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CURRICULUM VITAE

WAHYUNI INDAWATI

PENDIDIKAN : Konsultan Respirologi Anak FKUI RSCM

TRAINING :
Cystic Fibrosis : Sophia Children Hospital Rotterdam
Bronchoscopy : NUH Singapore, Hongkong University
Pediatric TB : Stellenbosch University South Africa

PEKERJAAN : Staf medis Divisi Respirologi FKUI-RSCM

ORGANISASI :
Sekretaris Bidang III PP IDAI 2011-2014
Sekretaris UKK Respirologi PP IDAI 2014-2017
Sekretaris Satgas Farmasi PP IDAI 2014-2017
DYSPNEA IN CHILDREN
A DIAGNOSIS APPROACH

Wahyuni Indawati
Respirology Division Child Health Department
Cipto Mangunkusumo Hospital
Faculty of Medicine Universitas Indonesia
DYSPNEA
Breathlessness or shortness of breath; labored
or difficult breathing
It is a sign of a variety of disorders and is
primarily an indication of inadequate
ventilation or of insufficient amounts of
oxygen in the circulating blood

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and


Allied Health, Seventh Edition.
DEFINITION
A subjective experience of breathing discomfort that consists
of qualitatively distinct sensations that vary in intensity

Objective
Subjective - Breathing effort
- Uncomfort breathing - Forced breathing
- Difficult breathing - Changed breathing
pattern
BREATHING

Process of taking air into the lung Process of taking air out from the
(Inspiration ) lung (Ekspiration)

VENTILATION
RESPIRATION Steps of respiration

1. Ventilation or gas exchange


EXTERNAL RESPIRATION

between atmosphere & alveoli

2. Diffusion of O2 & CO2


between alveoli & the blood

3. Circulation (transport) of
O2 & CO2 between the lungs
and the tissue

4. Exchange of O2 & CO2


INTERNAL

between the blood and the


tissues
Sherwood L, The Respiratory System, 2004
RESPIRATION
External
respiration

Internal
respiration
EXTERNAL RESPIRATION

Respiratory system
Ventilation ~ Breathing
function
EXTERNAL RESPIRATION

V a sum VOLUME of
air FLOW in and out
L/mnt
the respiratory tract 4.2

Diffusion of O2 & CO2 between


alveoli & the blood crucial point

Q a sum VOLUME of
L/mnt
blood FLOW through
alveolar capillary 5
Sherwood L, The Respiratory System, 2004
EXTERNAL RESPIRATION
to take place, the optimal gas
ventilation exchange (diffusion) from air to
V blood in alveolar capillary bed
need an certain ratio between
VENTILATION & PERFUSION

V/Q = 4/5

perfusion Q V
Q Q V
PATHOPHYSIOLOGY

VENTILATION / PERFUSION (V/Q =4/5)


MATCHING

VENTILATION/ PERFUSION (V/Q 4/5)


MISMATCHING

DYSPNEA
BREATHING DIFFICULTIES ~ VENTILATION
DISTURBANCE

BREATHING DIFFICULTIES VENTILATION DISTURBANCE

INSPIRATORY EFFORT VOLUME DISTURBANCE


RETRACTION, NASAL FLARE

EXPIRATORY EFFORT
PROLONGED EXPIRIUM,WHEEZING FLOW DISTURBANCE
DYSPNEA CLASSIFICATION
EXTRA Obstruction of proximal / larger
thorax airway
FLOW
disorders
INTRA Obstruction of distal / smaller airway
thorax

Lung parenchyme disorders


INTRA
thorax
Extra-pulmonary disorders
VOLUME
disorders
Lung compliance disorders
EXTRA
thorax
Resp center stimulation
DYSPNEA CLASSIFICATION
APROACH OF ACUTE DYSPNEA IN
EMERGENCY SETTING
APROACH OF ACUTE DYSPNEA IN
EMERGENCY SETTING
SUMMARY
Dyspnea is a terminology refer to subjective and
objective finding in patient

Dyspnea is a clinical condition due to ventilation


perfusion mismatch

Disturbances in respiration process may lead to dyspnea


and not only cause by respiratory system origin

Pathophysiological approach will help us to understand


dyspnea process in reasonable view
THANK YOU FOR YOUR ATTENTION