Download הבדיקה הגופנית של חולה במצוקה נשמתית

‫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 O2, CO2
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
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
PaCO2
PaO2
Pain (Stress)
Drugs
Ventilation Hardware
Diaphragm and Chest wall muscles,
Lung tissue and Airway conduits
Ventilation Physics
ΔP
Compliance
Resistance
Dead space
VA/Q Match
DO2 ≈ CO.Hb.SaO2
Hemoglobin Dissociation curve
Bicarbonate
pH ≈
CO2
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
For Unicellular life it is easy!
CO2
O2
PETCO2
FiO2
Environment. FiO2
Barometric Pressure
Respiratory System
VA
VA/Q
Circulatory System
Hb, SaO2, CO
CO2
Cases
Case 1
An unconscious young man found in the street with a
heavy snoring.
Case 2
A 70 years old lady with shortening of breath
Case 3
A 18 years old girl with tachypnea
Case 4
A 24 years old girl with tachypnea.
Case 5
A 4 years old boy with respiratory distress
Case 6
A 44 years man after an emergency cholecystectomy, with
an SpO2 of 82 in the RR.
Case 7
A 20 years “Golani” after an elective arthroscopy of knee,
with an SpO2 of 82 in the RR.
Case 8
A 28 years old, healthy woman, with an SpO2 that dropped
down to 82 after ETT insertion for General Anesthesia.
Case 9
A chronic ill patient with worsening of his chronic condition.
Case 10
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 11
A patient after MVA, 38 RPM, pulse , 8 bpm, cyanosis.
Case 12
65 years old man, shortness of breath.
Case 13
A 5 years old girl with fever and dyspnea
Case 14
A 68 years old heavy smoker with dyspnea.
Case 15
A 20 year old man found partially conscious
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?