Respiratory System

&
Auscultation

T Heffernan
 Respiratory System
Primary Function

Exchange of gases

• Carbon dioxide CO2 Oxygen O2

Via
• Alveoli Pulmonary Circulation
Respiratory System

Anatomic Structures
Upper Airway:

• Nasal cavity

• Pharynx - Nasopharynx
- Oropharynx
- Hypopharynx
Respiratory System
Respiratory System
Anatomic Structures
Lower Airway:
• Trachea
(located just below larynx, in the thoracic cavity, beneath
upper 2/3rds of sternum )

• Lungs - Pleura
• Bronchus
• Bronchioles
• Alveoli
 Respiratory System

Anatomic Structures
Lungs:
Rt Lung has 3 lobes
Lt Lung has 2 lobes

Pleurae:-
Thin membranous tissue between lung
surface (visceral) and chest wall (parietal)
allows smooth expansion and contraction
Location of Lungs and
Tracheobronchial Tree
 Respiratory System

Anatomic Structures
Alveolar Cells:
Type I - largest that covers 95% of surface area where
gas exchange takes place

Type II - Produce surfactant for surface

tension and stabilisation of air sacs

Macrophage - defend against infection

Respiratory System

Defense Mechanisms
Cilia
Motile, whip like extensions from cell
surfaces line the airways. Performing a
wave like motion, they filter and clean the
airways
Mucous membrane
The airways are lined with a mucous
membrane that trap impurities from the
airways
Structure of Cilia and Mucus Membrane
 Respiratory System

Primary Muscles
• Diaphragm-
consists of 2 hemidiaphragms attached to lower
rib cage

• External intercostal muscles -

situated in between the ribs
Movement of Muscles During Respiration
 Respiratory System

Accessory Muscles
Active in labored or forceful breathing

• Sternocleido mastoid
• Scalene
• Trapezius
• Rhomboid
 Respiratory System

Mechanics of Breathing
Inspiration
• Diaphragm flattens and pushes down
towards abdomen
• external intercostal muscles contract to
stabilize rib cage
• rib cage expands
• lung size increases
• Inspired air flows into the airways
 Respiratory System

Mechanics of Breathing
Expiration
• The thorax and elastic recoil force, return
lungs to resting position
• intrapleural pressure increases
• forces air out of upper & lower airways
• muscles relax
• diaphragm returns to resting position
 Respiratory System

Circulation
Pulmonary
• pulmonary artery -
leaves Rt ventricle divides • venules - that in turn
into form
• segmental arteries - • veins - lead to
ending in • pulmonary vein -
• pulmonary capillary ending in Lt atrium
bed - surrounding
• alveoli - where gas
exchange occurs
• capillaries - join to form
 Respiratory System

Circulation
Bronchial
originates in the
• aorta - branches along
• Deoxygenated blood
• bronchi - carrying
is returned to
• oxygen & nutrients at
• Lt atrium
the same time clearing
accounting for the
• metabolic waste - from
normal 2%-3%
• airways and lung tissue right to left shunt
Circulation
Respiratory System
Nervous system
there are 2 neuro pathways:-
Parasympathetic
(includes vagal nerve fibres and irritant receptors)
on stimulation facilitates -
• Smooth muscle contraction
• Cough
• Mucus discharge from bronchial
glands
Respiratory System

Nervous system
there are 2 neuro pathways:-
Sympathetic
innervation to the airways facilitates

• smooth muscle relaxation

• bronchial dilatation
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Auscultation

Sr T Heffernan
Senior Clinical Lead
Critical Care Outreach
 Auscultation
Definition

‘The act of listening to sounds made by

the body with a stethoscope’
Auscultation

Patient Positioning
• blood/airflow patterns are affected by
position/gravity

• Ideally the patient should be in the supine

position as blood flow and ventilation are
distributed equally in the lungs
 Stethoscope
Ear piece
The diaphragm of the
stethoscope is pressed over the
chest surface at the
‘auscultation sites’ to detect
breath sounds.
NB.- clothing and bone alter
transmission.

Bell
Diaphragm
transmits low pitch sounds
transmits high pitch sounds
Auscultation
Detecting Breath Sounds
Sites
Chest wall
• Anterior - 9 sites
• Posterior - 10 sites
• Lateral
Anatomic Dead Space
It should be noted that 150mls of inspired air
remains in the conducting airway at all times
(nose - terminal bronchials)
where no gas exchange takes place
 Auscultation Sites & Sequences
Anterior Posterior

The skeleton provides landmarks for auscultation - i.e

clavicle/scapula, ribs and sternum.
The chest is sounded right to left to pick up any
‘contralateral’ differences in breath sounds on opposite sites