fill their container, exhibit the phenomenon of flow

6. States of Matter Internal energy of matter
All matter possesses energy. There are 2 types of internal energy:
The energy of position, and the energy of motion.
Internal energy of matter
Potential energy (Position) The strong attractive forces between molecules that cause rigidity in solids
Kinetic energy (Motion) Gases have weak attractive forces that allow the molecules to move about more freely, interacting with other objects that they come in contact with
Internal energy and temperature
The two are closely related: internal energy can be increased by heating or by performing work on it.
Absolute zero = no kinetic energy

7. Change of State Liquid-solid phase changes (melting and freezing)
Melting = changeover from the solid to the liquid state
Melting point = the temperature at which melting occur.
Freezing = the opposite of melting
Freezing point = the temperature at which the substance freezes; same as its melting point

8. Temperature Celsius (used in health care)
Temperature: the amount of heat energy in matter expressed in terms of a specific scale
Three common scales of temperature:
Celsius (used in health care)
Body temperature 37 degrees C (+/-1)
Boiling point of water 100 degrees C
Freezing point of water 0 degrees C
Absolute 0 (no molecular movement) -273 C
Fahrenheit (common US household scale)
Body temperature 98.6 degrees (+/- 1)
Boiling point of water 212 degrees F
Freezing point of water 32 degrees F
Absolute 0 (no molecular movement) -280 F
Kelvin (used in research)
Absolute 0 (no molecular movement) 0 Kelvin

9. Temperature Kelvins = Celsius + 273 Example: Convert 37 C to Kelvins
Absolute Temperature Scale: A temperature measurement scale in which the 0 point is absolute 0 or the temperature at which all molecular motion ceases. Absolute 0 temperature is about -273 Celsius. The absolute temperature scale for Celsius is called the Kelvin temperature scale. Celsius temperatures can be converted to Kelvin temperatures by adding 273 degrees to the Celsius temperature as shown below:
Kelvins = Celsius + 273 
Example: Convert 37 C to Kelvins
 Kelvins = = 310 Kelvins
To convert Kelvin temperatures to Celsius, subtract 273 as shown below: 
Celsius = Kelvins - 273
 Example: Convert 298 Kelvins to Celsius
 Celsius = 298 K = 25 Celsius

10. Temperature Conversion
To convert Fahrenheit to Celsius, use the following formula:
C = .55 x (F - 32)
Example: Convert 60 Fahrenheit to Celsius
C = .55 ( ) = .55 x 28 = 15 Celsius
To convert Celsius to Fahrenheit, use the following formula:  
F = (1.8 x C) + 32
Example: Convert 20 Celsius to Fahrenheit
F = (1.8 x 20) +32 = = 68 Fahrenheit

11. Pressure
Pressure: A measurement of force per unit area, ie: pounds per square inch (PSI)
Absolute Pressure Scale: A pressure scale in which the 0 point is a complete vacuum or the pressure at which all molecular motion ceases. Absolute pressure includes atmospheric pressure.
Gauge Pressure Scale: A pressure scale in which the 0 point is atmospheric pressure or the pressure of the atmosphere pushing down on a given point on the earth.

12. Critical Temperature and Pressure
The temperature reached in which gaseous molecules cannot be converted back to a liquid, no matter what pressure is exerted on them.
The highest temperature at which a substance can exist in a liquid state.
Critical pressure:
The critical pressure of a substance is the pressure required to liquefy a gas at its critical temperature.

13. Atoms
An atom is classified according to the number of protons and neutrons in its nucleus: the number of protons determines the chemical element, and the number of neutrons determines the isotope of the element

14. Atomic Particles subatomic particles are particles smaller than atoms
Basic structures include protons, neutrons and electrons

15. Neutron Neutron is also in the atoms nucleus
It is a subatomic particle with no electric charge and a mass of 1 amu
The sum of the neutrons inside the nucleus he number of the protons = atomic mass
Most atoms of elements can accommodate additional neutrons in their nucleus
Ex: Oxygen, three variations with varying atomic mass

16. Electron
Electron is the lightest subatomic particle. It is a negatively charged particle.
Its mass is only 1/1,840 the mass of a proton. An electron is therefore considered to be mass-less in comparison with proton and neutron and is not included in calculating atomic mass of an atom.. Under ordinary conditions, electrons are bound to the positively charged nucleus by the attraction created from opposite electric charges.
An atom may have more or fewer electrons than the positive charge of its nucleus and thus be negatively or positively charged as a whole; a charged atom is called ion. In plasma, electrons exist in free state along with ions.

