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Pulmonology – Chapter 2

Pulmonology – Chapter 2. Pulmonary Anatomy. Muscles of respiration Nervous control Blood supply Defense of the lungs. Respiratory Physiology. Basic functions of the respiratory system Mechanics of Breathing Lung volumes and capacities Exercise physiology Effects of aging.

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Pulmonology – Chapter 2

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  1. Pulmonology – Chapter 2

  2. Pulmonary Anatomy • Muscles of respiration • Nervous control • Blood supply • Defense of the lungs

  3. Respiratory Physiology • Basic functions of the respiratory system • Mechanics of Breathing • Lung volumes and capacities • Exercise physiology • Effects of aging

  4. Signs & Symptoms of Pulmonary Disease (Table 2-4) • Anorexia • Bradycardia • Dec Breath sounds • Dec chest expansion • Chest pain • Coma • Confusion • Cough • Crackles, rales • Cyanosis • Diaphoresis • Digital clubbing • Dullness to percussion • Dyspnea • Fever • Hemoptysis • Hypercapnea • Hypoxemia • Mediastinal shift • Nasal secretions • Orthopnea • Paroxysmal nocturnal dyspnea • Pleural friction rub • Etc………

  5. Cytologic - Hematologic • Sputum analysis • Green sputum 94% sensitive, 77% specific for high bacteria count that benefits from antibiotics • Hematological • ABG’s (later) • CBC (Lab Medicine) • Coagulation (Lab Medicine)

  6. Chest Radiography

  7. PFT’s • Volumes • TLC, VC, RV • Ventilation • VT, RR, Ve, Vd, VA • Common PFT measures • FVC, FEV1, FEV1/FVC ratio, PEFR, MVV • Diffusion studies • DLCO • Maximal Respiratory Pressures • MIP (PiMax); MEP (PeMax) • Chemical Control of Ventilation

  8. ABG’s • PaO2 • PaCO2 • pH • SaO2 • HCO3- • Base excess / deficit

  9. Pulse Oximetry • SpO2 • Ambulatory Oximetry

  10. Electrocardiography • 12 lead - ? Right ventricular hypertrophy • Hypoxemia -> arrhythmias

  11. Exercise testing • Pulmonary exercise testing • Walk tests

  12. Pulmonary Imaging Studies • Fluoroscopy • Computed tomography • MRI • Ultrasonography

  13. Nuclear Medicine • VQ Scans • Single photon Emission Computed Tomography • Positron Emission Tomography • Other Scintigraphic Imaging Studies • Gallium (high affinity for tumors)

  14. Invasive Diagnostic Techniques • Pulmonary Angiography • Bronchography • Bronchoscopy • PercutaneousTransthoracic Needle Aspiration (biopsy) • Thoracocentesis • Thoracoscopy • Mediastinoscopy & Mediastinotomy • Open Lung Biopsy (Exploratory Thoracotomy)

  15. Medical Management • Pharmacological therapy • Oxygen therapy • Airway adjuncts • Mechanical ventilation • Invasive • Non-invasive • Extracorporeal ventilation • Airway suctioning • Airway clearance • Incentive Spirometry • Smoking Cessation • Pulmonary Rehabiltation • Social Services

  16. Surgical Interventions • Tracheotomy • Cricothyroidotomy • Excision of pulmonary emboli • Catheter / chest tube drain placement • Pulmonary resection / thoracotomy • Bullectomy • Lung Volume Reduction Surgery • Lung & Heart-Lung Transplansation • BroncialThermoplasty • Decortication • Pleurodesis • Pulmonary Metastasectomy • Tracheal Resection

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