Академический Документы
Профессиональный Документы
Культура Документы
Dr. M Qathar RF T
Contents
Anemic hypoxia- HB
CO intoxication- HB availabilty, shifts O2 HB
dissociation curve to the left
Respiratory hypoxia-next slide
R to L extrapulmonary shunting- ASD,VSD,PDA
Circulatory hypoxiacardiac failure, shock-
Ischemic hypoxia- arterial obstruction
Increased O2 requirements- fever, exercise,
thyrotoxicosis
Improper O2 utilization- cyanide, diptheria toxin
Blood gases: PO2 and PCO2
Hypoxemia Hypercarbia
Hypoventilation Hypoventilation
Diffusion Ventilation / perfusion
Ventilation / perfusion inequality
inequality
AV Shunt
High altitude
How is the respiratory system affected by disease?
Pathology
Alveolar hypoventilation
Sleep-related: central and obstructive sleep apnoea,
Ondines curse
Neuro-muscular diseases: polio, Guillain-Barre
syndrome, myasthenia gravis, resp muscle fatigue,
polimyositis
Chest wall: kyphoscoliosis, rib fractures with flail
chest
Complications of Lung disease
Cor pulmonale
Respiratory failure: ventilatory failure vs oxygenation
failure hypercapnia, acidosis and hypoxaemia
Endstage lung disease
Pneumothorax
How is disease of the respiratory system recognized?
Clinical Manifestations
50
Signs of dyspnea:
Flaring nostrils
Use of accessory muscles in breathing
Retraction (pulling back) of intercostal spaces
51
Cough
52
Cough may result from:
53
When cough can raise fluid into pharynx, the cough is
described as a productive cough, and the fluid is sputum.
Production of bloody sputum is called hemoptysis
Usually involves only a small amount of blood
loss
Not threatening, but can indicate a serious
pulmonary disease
Tuberculosis, lung abscess, cancer, pulmonary
infarction.
54
If sputum is purulent, and infection of lung or airway is
indicated.
Cough that does not produce sputum is called a dry,
nonproductive or hacking cough.
Acute cough is one that resolves in 2-3 weeks from onset of
illness or treatment of underlying condition.
Us. caused by URT infections, allergic rhinitis, acute bronchitis,
pneumonia, congestive heart failure, pulmonary embolus, or
aspiration.
55
A chronic cough is one that persists for more than 3 weeks.
In nonsmokers, almost always due to postnasal drainage
syndrome, asthma, or gastroesophageal reflux disease
In smokers, chronic bronchitis is the most common cause,
although lung cancer should be considered.
56
Cyanosis
57
Central cyanosis can be due to :
Abnormalities of the respiratory membrane
Mismatch between air flow and blood flow
Expressed as a ratio of change in ventilation (V) to perfusion
(Q) : V/Q ratio
Pulmonary thromboembolus - reduced blood
flow
Airway obstruction reduced ventilation
In persons with dark skin can be seen in
the whites of the eyes and mucous
membranes.
58
Lack of cyanosis does not mean oxygenation is normal!!
In adults not evident until severe hypoxemia is present
Clinically observable when reduced hemoglobin levels reach 5
g/ dl.
Severe anemia and carbon monoxide poisoning give
inadequate oxygenation of tissues without cyanosis
Individuals with polycythemia may have cyanosis when
oxygenation is adequate.
59
Pain
60
Inflammation of trachea or bronchi produce a central chest
pain that is pronounced after coughing
Must be differentiated from cardiac pain
High blood pressure in the pulmonary circulation can cause
pain during exercise that often mistaken for cardiac pain
(angina pectoris)
61
Hemoptysis
66
Auscultation
Crackles
Insp & exp Excess airway secretions moving Coarse and often clear Bronchitis, respiratory
with airflow with cough infections
Late insp Sudden opening of peripheral Diffuse, fine; occur Atelectasis, pneumonia,
airways initially in dependent pulmonary edema,
regions fibrosis
Abnormality Initial Inspection Palpitation Percussion Ausculation Possible
impression causes
Acute airways Appears acutely Use of Reduced Increased Expiratory Asthma,
obstruction ill accessory expansion resonance wheezing bronchitis
muscles
Chronic airways Appears Increased Reduced Increased Diffuse reduction Chronic
obstruction chronically ill antero-posterior expansion resonance in breath sounds; bronchitis,
diameter, use of early inspiratory emphysema
accessory crackles
muscles
Consolidation May appear Inspiratory lag Increased Dull note Bronchial breath Pneumonia,
acutely ill fremitus sounds; crackles tumor
Pneumothorax May appear Unilateral Decreased Increased Absent breath Rib fracture, open
acutely ill expansion fremitus resonance sounds wound
Pleural effusion May appear Unilateral Absent fremitus Dull note Absent breath Congestive heart
acutely ill expansion sounds failure
Local bronchial Appears acutely Unilateral Absent fremitus Dull note Absent breath Mucous plug
obstruction ill expansion sounds
Diffuse intersitial Often normal Rapid shallow Often normal; Slight decrease in Late inspiratory Chronic exposure
fibrosis breathing increased resonance crackles to inorganic dust
fremitus
Acute upper Appears acutely Laboured Often normal Often normal Inspiratory or Epiglottitis,
airway ill breathing expiratory stridor croup, foreign
obstruction or both body aspiration
Diagnostic procedures
Patient education
Immunization
Medication: antibiotics, bronchodilators, anti-
inflammatory drugs,diuretics, anti-coagulants
Ventolators
Physiotherapy
Surgery
Why do you have to know all this?