Download - 2 Cardiopulmonary Physical Therapy
-
8/2/2019 2 Cardiopulmonary Physical Therapy
1/26
Cardiopulmonary physical therapy
lecture 2
Dr. Shaukat Ali Pt, Dpt.
Lecturer ISRS
-
8/2/2019 2 Cardiopulmonary Physical Therapy
2/26
Why anatomy of cardiopulmonary
system is important to pt?
The heart lies in series with the lungs, constituting thecardiopulmonary unit, the central component of theoxygen transport pathway .Virtually all the blood returned to the right side of the heart passes through the
lungs and is delivered to the left side of the heart forejection to the systemic, coronary, andbronchopulmonary circulations.
Because of this interrelationship, changes in either lungor heart function can exert changes in the function of
the other organ. A detailed understanding of theanatomy of the heart and lungs, and how these organswork synergistically is essential to the practice ofcardiopulmonary physical therapy.
-
8/2/2019 2 Cardiopulmonary Physical Therapy
3/26
Layout of todays lecture.
anatomy of the cardiopulmonary system,
including
Bony thorax
Thoracic cavitypleural cavities and
mediastinum
heart
-
8/2/2019 2 Cardiopulmonary Physical Therapy
4/26
Thoracic cage
-
8/2/2019 2 Cardiopulmonary Physical Therapy
5/26
Thorax
Trunk.. Divided into thorax and abdomen
Thoracic cage.an osseocartilaginous elastic cage.
How thoracic cage is formed?
Shape of the thoracic cage.cone like
The transverse section of thorax .. Kidney shaped.. Oval shaped
,the transverse diameter is
Childern up to the age of 2 years.. The thoracic cavity is circular
the AP diameter.
In infants the ribs are placed horizontal while in adult the ribs are
placed obliquely ..
Applied anatomy of thoracic cagerib fracture and cervical rib
-
8/2/2019 2 Cardiopulmonary Physical Therapy
6/26
Approaches to cavity of thoracic cage
Two ends, superior and inferior
Superior apertureinlet of thorax
Shape kidney shaped
Formation of inlet.
Plane of inlet
Diaphragm of the inlet.
Function of the diaphragm of the inlet.
Structures passing through the inlet.viscera,vessels and nerves, muscles
Applied anatomy of the inlet of the thorax.
-
8/2/2019 2 Cardiopulmonary Physical Therapy
7/26
Inferior aperturebroader
How outlet is formed?....
Diaphragm of the out let. Openings in the out let diaphragm.
Principal muscle of inspiration.
Contribution of diaphragm to the tidal volumeand vital capacity of the lungs in different
postures.
-
8/2/2019 2 Cardiopulmonary Physical Therapy
8/26
Origin of diaphragm
Diaphragm is divided into 2 halves.. Right and left
Each half has got three parts.
Central tendon insertion of the diaphragm.
Position of the diaphragm in different postures.
On x-ray the position of the diaphragm indicates
about the phase of respiration. Nerve supply
Clinical anatomy
-
8/2/2019 2 Cardiopulmonary Physical Therapy
9/26
-
8/2/2019 2 Cardiopulmonary Physical Therapy
10/26
Mechanism of action.
Increase in vertical and transverse diameter of
thoracic cavity
How?
-
8/2/2019 2 Cardiopulmonary Physical Therapy
11/26
Bones of the thoracic cage
Sternum.
Vertebral column.vertebrae
Ribs 12 in number, number can be morethan 12 or less than 12typical ribsatypical
ribsobliquity of ribs increases.. Length of
ribs increasestrue ribs, false
ribsfeatures of typical ribs
Joints of thorax.
-
8/2/2019 2 Cardiopulmonary Physical Therapy
12/26
Respiratory movements.
Lungs expand passively during inspiration and
retracts during expiration..due to..two
factors1)alteration in the capacity of
thoracic cavity is brought about
by..2)elastic recoil of the pulmonary alveoli
and of the thoracic wall.
Principles of movements. (Pump handlemovement and Bucket handle movement)
-
8/2/2019 2 Cardiopulmonary Physical Therapy
13/26
Pump handle movement.sternum acts like a pump andvertebrosternal ribs (2-6) act like the handle of the pump handlemachine.rib acts like a lever with fulcrum some what near itstubercle.. Effort arm. Load arm, disproportionality b/w the twoarms lengththe effort arm is longer than the load arm, slight
movement at the effort arm results in. Magnified movement atthe load arm end.
The anterior end of a rib is lower than the posterior end, so whenthe posterior end is pushed downward the anterior end is pulledupward and forward in this way AP diameter of the thorax isincreased along the up and downward movements of the 2 to 6
true ribs the sternum moves up and forward in what are calledpump handle movement. The movements takes place at thecostovertebral and manubriosternal joints.
-
8/2/2019 2 Cardiopulmonary Physical Therapy
14/26
Bucket handle movement. Occurs at the 8, 9 and 10thfalse ribs the shafts of these ribs lie below the planepassing the two end of these ribs, so when ever theseribs are elevated the shaft moves outward like bucket
handle movement which results in increase in thetransverse diameter of the thorax.