18. What is the difference between a compound and a molecule?
A molecule is formed when two or more atoms join together chemically.
A compound is a molecule that contains at least two different elements. All compounds are molecules but not all molecules are compounds.
Molecular hydrogen (H2), molecular oxygen (O2) and molecular nitrogen (N2) are not compounds because each is composed of a single element.
Water (H2O), carbon dioxide (CO2) and methane (CH4) are compounds because each is made from more than one element.

19. Chemical Bonding (type I)
Electrovalent (Ionic) Bonding
Two or more elements combine with each other by transferring electrons
One electron leaves outermost electron shell of one atom and enters outermost shell of other atom
Tendency in nature is for all atoms to seek eight electrons in their outermost electron shell (RULE OF EIGHT)
Ex: Na and Cl, Cl has 7 electrons in its outermost shell and Na has one. When the two elements react NA transfers its lone electron to Cl making Cl negatively charged, and sodium becomes positively charged since it lost an electron. Creating ions of Na and Cl
The bond that holds Na and Cl together is called electrovalent
The electrostatic attraction between these opposite charges maintains molecular integrity (NaCl)

20. Chemical Bonding (type II)
Covalent Bonding
Results from the sharing of one or more pairs of electrons to form covalent molecules
Example: two Oxygen Molecules
Oxygen has two unpaired electrons in its outermost shell (total of 6), this combines with two from another Oxygen molecule to form O2

21. Chemical Bonding
Some compounds are held together from a combination of both types of bonds
As elements react to form compounds, electrons are either shared or transferred or both
The electrons involved in these processes are called valence electrons
The valence of an atom is the number of electrons transferred (donated or received) in forming ions
Ex: Na has a valence of 1 because it donates one electron and forms the Na+ cation. The Cl- anion also has a valence of 1, it receives one electron and becomes Cl-.
Oxygen has a valence of 2, because two electrons are involved in the covalent bond formation
Some have multiple valences such as Fe, either Fe2+ or Fe3+

22. Henry’s Law
Describes the diffusion rate, or dissolving of a gas molecules into liquid.
It states “For a given temperature, the rate of a gas’s diffusion into a liquid is proportional to the partial pressure of that gas and its solubility coefficient”.
Does not apply to gases that chemically react with the solvent

23. CaO2 Formula
Total Oxygen Content (formula to determine tissue oxygenation)
CaO2 = (Hb x 1.34 x SaO2) + (0.003 x PaO2) NORMAL 17-21vol%
Amount of O2 combined with Hb + Amount dissolved in Plasma
Hb = Hemoglobin
Normal males: 13.5 to 17.5 grams per deciliter
Normal f es: 12.0 to 15.5 grams per deciliter
1.34 = number of millimeters of Oxygen that combine with each gram of hemoglobin
SaO2 = Percentage of saturated Hemoglobin with Oxygen
Normal 92-99%
0.003= Solubility coefficient of O2
PaO2 = Partial pressure of oxygen in the blood
Normal value mmHg
EX: CaO2 = (15 x 1.34 x .95) + (0.003 x 90)
= vol%

24. Solubility of CO2
CO2 diffuses about 22 times faster than O2 into the blood
Based on:
Plasma being the solvent
Normal body temperature
760 mmHg atmospheric blood pressure
The solubility coefficient for CO2 at 37C and 760 torr is (A lot higher than O2)
0.510 ml CO2/ml plasma/760 torr
Reduced to
0.510 ml CO2/ml plasma = ml CO2/ml plasma/torr PCo2
760 torr
Further broken down to: vol%

