环境管理体系肺讲座-英文课件

1、EMS Pulmonary LectureMike MD, MPHOutlineAnatomyPhysiologyAirway ManagementMedical ManagementTrauma ManagementEpidemiology25% Infectious5% Tb28 % Neoplasia13 % Multiple or miscellaneous28 % UndeterminedRisk Factors Marlboro Man +/- horseFunctions of Respiratory SystemMoves AirCommunicationNon-specifi

2、c ImmunityAcid/BaseRespiratory Tract AnatomyConductingNose/MouthNasopharynx/OropharnyxLaryngopharynxTracheaRespiratory Tract AnatomyConductingTracheaBronchusBronchioleTerminal BronchioleRespiratory Tract AnatomyRespirationAlveolar ductsAlveoliRespiratory MechanicsPressureVolumeAdhesionComplianceSurf

3、ace TensionGas ExchangeRespiratory MechanicsAdhesionParietalVisceralPleural FluidRespiratory MechanicsSurface TensionRespiratory CycleRespiratory ControlMechanoreceptorsInflationDeflationChemoreceptorspHPCO2PO2Respiratory DistressDyspneaOrthopneaPNDCyanosisCentralPeripheralLung SoundsPT 630 - Breath

4、 SoundsRespiratory DistressAirwayCardiacLungThoracic CavityVascularNeuromuscularInfectionsBronchitisPneumoniaTuberculosisHemoptysisDual Blood SupplyMechanismsIntravascularInflammatoryCoagulationPathophysiologyIntravascular LV CHFMitral Valve StenosisRheumatic Heart DiseasePathophysiologyInflammatory

5、BronchitisBronchiectasisMycetomaFBPEPneumoniaNeoplasiaTBVasculitidiesPathophysiologyCoagulopathiesHemophiliaThrombocytopeniaAnticoagulantsThrombolyticsClinical FeaturesHistoryFeverSputumWeight lossNight sweatsPhysical ExaminationVitalsNasalCavity and oropharynxMurmursClubbingRales vs RhonchiDiagnost

6、ic ApproachConfirm LocationPseudo, GI or pulmonaryUrgent BronchoscopyCXRNeoplasia20-30% normalChest CTNeoplasia vs bronchiectasisTreatmentIdentify history of Tb or COPDDecubitus PositionIntubation with large ETT Mainstem Bronchus intubationAsthma in AdultsChronic inflammatory diseasePrevalenceChildr

7、enElderlyIncidence 10 100% increaseMortalityNon uniform increasePathophysiologyLarge and Small AirwaysMuscularVascular CellularMast CellsPMNEosinophilsGoblet CellFibroblastsPathophysiologyAcuteMastEosinophilsPMNPlateletsLymphocytesSubacute“resident cell activation”ChronicDeposition of CollagenPathop

8、hysiologyAllergicFamily historyIdiosyncraticNormal IgETriggersEnvironmentalInfectiousBehavioralMedicationEmotionalPathophysiologySymptomsDyspneaChest TightnessWheezingCoughTachypneaTachycardia* pay attention in pediatricsSeverity Of ExacerbationBreathlessnessWalking, talking, restPositionLying, sitt

9、ing, uprightSpeechSentences, phrases, wordsTachycardia100, 100-120, 120PEFR80%, 50-80%, 95%, 91-95%, 91%ABGYou know its severe if you order an ABGAssessmentPEFR Pulse OximetryEKGReversibleTreatmentAdrenergic AgentsIV vs InhaledAlbuterolTo space or not to space?TreatmentCorticosteroidsIV vs POAnticho

10、linergicsMgHelioxTreatmentAssisted VentilationIndicationsRisksBarotraumaHypotensionMucus PluggingVentilation RateSpecial CircumstancesAgePregnancyIncidenceOxygenFetal RisksTreatmentThe Things You Ask if You Have the TimeRisk Factors for DeathSudden severe exacerbationsICUIntubationRecent Withdrawl o

11、f SteroidsED visitsAlbuterol useCOPDChronic BronchitisClinical definition EmphysemaPathological definitionCOPD EpidemiologyPrevalenceMen vs WomenWHO estimatesHospitalization mortalityFloorICUWithin 1 year after dischargePathophysiologyRisk FactorsBehavioralGeneticBronchitis/EmphysemaExpiratory FlowI

12、nflammation and ElastancePathophysiologyHypoxemia and hypoventilationNeurochemical regulationPulmonary blood flowCardiac risksClinical Features - ChronicCoughCracklesWheeze HyperinflationWeight ChangeMental StatusClinical Features AcuteCausesInfectiousBehavioral IatrogenicCardiacHypoxemiaHypercapniaR/O other intrathoracic diseaseTreatment - AcuteOxygenAlbuterolAtroventSteroidsTreatment - AcuteAssisted VentilationComplicationsInfectiousCardiacTraumaticBIPAPTraumaPneumothoraxBluntPenetratingHemothoraxTension PneumothoraxAssisted VentilationProsConsBasic A