הבדיקה הגופנית של חולה במצוקה נשמתית – פתופיזיולוגיה נשמתית דר' פאולו פרישו החטיבה להרדמה בית חולים סורוקה
The mechanical function of the respiratory system is to accomplish Alveolar Ventilation. Its main homeostatic responsibility is the maintenance of normal levels of O 2, CO 2 and pH in blood.
Some Respiratory Acronyms PaO2 - Partial Arterial Pressure of O2 PAO2 - Partial Alveolar Pressure of O2 (BarP-47) * FiO2 - PaCO2 SpO2 - Pulse oximetry PaCO2 - Arterial Partial Pressure of CO2 PETCO2 - End Tidal CO2 Pressure Vt - Tidal Volume RR - Respiratory Rate Vm - Minute Volume Va - Alveolar Ventilation FiO2 – Fractioned Inspiratory O2
הבדיקה הגופנית של חולה במצוקה נשימתית
History
Physical Examination
Use your eyes, ears, nose, hands and devices.
Devices Stethoscope Pulse Oximeter Capnograph
SpO2 Interpretation What are the limitations of SpO2? What is the meaning of a SpO2 of 100%?
Capnography Trace What are its uses?
Auscultation
Percussion
Palpation
Assess Consciousness Behavior Color Sweat Speech Work of Breath
Cyanosis Interpretation Is a hypoxemic patient always cyanotic? Can a patient with a normal PaO2 be Cyanotic?
Work of Breath
Respiratory Rate Respiratory Rate Tachypnea Bradypnea
Respiratory Pattern
What is the pattern of the respiratory disorder caused by opiates?
What is the pattern of the respiratory change caused by metabolic Acid-Base disorder?
Respiratory Sounds 1
Respiratory Sounds 2
Respiratory Sounds 3
Respiratory Sounds 4
פתופיזיולוגיה נשימתית
Spirometry
Ventilation Software Respiratory center pH PaCO 2 PaO2 Pain (Stress) Drugs
Ventilation Hardware Diaphragm and Chest wall muscles, Lung tissue and Airway conduits
Ventilation Physics ΔP Compliance Resistance Dead space
V A /Q Match
DO 2 ≈ CO.Hb.SaO2
Hemoglobin Dissociation curve
Bicarbonate pH ≈ CO 2 Bicarbonate pH ≈ CO 2
Pathologies
Infectious diseases Malignance Trauma Lung contusion, pneumothorax, hemothorax Upper airway Atelectasis Metabolic Acidosis, Sepsis, fever Pulmonary Edema Cardiac CNS Post Obstructive Chemical Injury Smoke inhalation, hot air inhalation, Aspiration Obstruction, upper and lower airways Asthma, COPD, foreign body, malignance, allergy, laryngospasm ARDS Cardiac diseases Heart failure Pleural effusion Drugs Opiates, Benzodiazepines
O2O2 CO 2 For Unicellular life it is easy!
Environment. FiO 2 Barometric Pressure Respiratory System V A Circulatory System Hb, SaO2, CO FiO 2 CO 2 PETCO 2 V A /Q
Cases
An unconscious young man found in the street with a heavy snoring. Case 1
A 70 years old lady with shortening of breath Case 2
A 18 years old girl with tachypnea Case 3
A 24 years old girl with tachypnea. Case 4
A 4 years old boy with respiratory distress Case 5
A 44 years man after an emergency cholecystectomy, with an SpO2 of 82 in the RR. Case 6
A 20 years “Golani” after an elective arthroscopy of knee, with an SpO2 of 82 in the RR. Case 7
A 28 years old, healthy woman, with an SpO2 that dropped down to 82 after ETT insertion for General Anesthesia. Case 8
A chronic ill patient with worsening of his chronic condition. Case 9
An unconscious patient immediately after MVA is breathing 20 BPM, on auscultation there is a lot of noise, but air can be heard entering both lungs. Case 10
A patient after MVA, 38 RPM, pulse, 8 bpm, cyanosis. Case 11
65 years old man, shortness of breath. Case 12
A 5 years old girl with fever and dyspnea Case 13
A 68 years old heavy smoker with dyspnea. Case 14
A 20 year old man found partially conscious Case 15
A 55 YO woman in a full-blown pulmonary edema, was treated with O2 by mask with bag, high flow of 100% O2. SpO2 100%, but the she is refusing to use the mask, trying to take it off every time it is put in. Why is this patient with acute respiratory failure, cannot tolerate an oxygen mask with a high FiO2?
A 70 YO CIHD patient is in the ER for 20 minutes receiving a protocol for Pulmonary Edema. The SpO2=100% with a respiratory rate of 40 bpm. What to do next?