25. PAO2 formula PAO2 = FIO2 (PB- PH2O) – PaCO2 /RQ
Called the Alveolar air equation
PAO2 = FIO2 (PB- PH2O) – PaCO2 /RQ
PAO2 = Alveolar air equation
Normal 100 mmHg
FIO2 = Fractional inspired Oxygen
Room air = 21%, with supplemental Oxygen can increase to 100%
PB = Barometric pressure
At sea level = 760 mmHg
PH2O = Water vapor pressure
At normal BTPS = 47 mmHg
PaCO2= Partial pressure of Co2 in the blood
Normally mmHg, varies with ventilation status
RQ= Respiratory quotient
Default number 0.8, this represents cellular uptake and elimination of O2 and CO2

26. PAO2 formula Inputting normal values:
PAO2= .21(760 mmHg-47mmHg)- 40 / 0.8
0.21 (713) – 50
– 50 = (rounded to 100)
This varies with changes in all the variables in the formula. Under normal lung conditions, a PAO2 of 100 results in a PaO2 of mmHg

27. Definition of Pressure
Defined as force (F) acting perpendicularly to a surface area (A)
P = F/A
In the atmosphere the gas we breathe (Nitrogen, Oxygen, Co2 and trace gases) are in constant motion, creating kinetic energy and FORCE applied against the surface of the earth. This is the atmospheric pressure

28. Atmospheric pressure
Atmospheric pressure is usually measured by the height of a liquid in a closed, evacuated tube as shown on pages in the text book.
You have already learned the normal values at sea level for one atmosphere in several different pressure scales.
At altitudes above sea level the atmospheric pressure is lower because there is less air pushing down on the surface.
At sea level, 1 ATM = 760 torr, In Denver, 1 mile above sea level, 1 ATM = 680 tor.

29. Atmospheric pressure units
At sea level:
760 mmHg
760 torr
1034 cmH2O
33 ft H2O
14.7 PSI
29.9 inHg
kPa
*in respiratory we will use mmhg/torr

30. Barometric pressure goes down.
As elevation goes up
Barometric pressure goes down.
This is an inverse relationship.

31. Fluids (air and water) flow from areas of high pressure to areas of low pressure.
Change in pressure across a horizontal distance is a pressure gradient.
Greater the difference in pressure and the shorter the distance between them, the steeper the pressure gradient and the high the velocity of flow
In the lung, flow travels to the alveoli based on the diameter of the airway and also the pressure gradient. We will learn about this in another lecture
6-1

32. speed, velocity, and flow.
Speed is a measurement of an object’s movement in units of distance or length /time, (ie cm/sec, miles per hour).
Velocity is the speed of an object with its direction at a given instant, (ie 50 miles/hour South).
Fluid flow is a special kind of velocity expressed in units of volume/time, ie ml/sec, l/min. Remember that a fluid is a substance capable of flowing ---a gas or liquid.

33. Kinetic Theory of Matter
The Kinetic Theory of Matter is the theory that all molecules are in constant motion resulting in kinetic energy. This theory applies to all three states of matter -- solids, liquids and gases.

34. States of Matter
Solids – have a high degree of internal order; their atoms have a strong mutual attractive force
Liquids – atoms exhibit less degree of mutual attraction compared with solids, they take the shape of their container, are difficult to compress, exhibit the phenomenon of flow
Gases – weak molecular attractive forces; gas molecules exhibit rapid, random motion with frequent collisions, gases are easily compressible, expand to fill their container, exhibit the phenomenon of flow

35. Change of State (cont.) Heat transfer
Conduction – transfers heat in solids
Convection – transfers heat in liquids and gases
(Example: heating homes or infant incubators)
Radiation – occurs without direct contact between two substances - example: microwave oven
Evaporation/Condensation: requires heat energy to occur
Sublimation - change from a solid to a gas without an intermediate change to a liquid - example dry ice turning into CO2

36. Change of State (cont.)
Pascal’s Principle. Liquid pressure depends only on the height and weight density of the liquid and not the shape of the vessel or total volume of a liquid.

37. Pascal's law
Pascal's law states that pressure exerted anywhere in a confined incompressible fluid is transmitted equally in all directions throughout the fluid such that the pressure ratio (initial difference) remains the same.
Pascal’s Law states that when you apply pressure to confined fluids (contained in a flexible yet leak-proof enclosure so that it can’t flow out), the fluids will then transmit that same pressure in all directions within the container, at the same rate. The simplest instance of this is stepping on a balloon; the balloon bulges out on all sides under the foot and not just on one side. This is precisely what Pascal’s Law is all about – the air which is the fluid in this case, was confined by the balloon, and you applied pressure with your foot causing it to get displaced uniformly.

