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The Virtual Anaesthesia Textbook

Respiration

Last modified 9/11/2014. Comments to: Chris Thompson

Contents:


Respiration

Anatomy and Radiology

Let's start with a google search for respiratory anatomy images.

AnatomyZone has a wonderful collection of videos and 3D representations of human anatomy including the larynx and respiratory system.

Radiology basics can be found at Dr. Chandrasekhar's Loyola University introduction to Chest Radiology, chestx-ray.com, usuhs basic chest review, these Uni Virginia Radiology courses on Chest X-Rays , ICU Chest Film interpretation, chest CT interpretation and CTPA. RadiologyMasterClass.

Afterwards test your knowledge at CIDER.

Radiologyeducation.com and Health on the Net include a number of educational sites.

There are a number of annotated Chest X-Ray libraries. Try RadioPaedia.org and the collaborative hypertextbook of radiology.

Basics of laryngeal anatomy can be found at Emory, York, AirwayCam, AnatomyZone, Gray's Anatomy and others.

Physiology

Johns Hopkins School of Medicine has a fantastic set of pages on Respiratory Physiology. For a graphically rich experience look at Ritchi Song's pages. The Worldwide Anaesthetist has a page on Normal Lung Function (highly recommended). Also consider AC Brown's site, the World Federation of Anaesthetists notes, For links try Wikipedia

Acid-Base Physiology is covered in the VAT chapter on Water and Electrolyte Homeostasis, Renal and Acid-Base Physiology.

Chris Thompson's notes on Ventilation contain a section on lung physiology and mechanics. Paul Forrest provides slides on Control of Ventilation, GasExchange, the Pulmonary Circulation and Ventilation and Perfusion.

Some classic books:

Respiratory Physiology - The Essentials; John B. West (also soon in hardcover)

Nunn's Applied Respiratory Physiology; Andrew Lumb

The Lung : Scientific Foundations; Ronald G. Crystal (Editor) et al.

Physiology and Pharmacology of Cardio-Respiratory Control; Albert Dahan (Editor) et al.

Cardiovascular Physiology; Robert M. Berne, Matthew N. Levy

Review of Medical Physiology (18th Ed); William F. Ganong

Textbook of Medical Physiology; Arthur C. Guyton, John E. Hall

Physical Examination

The R.A.L.E. Repository at Winnipeg in Canada has a variety of normal and pathological lung sounds (both WAV and Realaudio formats) to check out. You can also download demo versions of their new software which features more extensive sets of lung sounds as well as other fantastic teaching material. Magill University also has a Virtual Stethoscope but you'll need a java enabled browser to hear the sounds. Martingdale lists similar resources.

UCSD Clinical Skills presents an organized approach based upon observation, palpation, percussion, and auscultation. Aimed at medical students they may nevertheless be useful for all of us. Other systems are presented as well. This YouTube video shows the basics.

easyauscultation.com and www.practicalclinicalskills.com both provide lung sound lessons, quizzes and other information.

Respiratory Tests

Jeff Pray has a page to test your knowledge of spirometry and includes some good looking references and other information.

Loyola University has an incomplete set of pages on Respiratory Medicine for Medical Students with some lessons on respiratory function tests.

Monitoring

Chris Thompson has some notes on Oxygen Monitoring which has a small section on monitoring patient oxygenation.

If you use an oesophageal/precordial stethoscope you might be interested in an FM transmitter.

Airway pressure disconnect alarms and/or exhaled volume alarms are important during anaesthesia.

Modern ventilators provide waveforms for airflow and pressure, including flow/volume loops etc. Useful information is difficult to find. Chris Thompson has made a set of slides (html) that explain how to optimise PEEP, adjust inspiratory/expiratory times and recruit collapsed lung using flow curve and tidal volume data. Here is excellent graphical description of how to interpret flow and volume waveforms in neonatal ventilation, including optimisation of inspiratory time etc.

Information on interpretation of loops is available from Anaesthesia UK and Arora and Raghu.

Wikipedia provides an overview of mechanical ventilation technologies.

Sleep Disordered Breathing

For an excellent discussion of the subject by John Loadsman check out this review. For Sleep Apnoea patients John Loadsman has a document about Anaesthesia and the Sleep Apnoea Sufferer. More general information on Sleep Disorders, for everyone from patients to specialists, can be found at or via the following pages:

Airway Management

Monash University provide and excellent review of paediatric upper airway obstruction and its acute management.

See also the VAT chapter on intubation and the airway.

Trauma.org has a page dedicated to anaesthesia of the trauma victim which contains several resources dealing with airway management in trauma.


Drugs and Respiration

The Central Respiratory Effects of Benzodiazepines are notes from John Loadsman. It includes a fairly extensive literature review on the subject as well as detailed info about their mechanism of action.

Ards.net has a page on the role of nitric oxide. There is a overview in Medscape. More detailed information requres a PubMed search.

The Worldwide Anaesthetist hosts a page about Selective Pulmonary Vasodilators. They also have a section on Lung Recruitment in Intensive Care.


This chapter is kindly sponsored by Wavelength Consulting Medical Recruitment and Locum Service. We are most grateful for their assistance


Link to VAT

visitors to this chapter since April 29th 2000.

Original concept for the Virtual Anaesthesia Textbook by:
Dr. Chris Thompson
Senior Staff Specialist Anaesthetist
Royal Prince Alfred Hospital
Sydney Australia

 

This chapter originally written by John Loadsman.