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Introduction to Pulmonary Medicine

Introduction to Pulmonary Medicine

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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