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  <head>
    <title>014-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Respiratory mechanics, control, and respiratory failure">
      <outline text="Effort, reserve, and danger signs">
        <outline text="Drive, pump, airways, compliance, endurance"/>
        <outline text="Failure of oxygenation, ventilation, or both"/>
        <outline text="Compensation can precede abrupt deterioration"/>
        <outline text="Assess effort, trajectory, and reserve"/>
        <outline text="Danger: exhaustion, silent chest, falling rate"/>
        <outline text="Less wheeze may mean critical airflow loss"/>
      </outline>
      <outline text="Pressure and the respiratory pump">
        <outline text="Air moves on alveolar minus atmospheric pressure"/>
        <outline text="Diaphragm descends and external intercostals expand thorax"/>
        <outline text="Transpulmonary pressure keeps the lungs expanded">
          <outline text="Chest wall outward against inward lung recoil"/>
          <outline text="Balance sets functional residual capacity"/>
        </outline>
        <outline text="Inward route: parietal pleura, space, visceral pleura">
          <outline text="Pleural space and alveolus are separate compartments"/>
          <outline text="Flow stops when alveolar equals atmospheric pressure"/>
        </outline>
        <outline text="Pneumothorax lets the lung recoil inward">
          <outline text="Tension physiology impairs venous return"/>
        </outline>
      </outline>
      <outline text="Compliance and elastic recoil">
        <outline text="Volume change per unit pressure change"/>
        <outline text="Stiffness: fibrosis, oedema, acute respiratory distress syndrome"/>
        <outline text="Emphysema raises compliance, reduces elastic recoil"/>
        <outline text="Surfactant from type two cells lowers surface tension">
          <outline text="Deficiency central to neonatal respiratory distress"/>
        </outline>
        <outline text="Elastic work, resistive work, tissue resistance"/>
        <outline text="Stiff lungs favour rapid shallow breathing"/>
        <outline text="Obstruction favours slower deeper breathing"/>
      </outline>
      <outline text="Airway resistance and flow limitation">
        <outline text="Resistance depends strongly on airway radius"/>
        <outline text="Mediators, mucus, oedema, smooth-muscle contraction"/>
        <outline text="Loss of radial traction narrows airways"/>
        <outline text="Beta two relaxation via catecholamines and medicines"/>
        <outline text="Dynamic compression beyond the equal-pressure point"/>
        <outline text="More effort without proportionally more flow"/>
        <outline text="Air trapping raises end-expiratory lung volume">
          <outline text="Intrinsic positive end-expiratory pressure as threshold"/>
        </outline>
      </outline>
      <outline text="Lung volumes and spirometry">
        <outline text="Tidal volume and the reserve volumes"/>
        <outline text="Residual volume escapes simple spirometry"/>
        <outline text="Obstruction reduces the one-second ratio"/>
        <outline text="Restriction needs confirmed low total lung capacity"/>
        <outline text="Absent bronchodilator response does not exclude asthma"/>
        <outline text="Flow-volume loops suggest upper-airway lesions"/>
      </outline>
      <outline text="Neural control of breathing">
        <outline text="Brainstem networks generate respiratory rhythm"/>
        <outline text="Cortical, limbic, and hypothalamic influences"/>
        <outline text="Central chemoreceptors sense brain extracellular acidity">
          <outline text="Carbon dioxide crosses and forms acid"/>
        </outline>
        <outline text="Carotid and aortic bodies sense low arterial oxygen"/>
        <outline text="Chronic retention buffered by renal bicarbonate"/>
        <outline text="Never withhold oxygen from dangerous hypoxaemia">
          <outline text="Worsened matching, Haldane effect, altered drive"/>
        </outline>
      </outline>
      <outline text="Respiratory failure">
        <outline text="Type one is predominantly hypoxaemic">
          <outline text="Mismatch, shunt, diffusion limitation, low inspired oxygen"/>
        </outline>
        <outline text="Type two adds hypercapnia from low alveolar ventilation"/>
        <outline text="Central, nerve, junction, muscle, chest-wall causes"/>
        <outline text="Fever and seizures raise carbon dioxide production"/>
        <outline text="Near-normal pH with high carbon dioxide suggests chronicity"/>
        <outline text="Falling pH suggests acute deterioration"/>
      </outline>
      <outline text="Oxygen and ventilatory support">
        <outline text="Titrate oxygen to a context-appropriate target"/>
        <outline text="High-flow nasal therapy washes out dead space"/>
        <outline text="Continuous positive airway pressure recruits lung">
          <outline text="It adds no direct inspiratory assistance"/>
        </outline>
        <outline text="Bilevel support raises tidal volume, clears carbon dioxide"/>
        <outline text="Invasive ventilation when work is unsustainable"/>
        <outline text="Injury from volume, pressure, repeated opening, oxygen"/>
      </outline>
      <outline text="Sleep-disordered breathing">
        <outline text="Sleep lowers ventilatory response and airway tone"/>
        <outline text="Obstructive apnoea: pharyngeal collapse despite effort">
          <outline text="Intermittent hypoxaemia, arousal, sympathetic activation"/>
        </outline>
        <outline text="Body size alone neither confirms nor excludes"/>
        <outline text="Central apnoea: reduced or unstable drive"/>
        <outline text="Obesity hypoventilation: awake hypercapnia after exclusions"/>
      </outline>
      <outline text="Weaning and respiratory-muscle reserve">
        <outline text="Resolved disease does not guarantee weaning"/>
        <outline text="Readiness: oxygenation, secretions, stability, consciousness, load"/>
        <outline text="Spontaneous breathing trial tests integrated reserve"/>
        <outline text="Failure: cardiac, weakness, obstruction, anxiety, fever"/>
        <outline text="Diaphragm weakens with illness and controlled ventilation"/>
        <outline text="Cough strength and vital capacity in neuromuscular disease"/>
        <outline text="Deterioration can precede falling oxygen saturation"/>
      </outline>
    </outline>
  </body>
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