The thorax resembles a cone tapering upward, thatwhy each rib is longer than the rib above so when a
lower rib is elevated it takes the place of the higherone and in this the transverse diameter is increased.
-
8/2/2019 2 Cardiopulmonary Physical Therapy
15/26
Respiratory muscles
Diaphragmalready discussed
External intercostal, 11 in number. Origin,
insertion, fibers direction, role.. Internal intercostal, 11 in number. Origin,
insertion, fibers direction, role..
Accessory muscles.SCM, scalenes. Serratus
anterior, rhomboids major and minor, pectoralismajor, pectoralis minor, trapezius, erector spinae,abdominal muscles.
-
8/2/2019 2 Cardiopulmonary Physical Therapy
16/26
Thoracic cavity
-
8/2/2019 2 Cardiopulmonary Physical Therapy
17/26
Thoracic cavity containsright and left pleuralcavities occupied by thelungs on either sides, thetwo pleural cavities areseparated by a thickpartition calledmediastinum.
Mediastinum is the
median septum of thethoracic cavity
How mediastinum isformed?
-
8/2/2019 2 Cardiopulmonary Physical Therapy
18/26
Divided into superior
and inferior
mediastinum
The inferior is dividerinto anterior, middle
and posterior
mediastinum
Contents of each part of
mediastinum.
-
8/2/2019 2 Cardiopulmonary Physical Therapy
19/26
trachea
Wide tube lying
Starts at the lower border of. And lower end deviatesslightly to the right side anddivides in to ..
Length4-6 inch Diameter, 2cm in male and 1.5
cm in female
The upper end lies at the leverof ..
The lower end lies at the levelof in supine
And in sitting.
Clinical importance.
-
8/2/2019 2 Cardiopulmonary Physical Therapy
20/26
Pleura
Parietal pleurae:lines the thoracic wall, covers the thoracicsurface of the diaphragm and the lateralaspect of the mediastinum, and extends intothe root of the neck to line the undersurfaceof the suprapleural membrane at thethoracic inlet.
Visceral Pleurae:completely covers the outer surfaces of thelungs and extends into the depths of theinterlobar fissures.
The parietal and visceral layers of pleura areseparated from one another by a slitlikespace, the pleural cavity, which contains
pleural fluid to minimize friction duringmovement.
-
8/2/2019 2 Cardiopulmonary Physical Therapy
21/26
Divisions of Parietal pleurae
Cervical pleuraeextends up into the neck, lining
the undersurface of the suprapleuralmembrane.
Costal pleuralines the inner surfaces of the ribs,
the costal cartilages, the intercostal spaces,the sides of the vertebral bodies, and theback of the sternum
Diaphragmatic Pleuraecovers the thoracic surface of the
diaphragm
Mediastinal Pleuraecovers and forms the lateral
boundary of the mediastinum
-
8/2/2019 2 Cardiopulmonary Physical Therapy
22/26
The parietal pleura is sensitive to pain,temperature, touch, and pressure and issupplied as follows:
The costal pleura is segmentally supplied bythe intercostal nerves.
The mediastinal pleura is supplied by the
phrenic nerve.
The diaphragmatic pleura is supplied overthe domes by the phrenic nerve and aroundthe periphery by the lower six intercostalnerves.
Visceral Pleurae covering the lungs issensitive to stretch but is insensitive tocommon sensations such as pain and touch.It receives an autonomic nerve supply fromthe pulmonary plexus
-
8/2/2019 2 Cardiopulmonary Physical Therapy
23/26
bronchi
The trachea bifurcates behind thearch of the aorta into the rightand left principal (primary, ormain) bronchi.
The bronchi divide , giving rise toseveral million terminalbronchioles that terminate in oneor more respiratory bronchioles.
Each respiratory bronchioledivides into 2 to 11 alveolar ducts
that enter the alveolar sacs. Thealveoli arise from the walls of thesacs
-
8/2/2019 2 Cardiopulmonary Physical Therapy
24/26
The right principal (main) bronchusis wider, shorter, and more verticalthan the left and is about 1 in. (2.5cm) long. Before entering the hilumof the right lung, the principalbronchus gives off the superior lobarbronchus. On entering the hilum, itdivides into a middle and an inferiorlobar bronchus.
The left principal (main) bronchusis narrower, longer, and morehorizontal than the right and is about2 in. (5 cm) long. It passes to the leftbelow the arch of the aorta and in
front of the esophagus. On enteringthe hilum of the left lung, theprincipal bronchus divides into asuperior and an inferior lobarbronchus.
-
8/2/2019 2 Cardiopulmonary Physical Therapy
25/26
assignment
Q.1 Discuss the lung under the following headings.
Borders
Fissures and lobes
Bronchopulmonary segments Q.2 Discuss the heart under following headings
Surface anatomy
External features of heart
Chambers of heart
Conduction system of heart
Coronary circulation of heart.
-
8/2/2019 2 Cardiopulmonary Physical Therapy
26/26
BEST WISHES.Thanks..