38. Change of State (cont.) Cohesion and adhesion
The attractive force between like molecules is cohesion.
The attractive force between unlike molecules is adhesion.
The shape of the meniscus depends on the relative strengths of adhesion and cohesion.
H20: Adhesion > Cohesion
Mercury: Cohesion > Adhesion
Mercury
H20

39. Cohesion and Adhesion http://www.youtube.com/watch?v=VHnFMPxteGo
Cohesion: Water is attracted to water Adhesion: Water is attracted to other substances
Adhesion and cohesion are water properties that affect every water molecule on earth and also the interaction of water molecules with molecules of other substances. Essentially, cohesion and adhesion are the "stickiness" that water molecules have for each other and for other substances.
The water drop is composed of water molecules that like to stick together, an example of the property of cohesion. The water drop is stuck to the end of the pine needles, which is an example of the property of adhesion. Notice I also threw in the all-important property of gravity, which is causing the water drops to roll along the pine needle, attempting to fall downwards. It is lucky for the drops that adhesion is holding them, at least for now, to the pine needle.

40. Humidity and Aerosol
Vapor pressure – Pressure water as a vapor or gas exerts and is part of the total atmospheric pressure. Water vapor pressure in the lungs exert 47 mmHg
Absolute Humidity – the actual amount (in mg./l) of water vapor in the atmosphere
Relative Humidity – the percent of water vapor in the air as compared to the amount necessary to cause saturation at the same temperature.
% Body Humidity – the relative humidity at 37 degrees Celsius
Humidity Deficit – the amount of water vapor needed to achieve full saturation at body temperature (44 mg/l - A.H)

41. Vapor pressure
Vaporization: the change of matter from a liquid to a gaseous form
Water vapor pressure – the direct measure of the kinetic activity of water vapor molecules
Reducing the pressure above a liquid lowers its boiling point. Ex. water boiling in mountains

42. Water Vapor Pressure
That is, since water vapor partial pressure must be 47 mmHg in a saturated gas mixture at 37°C, the total pressure remaining for the inspired gases is only or 713 mmHg. The composition of this remaining gas is 21% O2 and 79% N2, giving the partial pressures indicated above which is then substrated by the partial pressure of PaCO2 (PACO2, is a product of the amount of CO2 diffused into the lung)
PAO2 = FIO2 (Pb-PH2O) – (PaCO2/0.8)

43. Humidity and Aerosol Solutions Used
Sterile water used in humidifiers and continuous nebulizers (Hypotonic)
(Normal) Isotonic saline (.9% Na) with (Aerosol / Medicine) Treatments
Hypertonic saline (10%) (for sputum induction)

44. Formulas Used When Calculating Humidity
%RH=(absolute humidity/saturated capacity) x 100
%BH = (absolute humidity/43.8mg/L) x 100

45. Importance of Humidity
If the upper airway were bypassed or dry gases were inhaled, a series of adverse reactions could occur, including:
Slowing of mucus movement
Inflammatory changes and possible necrosis of pulmonary epithelium
Retention of thick secretions and encrustation
Bacterial infiltration of mucosa (bronchitis)
Atelectasis
Pneumonia
Impairment of ciliary activity

46. Sign/Symptoms of Inadequate Airway Humidification
Atelectasis
Dry, nonproductive cough
Increased airway resistance
Increased in incidence of infection
Increased work of breathing
Substernal pain
Thick, dehydrated secretions

47. Aerosol Therapy
It is important to remember that an aerosol is not the same as humidity.
Humidity is water in a gas in molecular form, while an aerosol is liquid or solid particles suspended in a gas.
Examples of aerosol particles can be seen everywhere: as pollen, spores, dust, smoke, smog, fog, mists, and viruses.

48. Aerosol Therapy
Aerosol therapy is designed to increase the water content delivered while delivering drugs to the pulmonary tree
Deposition location is of vital concern
Some factors that affect aerosol deposition are aerosol particle size and particle number.

