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Thread: Respiratory System

  1. #1
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    Thumbs up Respiratory System

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    Respiratory System



    Decompression sickness
    Boyle's law: volume of gas is inversely proportionate to its pressure.
    · Therefore, BOYLE:
    Breathe (as you ascend)
    Or
    Your
    Lung
    Explodes
    · Breathe as you ascend after scuba diving, since the pressure decreases on surfacing, so the gas volume in lungs increases.



    Endotracheal tube: troubleshooting
    DOPEY:
    Displaced: esophagus, right mainstem, back of throat, etc
    Obstructed: secretions, blood, mucus plug, kink, etc
    Pneumothorax
    Equipment: malfunctions, O2, ETT, BVM, ventilator, monitor
    You: your approach, technique: missing something?


    ARDS: diagnostic criteria
    ARDS:
    Acute onset
    Ratio (PaO2/FiO2) less than 200
    Diffuse infiltration
    Swan-Ganz Wedge pressure less than 19 mmHg



    ARDS: full differential
    CARDS? HOPE ITS NOT ARDS:
    CNS disorders
    Aspiration (gastric)
    Radiation
    Drugs (heroin, morphine, barbiturates, etc)
    Smoke, toxic gas inhalation
    Hypotension, shock
    Oxygen toxicity
    Pancreatitis
    Emboli
    Infection, sepsis
    Transfusion reaction
    Surgery (esp. cardiac)
    Near drowning
    Obstetrical emergencies (eg eclampsia, HELLP)
    Thermal injuries/ burns
    Altitude sickness
    Renal failure
    DIC
    SLE



    Pneumothorax: causes
    SIT, 3 A's, 3 C's:
    Spontaneous (often tall thin men)
    Iatrogenic
    Trauma
    Asthma
    Alveolitis
    AIDS
    COPD
    Carcinoma
    Cystic fibrosis




    Shortness of breath: short differential
    AAAA PPPP:
    Airway obstruction
    Angina
    Anxiety
    Asthma
    Pneumonia
    Pneumothorax
    Pulmonary Edema
    Pulmonary Embolus



    Dyspnea: differential
    3A's: Three Airways: Airway obstruction, Anaphylaxis, Asthma
    3P's: Three Pulmonary's: Pneumothorax, PE, Pulmonary edema
    3C's: Three Cardiacs: Cardiogenic pulmonary edema, Cardiac ischemia, Cardiac tamponade
    3M's: Three Metabolics: (DOC) DKA, Organophosphates, Carbon monoxide poisoning



    Pneumonia: hospitalisation criteria
    ABCD:
    Age greater than 60
    Blood urea greater than 7 mmol/l
    Confusion
    Diastolic BP less than 60 mmHg
    ·Hospitalise the pneumonia patient if 2 or more of these criteria are met.



    Asthma acute attack: 5 life threatening signs
    SHOCK:
    Silent chest
    Hypotension
    One third of best/predicted PFR
    Cyanosis
    Konfusion
    Last edited by pintunoor; 12-18-2007 at 01:19 AM.

  2. #2
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    Bronchiectasis: differential
    BRONCHIECTASIS:

    Bronchial cyst
    Repeated gastric acid aspiration
    Or due to foreign bodies
    Necrotizing pneumonia
    Chemical corrosive substances
    Hypogammaglobulinemia
    Immotile cilia syndrome
    Eosinophilia (pulmonary)
    Cystic fibrosis
    Tuberculosis (primary)
    Atopic bronchial asthma
    Streptococcal pneumonia
    In Young's syndrome
    Staphylococcal pneumonia



    Bronchiectasis: causes

    A SICK AIRWAY:
    Airway lesion, chronic obstruction
    Sequestration
    Infection, inflamation
    Cystic fibrosis
    Kartagners syndrome
    Allergic brochopulmonary aspergilliosis
    Immunodeficiencies (hypogammaglobinaemia, myeloma, lymphoma)
    Reflux, inhalation injury
    William Campbell syndrome (and other congenitals)
    Aspiration
    Yellow nail sy
    ndrome/ Young syndrome



    Respiratory disease: hand signs

    CASH:
    Clubbing
    Asterixis
    Small muscle wasting
    HPOA


    Clubbing: respiratory causes
    ABCDEF:
    Abcess (lung)
    Bronchiectasis (including CF)
    Cancer (lung)
    Decreased oxygen (hypoxia)
    Empyaema
    Fibrosing alveolitis


    Pulmonary edema: treatments
    MAD DOG:
    Morphine
    Aminophylline
    Digitalis
    Diuretics
    Oxygen
    GGases in blood (ABG's)


    Acute stridor: differential
    ABCDEFGH:
    · With fever:
    Abscess
    Bacterial tracheitis
    Croup
    Diphtheria
    Epiglottitis
    · Without fever:
    Foreign body
    Gas (Toxic Gas)
    Hypersensitivity



    Pulmonary edema: treatment
    LMNOP:
    Lasix
    Morphine
    Nitrates (NTG)
    Oxygen
    Position (upright vs. flat)



    Hemoptysis: causes
    HEMOPTYSIS:
    Haemorrhagic diathesis
    Edema [LVF due to mitral stenosis]
    Malignancy
    Others [eg: vasculitis]
    Pulmonary vascular abnormalities
    Trauma
    Your treatment [anticoagulants]
    SLE
    Infarction in lungs
    Septic


