L10: respiratory diseases Flashcards
bluish discoloration of skin :
cyanosis
FEV1:
normal is 80% or more
hypoxemia:
arterial oxygen tention below 60 mmHg as a result of lung disease ( normal should be 80-100mmHg)
hypoxemia:
arterial oxygen tension below 60 mmHg as a result of lung disease ( normal should be 80-100mmHg)
type 1 respiratory failure:
hypoxemia with no CO2 retention : pneumonia , asthma
type II respiratory failure:
CO2 retention with hypoxemia : chronic bronchitis , emphysema
asthma is characterized by
increased responsiveness of lower airways to stimuli
-strongly associated with atopy
wheezing in asthma is
most marked in expiration
physical signs of asthma :
tachypnea
-wheezing on expiration
-hyperinflation of the chest
-nasal polyps (particularly in aspirin sensitive asthmatics )
-atopic eczema
diagnosis of asthma is most often confirmed by :
daily recordings of peak expiration flow rate
patient with unstable asthma should be referred for medical care and dental appointment should be postponed
patient having night asthmatic attack should be given :
late morning appointments
what drugs should be avoided for patients taking theophylline ?
macrolides and cephalosporins
which sedative should be used in stressed asthmatic patients ?
nitrous oxide because it has no respiratory depressing properties
or if oral drug is required then benzodiazepines
plain local anesthesia is recommended in asthmatic patients because:
local anesthesia containing epinephrine/ levonordefrin also contains sulfite component which may precipitate asthmatic attack
characteristics of COPD :
airflow limitation that is not fully reversible . it is both progressive and associated with abnormal inflammatory response of the lung to noxious particles or gases associated with systemic manifestations
what is chronic bronchitis ?
cough productive of sputum for at least 3 months of 2 consecutive years excluding other cardiopulmonary disease
what is emphysema :
enlargement of terminal air space due to destruction of alveolar wall without fibrosis
host factor genes for COPD
alpha 1 anti-trypsin deficiency
hyper-responsiveness
lung growth
pathogenesis of COPD :
-inflammation
-protease-antiprotease imbalance
-oxidative stress
-mucus HYPERsecretion
how does inflammation lead to airflow limitation ?
it causes small airway disease (airway inflammation and remodeling)
and also parenchymal destruction : loss of alveolar attachments —decreases elastic recoil
symptoms of COPD:
-patient being a heavy smoker
-cough and putum production for many years
-cough often presents when waking up then it continues throughout the day
-sputum is usually mucoid and becomes purulent with exacerbation of disease
-insidious onset of breathlessness on exertion with wheezing or tightness of chest
physical examination of patient suffering from COPD will show :
-large barrel shaped chest
-prominent accessory respiratory muscle in neck
-low , flat diaphragm causing costal margin retraction on inspiration
-diminished breath sound with distant heart sound
-prolonged expiration with general wheezing
-depressed liver which is not enlarged
differential diagnosis of COPD :
-asthma
-congestive heart failure
-bronchiectasis
-pulmonary TB
Diagnosis of COPD is dependent on :
-symptoms : couch , sputum , dyspnea (shortness of breathe)
-exposure to risk factors
-spirometry
FEV1 for moderate COPD , severe COPD , and very severe COPD :
moderate : 50-79%
severe : 30-49%
very severe: <30%
bronchodialators are also used in stable COPD
smoking should be ceased 6 weeks before dental procedure
asthma , bronchitis , and COPD are best managed by which anesthetic ?
local anesthetic ( avoid local anesthetic containing sulfites)
SEDATIVES SHOULD BE AVOIDED
_____ cause respiratory depression
salicylates
safe to use:
acetaminophen and COX2 inhibitors