49. Particle Size

50. Deposition
The aerosol particles are retained in the mucosa of the respiratory tract. They get stuck!
The site of deposition depends on size, shape, motion and physical characteristics of the AIRWAYS

51. Mechanism resulting in Deposition: Inertial Impaction
Moving particles collide with airway surface.
Large particles (>5micros), upper and large airways
Physics: the larger the particle, the more likely it will remain moving in a straight line even when the direction of flow changes.
Physics: greater velocity and turbulence results in greater tendency for deposition

52. Mechanism resulting in Deposition: Sedimentation
Particles settle out of aerosol suspension due to gravity.
The bigger it is the faster it settles!
Medium particles: 1-5 microns, central airways
Directly proportional to time.
The longer you hold your breath the greater the sedimentation

53. Mechanism resulting in Deposition: Diffusion
Actual diffusion particles via the alveolar-capillary membrane and to a lesser extent tissue-capillary membranes of respiratory tract
Lower airways: 2-5 microns
Alveoli: 1-3 microns
These values are from your book

54. Deposition of Particles is also affected by:
Particle inertia (repeated) - Affects larger particles which are less likely to follow a course or pattern of flow that is not in a straight line.
As the tracheobronchial tree bifurcates, the course of gas flow is constantly changing, causing deposition of these large particles at the bifurcation.

55. Deposition of Particles is also affected by:
Composition or nature of the aerosol particles - Some particles absorb water, become large and rain- out, while others evaporate, become smaller and are conducted further into the respiratory tree.
Hypertonic solutions absorb water from the respiratory tract, become larger and rain-out sooner.
Hypotonic solutions tends to lose water through evaporation and are carried deeper into the respiratory tract for deposition.
Isotonic solutions (0.9% NaCl) will remain fairly stable in size until they are deposited.

56. Boyle’s Law
This law is named for Charles Boyle, who studied the relationship between pressure, p, and volume, V, in the mid-1600s.
Boyle determined that for the same amount of a gas at constant temperature,
p * V = constant
This defines an inverse relationship: when one goes up, the other comes down.
pressure
volume
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57. Boyle’s Law
This law is named for Charles Boyle, who studied the relationship between pressure, p, and volume, V, in the mid-1600s.
He determined that for the same amount of a gas at constant temperature,
p * V = constant
This defines an inverse relationship: when one goes up, the other comes down.
pressure
volume
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58. What does Boyle’s Law mean?
p * V = constant
Suppose you have a cylinder with a piston in the top so you can change the volume. The cylinder has a gauge to measure pressure, is contained so the amount of gas is constant, and can be maintained at a constant temperature.
A decrease in volume will result in increased pressure.
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59. A factor in breathing:
For inhalation to occur,
1. Diaphragm muscle flattens/moves down
2. Increases the volume of the chest cavity
3. Pressure within the chest decreases
4. Air pressure within the lung is now less than atmospheric air pressure
5. Air flows into your lungs.

60. Charles’ Law
This law is named for Jacques Charles, who studied the relationship volume, V, and temperature, T, around the turn of the 19th century.
He determined that for the same amount of a gas at constant pressure,
V / T = constant
This defines a direct relationship: an increase in one results in an increase in the other.
volume
temperature
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61. What does Charles’ Law mean?
V / T = constant
Suppose you have that same cylinder with a piston in the top allowing volume to change, and a heating/cooling element allowing for changing temperature. The force on the piston head is constant to maintain pressure, and the cylinder is contained so the amount of gas is constant.
An increase in temperature results in increased volume.
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62. COMBINED GAS LAW
P1 x V1 T1
P2 x V2 T2
States: “The state of an amount of gas is determined by its pressure, volume, and temperature”
The absolute pressure of a gas is inversely related to the volume it occupies & directly related to its absolute temp. =

63. Gay-Lussac’s Law: “With volume remaining constant, pressure and temperature are directly related”

64. DALTON’S LAW OF PARTIAL PRESSURE
States: “The sum of the partial pressures of a gas mixture equals the total pressure of the system and that the partial pressure of any gas within a gas mixture is proportional to its % of the mixture”.
Example:
OXYGEN = 21%
NITROGEN = 78%
TRACE GASES = 1%
100% Atmospheric
At 100% atmospheric,
these gases exert a pressure
of 760mmHg at sea level