    Pulmonary fibrosis: causes
    SCAR:
    · Upper lobe:
    Silicosis/ Sarcoidosis
    Coal worker pneumonconiosis
    Ankylosing spondylitis
    Radiation
    · Lower lobe:
    Systemic sclerosis
    Cyptogenic fibrosing alveolitis
    Asbetosis
    Rheumatoid arthritis



    Caplan syndrome: characteristics
    CAPlan:
    Coal worker pneumoconiosis
    Arthritis
    Pulmonary nodule


    Pleural effusion: investigations
    PLEURA:
    Pleural fluid (thoracentesis)
    Lung, pleural biopsy
    ESR
    Ultrasound
    Radiogram
    Analysis of blood



    Chronic cough: full differential
    GASPS AND COUGH:
    GORD
    Asthma
    Smoking, chronic bronchitis
    Post-infection
    Sinusitis, post-nasal drip
    ACE inhibitor
    Neoplasm
    Diverticulum
    Congestive heart failure
    Outer ear
    Upper airway obstruction
    GI-airway fistula
    Hypersensitivity



    Dyspnea: causes
    SHE PANTS:
    Stress, anxiety
    Heart disease
    Emboli
    Pulmonary disease
    Anaemia
    Neuromuscular disease
    Trachea obstruction
    Sleep disorder



    Wheezing: causes
    ASTHMA:
    Asthma
    Small airways disease
    Tracheal obstruction
    Heart failure
    Mastocytosis or carcinoid
    Anaphylaxis or allergy



    Pneumonia: risk factors
    INSPIRATION:
    Immunosuppression
    Neoplasia
    Secretion retention
    Pulmonary oedema
    Impaired alveolar macrophages
    RTI (prior)
    Antibiotics and cytotoxics
    Tracheal instrumentation
    IV dug abuse
    Other (general debility, immobility)
    Neurologic impairment of cough reflex, (eg NMJ disorders)



    Asthma: precipitating factors for acute attack
    DIPLOMAT:
    Drugs (aspirin, NSAIDs, beta blockers, etc)
    Infections (URTI/LRTI)
    Pollutants (at home, at work)
    Laughter(emotion)
    Oesophageal reflux (nocturnal asthma)
    Mites
    Activity and exercise
    Temperature (cold)


    Strep throat score
    NO FACE:
    NO cough: no cough is +1
    Fever: has fever is +1
    Age: less than 5 years is -1, 15-45 years is 0, greater than 45 years is +1
    Cervical nodes: cervical nodes palpable is +1
    Exudate: tonsillar exudate is +1
    · Scoring interpretation:
    Score 0-1: no strep throat.
    Score 1-3: possible strep throat, do a swab test.
    Score 4-5: strep throat is likely, so treat empirically.




    ENJOY
    Last edited by pintunoor; 12-18-2007 at 01:16 AM.

  3. #3
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    Acute Asthma
    NOAH

    Nebulisers,
    Oxygen,
    Antibiotics /
    Aminophylline,
    Hydrocortisone


    Asthma Triggers
    ASTHMAD

    Allergens,
    Stress/Sports,
    Temp,
    Hereditary,
    Microbiology,
    Anxiety,
    Drugs


    Chronic cough, non-smoker, normal CXR
    HARD

    Heart failure (MS),
    Asthma,
    reflux (GORD),
    drip / drugs


    Cryptogenic Fibrosing Alveolitis
    5Cs

    Clubbing,
    Cyanosis,
    Crackles,
    Cough,
    Corticosteroids


    Fibrosis
    Upper lobe CHARTS

    Coal workers pneumoconiosis (PMF),
    Histiocytosis X,
    Ank spon / ABPA,
    Radiation,
    TB,
    Silicosis (PMF) / Sarcoidosis

    Lower lobe RASIO
    RA,
    Asbestosis,
    Scleroderma,
    Idiopathic fibrosing alveolitis,
    Other (durgs –Amiodarone, busulphan, bleomycin, hydralazine, MTX, nitrofurantoin)


    Lung abscess
    SOAP

    Spread (hepatic, subphrenic) / Septic emboli,
    Obstruction (FB, tumour),
    Aspiration (alcohol,bulbar palsy, achalasia, CVA),
    pulmonary infarct / pneumonia


    Pleural effusions
    Exudative PINTARS

    Pneumonia / Pancreatitis,
    Infarction,
    Neoplasm,
    TB/ Trauma,
    Abscess,
    RA,
    Systemic stuff (SLE, Sarcoid, Systemic sclerosis)

    Transudative CHARM (All the failures - heart, liver, renal etc.)
    Carditis,
    Hypothyroid,
    Hypo-Albuminaemia,
    Renal,
    Meigs / Malabsorption


    Pneumothorax
    ST PATS FC

    Spontaneous / Sport,
    Trauma
    Pneumonia,
    Positive Ventilation,
    Abscess/ Asthma/ Ascend (in aeroplane),
    TB,
    Sarcoid
    Fibrosing Alveolitis,
    Carcinoma / COAD / CF


    Pulmonary Oedema, non-cardiac
    PONS

    Phosgene / paraquat / phenothiazines,
    opioids / organophosphates,
    Nitrous dioxide,
    salicylate
    Thank you GOD

  4. #4
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    thank you very much

  5. #5
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    Nice Work
    Thanx Alot,God Bless You

  6. #6
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    nice work!

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