环境管理体系肺讲座英文课件

EMS Pulmonary Lecture,Mike MD, MPH,Outline,Anatomy Physiology Airway Management Medical Management Trauma Management,Epidemiology,25% Infectious 5% Tb 28 % Neoplasia 13 % Multiple or miscellaneous 28 % Undetermined Risk Factors Marlboro Man +/- horse,Functions of Respiratory System,Moves Air Communication Non-specific Immunity Acid/Base,Respiratory Tract Anatomy,Conducting Nose/Mouth Nasopharynx/Oropharnyx Laryngopharynx Trachea,Respiratory Tract Anatomy,Conducting Trachea Bronchus Bronchiole Terminal Bronchiole,Respiratory Tract Anatomy,Respiration Alveolar ducts Alveoli,Respiratory Tract Anatomy,Respiratory Mechanics,Pressure and Volume PV=nRT PV=1 As pressure increases, volume decreases As volume increases, pressure decreases,Respiratory Mechanics,Pressure Volume Adhesion Compliance Surface Tension Gas Exchange,Respiratory Mechanics,Adhesion Parietal Visceral Pleural Fluid,Respiratory Mechanics,Surface Tension,Respiratory Mechanics,Compliance,Respiratory Mechanics,Gas Exchange Oxygen Transport Dissolved Bound pH O2 Temperature,Airway Resistance,R=8nL/R 4 Cross-sectional Area Dynamic,Respiratory Cycle,Respiratory Control,Mechanoreceptors Inflation Deflation Chemoreceptors pH PCO2 PO2,Respiratory Distress,Dyspnea Orthopnea PND Cyanosis Central Peripheral Lung Sounds PT 630 - Breath Sounds,Respiratory Distress,Airway Cardiac Lung Thoracic Cavity Vascular Neuromuscular,Respiratory Distress,O2 Hypoxia Hypoxemia Relative Hypoxemia CO2 Acute Chronic,Infections,Bronchitis Pneumonia Tuberculosis,Hemoptysis,Dual Blood Supply Mechanisms Intravascular Inflammatory Coagulation,Pathophysiology,Intravascular LV CHF Mitral Valve Stenosis Rheumatic Heart Disease,Pathophysiology,Inflammatory Bronchitis Bronchiectasis Mycetoma FB PE Pneumonia Neoplasia TB Vasculitidies,Pathophysiology,Coagulopathies Hemophilia Thrombocytopenia Anticoagulants Thrombolytics,Clinical Features,History Fever Sputum Weight loss Night sweats Physical Examination Vitals NasalCavity and oropharynx Murmurs Clubbing Rales vs Rhonchi,Diagnostic Approach,Confirm Location Pseudo, GI or pulmonary Urgent Bronchoscopy CXR Neoplasia 20-30% normal Chest CT Neoplasia vs bronchiectasis,Treatment,Identify history of Tb or COPD Decubitus Position Intubation with large ETT Mainstem Bronchus intubation,Asthma in Adults,Chronic inflammatory disease Prevalence Children Elderly Incidence 100% increase Mortality Non uniform increase,Pathophysiology,Large and Small Airways Muscular Vascular Cellular Mast Cells PMN Eosinophils Goblet Cell Fibroblasts,Pathophysiology,Acute Mast Eosinophils PMN Platelets Lymphocytes Subacute “resident cell activation” Chronic Deposition of Collagen,Pathophysiology,Allergic Family history Idiosyncratic Normal IgE Triggers Environmental Infectious Behavioral Medication Emotional,Pathophysiology,Symptoms,Dyspnea Chest Tightness Wheezing Cough Tachypnea Tachycardia* * pay attention in pediatrics,Severity Of Exacerbation,Breathlessness Walking, talking, rest Position Lying, sitting, upright Speech Sentences, phrases, words Tachycardia 100, 100-120, 120 PEFR 80%, 50-80%, 95%, 91-95%, 91% ABG You know its severe if you order an ABG,Assessment,PEFR Pulse Oximetry EKG Reversible,Treatment,Adrenergic Agents IV vs Inhaled Albuterol To space or not to space?,Treatment,Corticosteroids IV vs PO Anticholinergics Mg Heliox,Treatment,Assisted Ventilation Indications Risks Barotrauma Hypotension Mucus Plugging Ventilation Rate,Special Circumstances,Age Pregnancy Incidence Oxygen Fetal Risks Treatment,The Things You Ask if You Have the Time,Risk Factors for Death Sudden severe exacerbations ICU Intubation Recent Withdrawl of Steroids ED visits Albuterol use,COPD,Chronic Bronchitis Clinical definition Emphysema Pathological definition,COPD Epidemiology,Prevalence Men vs Women WHO estimates Hospitalization mortality Floor ICU Within 1 year after discharge,Pathophysiology,Risk Factors Behavioral Genetic Bronchitis/Emphysema Expiratory Flow Inflammation and Elastance,Pathophysiology,Hypoxemia and hypoventilation Neurochemical regulation Pulmonary blood flow Cardiac risks,Clinical Features - Chronic,Cough Crackles Wheeze Hyperinflation Weight Change Mental Status,Clinical Features Acute,Causes Infectious Behavioral Iatrogenic Cardiac Hypoxemia Hypercapnia R/O other intrathoracic disease,Treatment - Acute,Oxygen Albuterol Atrovent Steroids,Treatment - Acute,Assisted Ventilation Complications Infectious Cardiac Traumatic BIPAP,Trauma,Pneumothorax Blunt Penetrating Hemothorax Tension Pneumothorax Assisted Ventil