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Introduction to Pulmonary Medicine

Introduction to Pulmonary Medicine. Dr. Gerald Supinski Professor of Medicine and Physiology. Topics to Cover. Classification of Pulmonary Disorders History Physical Examination PFT CXR ABG Cases. Classification of Pulmonary Disorders. History: Dyspnea. “Shortness of breath”

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Introduction to Pulmonary Medicine

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  1. Introduction to Pulmonary Medicine Dr. Gerald Supinski Professor of Medicine and Physiology

  2. Topics to Cover • Classification of Pulmonary Disorders • History • Physical Examination • PFT • CXR • ABG • Cases

  3. Classification of Pulmonary Disorders

  4. History: Dyspnea • “Shortness of breath” • Most common pulmonary symptom • Need further characterization as to timing, severity, relationship to exercise, body position, relationship to temperature (cold)

  5. History: Other Symptoms • Cough • Fever • Sputum production • Nocturnal awakening • Chest pain • Weakness • Leg swelling

  6. Physical Examination • Percussion • Auscultation

  7. Percussion • Original use for wine casks:

  8. Effect of Altering Media Density

  9. Percussion Responses

  10. Auscultation • Breath Sounds Bronchovesicular, Bronchial, Reduced Sounds • Adventitial Sounds Rales, Wheezes, Rhonchi

  11. Breath Sound Characteristics • Frequency of sounds (pitch) • Intensity or loudness of sounds

  12. Breath Sound Classes

  13. Adventitial Sounds

  14. Summary of History/Exam

  15. PFTs • Determine if normal or abnormal • Classify as restrictive or obstructive • Determine severity • Correlate with history, physical, CXR

  16. PFT Classification

  17. Standard PFTs • Spirometry • Flow-Volume Loops • Lung Volumes • DLCO • Pimax, Pemax

  18. Spirometry

  19. Obstructed vs Restricted

  20. DDX of Spirometry

  21. Reversibility

  22. Lung Volumes

  23. Lung Volumes Components

  24. Lung Volume Components

  25. DLCO • Diffusion capacity for carbon dioxide • A measure of gas exchange • Patient breathes a small amount of CO and uptake determined

  26. Concept of DLCO

  27. DDX of DLCO

  28. Pimax and Pemax • Pimax measures inspiratory strength • Pemax measures expiratory strength • Patient inhales/exhales thru mouthpiece attached to transducer

  29. Respiratory Muscle Strength

  30. Summary of PFTs

  31. CXR (Chest Radiograph) • Obstruction Clear lung fields, can see hyperinflation • Restricted-Interstitial Pattern Lines and nodules • Restricted-Alveolar Pattern See diffuse filling, air bronchograms • Chest Wall/Muscle Disorders Reduced lung volume

  32. Arterial Blood Gases • pH • paCO2 • paO2 • FiO2

  33. Mechanisms of Hypoxemia • Diffusion block • V/Q mismatch • Shunt • Hypoventilation

  34. Determinants of PaO2 • Alveolar Air Equation: PAO2=FiO2(BP-VP)-PaCO2/R • A-a Gradient= PAO2-PaO2 • So PaO2=FiO2(BP-VP)-PaCO2/R - A-a Gradient

  35. Increases in Inspired Oxygen Concentrations Do Not Substantially Improve paO2 in the Presence of Substantial Shunt

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