resp lung diseases e
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Lung diseases
Respiratory and Lung diseases
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Lung diseases
COPD
Pneumonia1
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3 ARDS
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Lung diseases
Pneumonia1
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Lung diseases
Pneumonia
Def.: infection of the lung tissue
Cause: Pneumonia results from bacterial settlement of the normally sterilelower respiratory tract.Germs can arrive in principle on the following way into the respiratory tract:
aspiration of secretions from the oropharynx inhalation of germs with the inhaled gas with the bloodstream from other settled regions
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Lung diseases
Diagnosis: coughingfever >38Cleucocytosisincreased secretion productionpulmonale infitrates
in the case of a ventilated patient these symptoms are caused by other reasons the diagnosis should rely therefor on being present further criteria
positive micro-biological findings in the tracheal secretionauscultation statefestering tracheal secretion
Pneumonia
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Lung diseases
Therapy: mucolytic and antitussive drugsfebrifugal drugs - antipyreticantibacterial drugs - antibioticsrespiratory exercises - breathing trainer
in complicated cases: ventilation
Complications: ARDS / ALI
Pneumonia
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Lung diseases
Pneumonia: - but now ventilated
Problems: *decreased mucociliary clearence
*risk of atelectasis*decreased oxygenation*decreased CO 2-removal because of increased shunt
Consequences: *ventilation should improve the oxygenation and eliminate CO 2
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Lung diseases
Pneumonia: Case report
boy in the age of 11 years dry coughing for 2 weeks subfebrile temperatures till light fever
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Lung diseases
Pneumonia: Case report
boy in the age of 11 years dry coughing for 2 weeks subfebrile temperatures till light fever
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Lung diseases
COPD2
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Lung diseases
COPD
Def.: COPD an abbreviation for Chronic Obstructive P ulmonary Disease long term inflammatory disease of the bronchus and the lung with an
obstruction of the airways a group of several diseases> chronic obstructive bronchitis> bronchial asthma> lung emphysema
Cause: cigarette smokingair pollutionexposure to particulate matter and gases
Leads to a chronic obstruction of the airways. The result is an extendedexpiration time - no complete exhalation possible because of the increasedresistance of the airways - leads to an INTRINSIC PEEP.
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Lung diseases
COPDDiagnosis: Spirometry is measuring the volume exhaled forcefully in 1
second (FEV 1) following a deep inspiration, andthe forced vital capacity
Chest X-ray / CT detecting emphysema
Arterial blood gas is showing a compensated respiratoryacidosis
Endoscopy (see below)
Tracheanormal state
Chronic bronchitiswith tram -lines
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Lung diseases
COPD
Therapy: cessation smoking - will slow the rate of decline in lung function
bronchodilators - will relax the airways and are use in the symp-tomatic treatment
corticosteroids - inhaled, have no effect on the inflammatoryresponse in COPD
- no evidence that they reduce long-term declinein lung function
Complications: exacerbation
ARDS / ALI
Influenza vaccination is recommended for the prevention of acute exacerbationof COPD during the winter months.
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Lung diseases
COPD
thorax a.p.normal state
thorax a.p.bullous (blistered) emphysema
with over distended areas
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Lung diseases
COPD: - but now ventilated
Problems: *increased inspiratory and expiratory resistance*increased work of breathing because of the resistance - muscle fatigue
*over distended areas - physiological intrinsic PEEP *decreased oxygenation*decreased CO 2- removal because of the increased resistance*compensated respiratory acidosis*drive of breathing by decreased p aO2 instead of increased p aCO 2 *high risk of infections and atelectasis due the ventilation
Consequences: *avoid intubation - ideal patient for noninvasive ventilation first *avoid application of oxygen - drive of breathing is lacking *ventilation should improve the oxygenation and eliminate CO 2*ventilation could increase the intrinsic PEEP*avoid high gas flows
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Lung diseases
COPD: - but now ventilated
normal state
COPD
prolonged expiration
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Lung diseases
COPD: Case report male, age of 56 years strong smoker round about 65 cigarettes per day allergic asthma for 40 years acute decline of respiratory complaints fever >39,0C
acute dyspnoea, cyanosis oxygen mask with 15 l/min thorax a.p. emphysema
Blood gas analysis: pH 7,28p aCO 2 68 mmHgp aO2 55 mmHgBE +8 mmol/lHCO 3- 31,2 mmol/lS aO2 82 %
Diagnosis: acute exacerbation of a long term COPDwith a no compensated respiratory acidosis
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Lung diseases
3 ARDS
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Lung diseases
ARDS
Def.: ARDS an abbreviation for Acute R espiratory Distress S yndrome
Cause: pulmonary and non pulmonary infections are the reasons of an ARDS
risk factors:infection: e.g. pneumoniatrauma: e.g. lung contusion (car accident)metabolic reasons: e.g. acute renal failuredrugs: e.g. narcotic intoxication
inhalation trauma: e.g. aspiration, oxygenothers: e.g. pulmonary embolismcomplication in blood transfusion
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Lung diseases
Diagnosis: acute occurrence ( car accident, aspiration... )disturbed oxygenation
p aO2 < 50 mmHg at F iO 2 = 0,6p aO2 / F iO2 < 200 mmHgincreased alveolar - arterial oxygen difference ( AaDO 2)
atelectasisdyspnoea, tachypnoea, cyanosisdecreased lung compliancebilateral infiltrates due the increased permeability of the blood vessels
ARDS
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Lung diseases
ARDS: - but now ventilated
Problems: *decreased compliance because of e.g. interstitial lung edema*decreased oxygenation and CO 2 - elimination due the prolongeddiffusion distance because of the infection
*increased inspiratory and expiratory resistance*high risk of atelectasis because of a wet lung - decreased FRC*ARDS based on multi organ failure as reaction of the lung*course in stages: from dyspnoea until irreversible fatigue
Consequences: *ventilation should improve the oxygenation and eliminate CO 2*find the balance between F iO2 , I:E-ratio, PEEP*lung protective ventilation *ventilation could increase the intrinsic PEEP*treatment of an ARDS includes several other therapy options
e.g. positioning, nutrition, renal replacement therapy
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Lung diseases
ARDS: - but now ventilated
normal state
ARDS
expiratory flow not zero
small tidal volume
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