1. הבדיקה הגופנית של חולה במצוקה נשמתית – פתופיזיולוגיה נשמתית דר' פאולו פרישו החטיבה להרדמה בית חולים סורוקה

2. 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.

9. 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

10. הבדיקה הגופנית של חולה במצוקה נשימתית

11. History

12. Physical Examination

13. Use your eyes, ears, nose, hands and devices.

14. Devices Stethoscope Pulse Oximeter Capnograph

15. SpO2 Interpretation What are the limitations of SpO2? What is the meaning of a SpO2 of 100%?

16. Capnography Trace What are its uses?

17. Auscultation

18. Percussion

19. Palpation

20. Assess Consciousness Behavior Color Sweat Speech Work of Breath

22. Cyanosis Interpretation Is a hypoxemic patient always cyanotic? Can a patient with a normal PaO2 be Cyanotic?

24. Work of Breath

25. Respiratory Rate Respiratory Rate Tachypnea Bradypnea

28. Respiratory Pattern

33. What is the pattern of the respiratory disorder caused by opiates?

34. What is the pattern of the respiratory change caused by metabolic Acid-Base disorder?

35. Respiratory Sounds 1

36. Respiratory Sounds 2

37. Respiratory Sounds 3

38. Respiratory Sounds 4

39. פתופיזיולוגיה נשימתית

40. Spirometry

41. Ventilation Software Respiratory center pH PaCO 2 PaO2 Pain (Stress) Drugs

42. Ventilation Hardware Diaphragm and Chest wall muscles, Lung tissue and Airway conduits

43. Ventilation Physics ΔP Compliance Resistance Dead space

44. V A /Q Match

45. DO 2 ≈ CO.Hb.SaO2

46. Hemoglobin Dissociation curve

47. Bicarbonate pH ≈ CO 2 Bicarbonate pH ≈ CO 2

48. Pathologies

49. 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

50. O2O2 CO 2 For Unicellular life it is easy!

51. Environment. FiO 2 Barometric Pressure Respiratory System V A Circulatory System Hb, SaO2, CO FiO 2 CO 2 PETCO 2 V A /Q

52. Cases

53. An unconscious young man found in the street with a heavy snoring. Case 1

54. A 70 years old lady with shortening of breath Case 2

55. A 18 years old girl with tachypnea Case 3

56. A 24 years old girl with tachypnea. Case 4

57. A 4 years old boy with respiratory distress Case 5

58. A 44 years man after an emergency cholecystectomy, with an SpO2 of 82 in the RR. Case 6

59. A 20 years “Golani” after an elective arthroscopy of knee, with an SpO2 of 82 in the RR. Case 7

60. A 28 years old, healthy woman, with an SpO2 that dropped down to 82 after ETT insertion for General Anesthesia. Case 8

61. A chronic ill patient with worsening of his chronic condition. Case 9

62. 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

63. A patient after MVA, 38 RPM, pulse, 8 bpm, cyanosis. Case 11

64. 65 years old man, shortness of breath. Case 12

65. A 5 years old girl with fever and dyspnea Case 13

66. A 68 years old heavy smoker with dyspnea. Case 14

67. A 20 year old man found partially conscious Case 15

68. 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?

69. 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?