环境管理体系肺讲座-英文ppt课件

1、EMS Pulmonary LectureMike MD, MPHOutline Anatomy Physiology Airway Management Medical Management Trauma ManagementEpidemiology 25% Infectious 5% Tb 28 % Neoplasia 13 % Multiple or miscellaneous 28 % Undetermined Risk Factors Marlboro Man +/- horseFunctions of Respiratory System Moves Air Communicati

2、on Non-specific Immunity Acid/BaseRespiratory Tract Anatomy Conducting Nose/Mouth Nasopharynx/Oropharnyx Laryngopharynx TracheaRespiratory Tract Anatomy Conducting Trachea Bronchus Bronchiole Terminal BronchioleRespiratory Tract Anatomy Respiration Alveolar ducts AlveoliRespiratory Tract AnatomyResp

3、iratory Mechanics Pressure and Volume PV=nRTPV=1As pressure increases, volume decreasesAs volume increases, pressure decreasesRespiratory Mechanics Pressure Volume Adhesion Compliance Surface Tension Gas ExchangeRespiratory Mechanics Adhesion Parietal Visceral Pleural FluidRespiratory Mechanics Surf

4、ace TensionRespiratory Mechanics ComplianceRespiratory Mechanics Gas Exchange Oxygen Transport Dissolved Bound pH O2 TemperatureAirway Resistance R=8nL/R 4 Cross-sectional Area DynamicRespiratory CycleRespiratory Control Mechanoreceptors Inflation Deflation Chemoreceptors pH PCO2 PO2Respiratory Dist

5、ress Dyspnea Orthopnea PND Cyanosis Central Peripheral Lung Sounds PT 630 - Breath SoundsRespiratory Distress Airway Cardiac Lung Thoracic Cavity Vascular NeuromuscularRespiratory Distress O2 Hypoxia Hypoxemia Relative Hypoxemia CO2 Acute ChronicInfections Bronchitis Pneumonia TuberculosisHemoptysis

6、 Dual Blood Supply Mechanisms Intravascular Inflammatory CoagulationPathophysiology Intravascular LV CHF Mitral Valve Stenosis Rheumatic Heart DiseasePathophysiology Inflammatory Bronchitis Bronchiectasis Mycetoma FB PE Pneumonia Neoplasia TB VasculitidiesPathophysiology Coagulopathies Hemophilia Th

7、rombocytopenia Anticoagulants ThrombolyticsClinical Features History Fever Sputum Weight loss Night sweats Physical Examination Vitals NasalCavity and oropharynx Murmurs Clubbing Rales vs RhonchiDiagnostic Approach Confirm Location Pseudo, GI or pulmonary Urgent Bronchoscopy CXR Neoplasia 20-30% nor

8、mal Chest CT Neoplasia vs bronchiectasisTreatment Identify history of Tb or COPD Decubitus Position Intubation with large ETT Mainstem Bronchus intubationAsthma in Adults Chronic inflammatory disease Prevalence Children Elderly Incidence 10 100% increase Mortality Non uniform increasePathophysiology

9、 Large and Small Airways Muscular Vascular Cellular Mast Cells PMN Eosinophils Goblet Cell FibroblastsPathophysiology Acute Mast Eosinophils PMN Platelets Lymphocytes Subacute “resident cell activation Chronic Deposition of CollagenPathophysiology Allergic Family history Idiosyncratic Normal IgE Tri

10、ggers Environmental Infectious Behavioral Medication EmotionalPathophysiologySymptoms Dyspnea Chest Tightness Wheezing Cough Tachypnea Tachycardia* * pay attention in pediatricsSeverity Of ExacerbationBreathlessnessWalking, talking, restPositionLying, sitting, uprightSpeechSentences, phrases, wordsT

11、achycardia100, 100-120, 120PEFR80%, 50-80%, 95%, 91-95%, 91%ABGYou know its severe if you order an ABGAssessment PEFR Pulse Oximetry EKG ReversibleTreatment Adrenergic Agents IV vs Inhaled Albuterol To space or not to space?Treatment Corticosteroids IV vs PO Anticholinergics Mg HelioxTreatment Assis

12、ted Ventilation Indications Risks Barotrauma Hypotension Mucus Plugging Ventilation RateSpecial Circumstances Age Pregnancy Incidence Oxygen Fetal Risks TreatmentThe Things You Ask if You Have the Time Risk Factors for Death Sudden severe exacerbations ICU Intubation Recent Withdrawl of Steroids ED

13、visits Albuterol useCOPD Chronic Bronchitis Clinical definition Emphysema Pathological definitionCOPD Epidemiology Prevalence Men vs Women WHO estimates Hospitalization mortality Floor ICU Within 1 year after dischargePathophysiology Risk Factors Behavioral Genetic Bronchitis/Emphysema Expiratory Fl

14、ow Inflammation and ElastancePathophysiology Hypoxemia and hypoventilation Neurochemical regulation Pulmonary blood flow Cardiac risksClinical Features - Chronic Cough Crackles Wheeze Hyperinflation Weight Change Mental StatusClinical Features Acute Causes Infectious Behavioral Iatrogenic Cardiac Hypoxemia Hypercapnia R/O other intrathoracic diseaseTreatment - Acute Oxygen Albuterol Atrovent SteroidsTreatment - Acute Assisted Ventilation Complications Infectious Cardiac Traumatic BIPAPTrauma Pneumothorax Blunt Penetrating Hemothorax Tension Pneumothorax Assisted Ventil