Cardiopulmonary Anatomy & Physiology EssEntials of REspiRatoRy CaRE Seventh Edition 94909_fm_ptg01.indd 1 11/3/18 11:21 AM 94909_fm_ptg01.indd 2 11/3/18 11:21 AM To Katherine, Alexander, Destinee, Ashley, and Jax The Next Generation Grandpa T 94909_fm_ptg01.indd 3 11/3/18 11:21 AM 94909_fm_ptg01.indd 4 11/3/18 11:21 AM Cardiopulmonary Anatomy & Physiology EssEntials of REspiRatoRy CaRE Seventh Edition Terry Des Jardins, MEd, RRT Professor Emeritus Former Director Department of Respiratory Care Parkland College Champaign, Illinois Faculty/Staff Member University of Illinois College of Medicine at Urbana-Champaign Australia ● Brazil ● Japan ● Korea ● Mexico ● Singapore ● Spain ● United Kingdom ● United States 94909_fm_ptg01.indd 5 11/3/18 11:21 AM Cardiopulmonary Anatomy & Physiology – © 2020, 2013, Cengage Learning, Inc. Essentials of Respiratory Care Unless otherwise noted, all content is © Cengage. Seventh Edition Terry Des Jardins ALL RIGHTS RESERVED. 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Printed in the United States of America Print Number: 01 Print Year: 2018 94909_fm_ptg01.indd 6 11/6/18 6:25 PM Contents List of Tables ● xiii List of Clinical Connections ● xv Foreword ● xxi Preface ● xxiii Acknowledgments ● xvii Section One The Cardiopulmonary System—The Essentials 1 Chapter 1 The Anatomy and Physiology of the Respiratory System 3 The Airways 4 The Lungs 52 ● ● The Upper Airways 4 The Mediastinum 56 ● ● The Lower Airways 26 The Pleural Membranes 56 ● ● The Sites of Gas Exchange 40 The Thorax 59 ● ● The Pulmonary Vascular System 43 The Muscles of Ventilation 61 ● ● The Lymphatic System 46 Chapter Summary 70 ● ● Neural Control of the Lungs ● 48 Review Questions ● 71 Chapter 2 Ventilation 75 Introduction 75 The Effect of Airway Resistance and Lung ● Mechanisms of Pulmonary Ventilation 76 Compliance on Ventilatory Patterns 136 ● ● Elastic Properties of the Lung and Chest Wall 94 Overview of Specific Breathing ● Dynamic Characteristics of the Lungs 115 Conditions 139 ● ● Ventilatory Patterns 127 Chapter Summary 143 ● ● How Normal Pleural Pressure Differences Review Questions 147 ● Cause Regional Differences in Normal Clinical Application Questions 149 ● Lung Ventilation 135 ● Chapter 3 Pulmonary Function Measurements 151 Lung Volumes and Capacities 151 Chapter Summary 176 ● ● Pulmonary Mechanics 155 Review Questions 181 ● ● Factors Affecting Predicted Normal Values 168 Clinical Application Questions 182 ● ● How the Effects of Dynamic Compression Decrease Expiratory Flow Rates 170 ● vii 94909_fm_ptg01.indd 7 11/3/18 11:21 AM viii Contents Chapter 4 The Diffusion of Pulmonary Gases 185 Introduction 185 Oxygen and Carbon Dioxide Diffusion across ● Dalton’s Law 186 the Alveolar-Capillary Membrane 192 ● ● Partial Pressures of Atmospheric Gases 186 Gas Diffusion According to Fick’s Law 195 ● ● Gas Diffusion—Pressure Gradients versus Perfusion-Limited Gas Flow 198 ● Diffusion Gradients 188 Diffusion-Limited Gas Flow 200 ● ● The Partial Pressures of Gases in the Air, Alveoli, How Oxygen Can Be Either Perfusion and Blood 189 or Diffusion Limited 202 ● ● The Ideal Alveolar Gas Equation 190 Chapter Summary 205 ● ● The Diffusion of Pulmonary Gases 191 Review Questions 208 ● ● Clinical Application Questions 209 ● Chapter 5 The Anatomy and Physiology of the Circulatory System 211 Introduction 211 The Cardiac Cycle and Its Effect on ● The Blood 212 Blood Pressure 234 ● ● The Heart 216 The Distribution of Pulmonary Blood Flow 237 ● ● The Pulmonary and Systemic Chapter Summary 249 ● Vascular Systems 228 Review Questions 252 ● ● Pressures in the Pulmonary and Systemic Clinical Application Questions 254 ● Vascular Systems 233 ● Chapter 6 Oxygen and Carbon Dioxide Transport 257 Introduction 257 Cyanosis 292 ● ● Oxygen Transport 258 Carbon Dioxide Transport 294 ● ● Oxyhemoglobin Dissociation Curve 263 Chapter Summary 302 ● ● Oxygen Transport Calculations 274 Review Questions 306 ● ● Hypoxia 287 Clinical Application Questions 307 ● ● Chapter 7 Acid–Base Balance and Regulation 309 Introduction 309 The Renal System and Acid–Base Balance 317 ● ● Basic Principles of Acid–Base The Role of the P /HCO2/pH Relationship in CO 3 2 Reactions and pH 310 Acid–Base Balance 317 ● ● Chemical Buffer Systems and Chapter Summary 343 ● Acid–Base Balance 313 Review Questions 346 ● ● The Respiratory System and Clinical Application Questions 347 ● Acid–Base Balance 316 ● 94909_fm_ptg01.indd 8 11/3/18 11:21 AM Contents ix Chapter 8 Ventilation-Perfusion Relationships 351 Ventilation-Perfusion Ratio 351 Chapter Summary 362 ● ● Respiratory Quotient 357 Review Questions 364 ● ● Respiratory Exchange Ratio 359 Clinical Application Questions 365 ● ● Chapter 9 Control of Ventilation 367 Introduction 367 Miscellaneous Factors That May Influence ● Control of Respiration 367 Breathing 378 ● ● Factors That Influence the Rate and Depth of Chapter Summary 381 ● Breathing 370 Review Questions 384 ● ● Other Important Factors That Influence Breathing 377 Clinical Application Questions 385 ● ● Chapter 10 Fetal Development and the Cardiopulmonary System 387 Fetal Lung Development 387 Clinical Parameters in the Normal Newborn 403 ● ● Placenta 391 Chapter Summary 405 ● ● Fetal Circulation 394 Review Questions 407 ● ● Birth 397 Clinical Application Questions 408 ● ● Control of Ventilation in the Newborn 402 ● Chapter 11 Aging and the Cardiopulmonary System 411 Introduction 411 Effects of Aging on the Cardiovascular ● Effects of Aging on the Respiratory System 411 System 418 ● ● Pulmonary Gas Exchange 416 Chapter Summary 423 ● ● Arterial Blood Gases 416 Review Questions 424 ● ● Section two Advanced Cardiopulmonary Concepts and Related Areas—The Essentials 425 Chapter 12 Electrophysiology of the Heart 427 Introduction 427 Chapter Summary 433 ● ● Five Phases of the Action Potential 428 Review Questions 433 ● ● Properties of the Cardiac Muscle 429 ● 94909_fm_ptg01.indd 9 11/3/18 11:21 AM