Flashcards in coughing Deck (53)
what sensory receptor receptors are simulated in sneezing?
CN V and CN IX
what sensory receptors are simulated in coughing?
CN IX and CN X
what is the carotid sheath?
- toilet roll tube
- protective tubes of cervical deep fascia
- attaches superiorly to bones of the skull base
- blends inferiorly with the fascia of the mediastinum
- it contains the vagus nerve, the internal carotid artery, the common carotid artery and the internal jugular vein
where do all motor axons travel from and what do they do?
- from the tracheal bifurcation along the branches of the resp tree to supply all mucous glands and all bronchiolar smooth muscle
what does the pulmonary plexus contain?
- sympathetic axons
- parasympathetic axons
- visceral afferents
where do the pulmonary visceral afferents travel from?
visceral pleural and resp tree to the plexus then follow the vagus nerve to the medulla of the brain stem
what are the inspiration mechanisms?
1. diaphragm contracts and descends = increases vertical chest dimension
22. intercostal muscle contract elevating ribs = increases A-P and lateral chest dimension
3. the chest wall pulls the lungs outwards with them (pleura) = air flows into the lungs , negative pressure
phrenic nerves and diaphagm
- main muscle of quiet respiration
- supplied by anterior rami pf C3, 4 and 5
- found in the neck on the anterior surface of scalneus anterior muscle
- found in the chest descending over the lateral aspects of the fibrous pericardium anterior to the lung root
- supplies somatic motor axons to the diaphragm
when does the diaphragm flatten?
- in a deep inspiration
- a greater outflow of action potential of lunger duration, via phrenic nerve occurs causing the diaphragm to flatten then descend maximally
what are the muscles of normal, quiet inspiration?
1. external intercosal muscles
2. internal intercostal musces
3. innermost intercostal muscles
what happenns in a deep forced inspiration?
the intercostal muscles contract forcefully and raise the ribs maximally
what is the pectoralis major?
- attaches between sternum/ribs and humerus
- adducts and medially rotates humerus if the upper limb postition is fixed
- this muscle can pull the ribs upwards
what is the pectoralis minor?
can pull ribs 3-4 superiorly towards the caracoid process of the scapula
where does the sternocleidomastoid attach?
between stenum/clavical and mastoid process of temporal bone
where do the slaneus anteroir, medius and posterior attach?
between cervical vertebrae and ribs 1&2
what are the intrinsic muscles of the larynx?
- all skeletal (voluntary) muscles
- attach between the cartilages
- movethe cartilages resulting in the movement of the vocal cords
- all supplied by somatic motor, branches of the vagus nerve CN X
- they adduct the vcal cords during the cough reflex
is the nerve is behind the root of the lung, what is it?
the vagus nerve
what do the right and left vagus nerves do?
connect with the CNS at the medulla of the brainstem
what are the expiration mechanisms?
1. diaphragm relaxes and rises = decreses vertical thoracic dimension
2. intercostal muscles rela lowing ribs = decreases A-P and lateral chest dimension
3. elastic tissue of lungs recoils =air flows out of the lungs
what are the 3 flat muscle layers?
what are the thoracoabdominal nerves?
they somatic mototr, somatic sensory and sympahetic nerve fibres suppling the structure of the abdominal part of the body wall are conveyed within the thoracoabdominal nerves
what is a small/large pneumothorax?
- when a small/large amount of air enters the pleural caivuty via penetrating injury to the prtietal pleural or rupture of the visceral pleural
- the vaccum is lost, the elastic lung tissue recoils towards the lung root and a small pnuemothorac results (<2cm gap between lung and pariteal pleura)
how is pneumothorax diagnosed?
2. exmaination = reduced ipsilateral chest expansion, reduced ipsilateral breath sounds, hypper-resonance on percussion
3. investigation (CXR) = absent lung markings peripherally, lung edge visable
what is tension pneumothorax?
- the torn pleural creases a one way valve that allow s air to enter th epleural cavity on each inspiration but prevents air eescaping on expiration
- the pneumothorax expands and the lung collapses towards its root
- eventuallt tension is applied to the medialstinal structures = causing a medialstinal shift
what are the consequences of a mediastinal shift?
- tracheal deviation = away from the side of the unilateral tension pneumothorax
how do you manage a large pneumothorax?
1. needle aspiration
2. the sitting of a chest drain
both via the 4th or 5th intercostal space in the mixaxillary line to avoid intercostal nerves/arteries/veins
how do you manage tension pneumothorax in an emergency situation?
- insert large gauge cannula into the pleural cavity via the 2nd or 3rd intercostal space in the midclavicular line on the side of the tension pneumothorax
in emergency management on tension pneumothorax, what will the cannula pass through?
- superficial/deep fascia
- 3 layers of intercostal muscles
- pariteal pleura
what is a herniae?
any structure passing through another and ending up in the wrong place