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Ms. G  25 yobf  Height 5’4”  Weight 272 lbs.  25 yobf  Height 5’4”  Weight 272 lbs.

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Presentation on theme: "Ms. G  25 yobf  Height 5’4”  Weight 272 lbs.  25 yobf  Height 5’4”  Weight 272 lbs."— Presentation transcript:

1 Ms. G  25 yobf  Height 5’4”  Weight 272 lbs.  25 yobf  Height 5’4”  Weight 272 lbs.

2 Chief Complaint  EDS - Epworth of 15/24  Nocturnal sleep disruption  Shift worker (doesn’t like it)  Snoring  EDS - Epworth of 15/24  Nocturnal sleep disruption  Shift worker (doesn’t like it)  Snoring

3 Family History  Maternal HTN  Mother has had a stroke  Maternal HTN  Mother has had a stroke

4 Obesity Hypoventilation and OSA  Excessive weight pushes against diaphragm causing shallow breathing  Baseline SaO2 <88%  Low V t - high respiratory rate (attempt to maintain normal minute ventilation)  Excessive weight pushes against diaphragm causing shallow breathing  Baseline SaO2 <88%  Low V t - high respiratory rate (attempt to maintain normal minute ventilation) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Oxyhemoglobin Dissociation Curve SaO 2 PO 2 mm Hg

5 Role of the Diaphragm in Respiration: Hering’s Model vs. Human Rib Cage  Diaphragm movement allows for inhalation and exhalation  Plural lining of the lungs allows for closed pressurization of about -7.5 cm H 2 O  Diaphragm movement allows for inhalation and exhalation  Plural lining of the lungs allows for closed pressurization of about -7.5 cm H 2 O

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7 Various Muscles of Respiration  Sternocleidomastoid  Trapezious  Scalene  Pectoralis Major  Rectus Abdominus  External / internal Obliques  Traversus Abdominus  Sternocleidomastoid  Trapezious  Scalene  Pectoralis Major  Rectus Abdominus  External / internal Obliques  Traversus Abdominus

8 Oximetry Strip Chart Trending

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13 Conclusion  Severe OSA - Controlled with CPAP 13 cm H20  Patient referred to Pulmonary Department for work- up  Patient referred to ENT specialist  Severe OSA - Controlled with CPAP 13 cm H20  Patient referred to Pulmonary Department for work- up  Patient referred to ENT specialist


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