Thread: 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

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

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 very much

Nice Work
Thanx Alot,God Bless You

nice work!