week 2 Flashcards
name 6 possible mechanical causes of increased work of breathing
increased airway resistance
increased elastic load
decreased energy supply
decreased power
increased drive to breathe
increased alveolar surface tension
Name some pathologies that cause increased airway load/resistance
COPD
asthma
chest infection
lung tumour
what are some of the causes of increased airway resistance
increased secretions
inflammation in the airways
bronchospasm
obstruction in the airway
name some pathologies that can cause increased elastic load
pulmonary fibrosis
surfactant depletion
hyperinflation
pregnancy
distended abdomen
obesity
abdominal surgery
kyphoscoliosis
ankylosing spondylitis
explain how increased elastic load increase WOB
reduction in lung compliance increases the inspiratory muscle work required to overcome the elastic recoil of the lungs
increases inspiratory muscle work
increased alveolar surface tension
reduction in chest wall compliance
name some pathologies that can cause decreased energy supply
eating difficulties
hypovolemic shock
explain how decreased energy supply is a problem
malnutrition
lack of perfusion tot he respiratory muscles
name some pathologies that can cause respiratory muscle dysfunction
MND
MS
GBS
COPD
kyphoscoliosis
malnourished
phrenic nerve damage
name some pathologies that increase the drive to breathe
pneumonia
fibrosis
acidosis
anaemia
how does respiratory muscle dysfunction affect WOB
there is reduced power or endurance
name some pathologies that increase alveolar surface tension
pulmonary oedema
acute respiratory distress syndrome (ARDS)
surfactant depletion
what are the preliminary checks for interpreting an X ray
name and date
projection (AP/PA)
exposure
position (supine, erect, rotated)
inspiration
What system do you use to interpret an X-ray
A-G
A=alignment
B=bones
C=cardiac
D=diaphragm
E=expansion
F=field
what are some common abnormalities for chest x-rays
consolidation
atelectasis/collapse
pleural effusion
pneumothorax
pulmonary oedema
fracture
what is consolidation
A condition in which the lung tissue becomes firm and solid rather than elastic and air-filled because it has accumulated fluids and tissue debris
what would you see on a chest x ray for someone with consolidation
white/grey shadow
no loss of volume
what would you hear on auscultation for someone with consolidation
increased breath sounds/bronchial breathing or decreased breath, with or without crackles or wheezes (dependent on stage of consolidation)
what are the main causes of consolidation
pneumonia
chest infection
lung contusion following trauma
what is atelectasis/ collapse
an airless state of the lung tissue which may involve all or part of the lung
what would you see on a chest x ray for someone with atelectasis/collapse
white/grey shadow, with loss of volume and shifting of structures
a total collapse may displace (pull the mediastinum towards the affected side
what would you hear when auscultating a patient with atelectasis/collapse
quiet breath sounds if occluded bronchus or bronchial breath sounds if patent bronchus
fine end-inspiratory crackles with smaller atelectasis
what are the main causes of atelectasis/collapse
shallow breathing
bronchial obstruction
absorption of trapped gas
surfactant depletion
compression from external pressure such as pleural disorder
abdominal or cardiothoracic surgery
what is pleural effusion
excess fluid in the pleural cavity
what is seen on the chest x ray of a patient with pleural effusion
A small amount of fluid will result in loss of the costo-phrenic angle
as the amount increases a fluid line may be visible
large amounts of fluid will displace (push) the mediastinum towards the non-affected side
what will you hear when auscultating a patient with pleural effusion
quiet breath sounds over the pleural effusion with bronchial breathing just above the top of the fluid level
what are the main causes of pleural effusion
disturbed osmotic or hydrostatic pressure in the plasma
changes in membrane permeability
malignancy
heart, kidney or liver failure
abdominal or cardiothoracic surgery
pneumonia
TB
what is pneumothorax
air in pleural space secondary to a rupture in either pleural layer
lung squashed towards the hilum in proportion to the amount of pleural air
what would you see on the chest x ray of a patient with pneumothorax
air in pleural space is very black
what would you hear when auscultating a patient with pneumothorax
quiet over the area of pneumothorax
what are the main causes of pneumothorax
fast growth, particularly in men
blebs particularly smokers
trauma such as #ribs, surgery, insertion of a line
barotrauma with high pressure positive pressure devices
bullae in emphysema
what is pulmonary oedema
extravascular water in the lungs - interstitial and alveoli
what would you see on the chest x ray of someone with pulmonary oedema
bilateral fleecy opacities spreading from the hila known as bats-wings or butterfly-wing shadows
depending on the cause there may also be an enlarged heart
what would you hear when auscultating someone with pulmonary oedema
Crackles that are more evident in dependent regions, sometimes fine, sometimes bubbly noise
what are the main causes of pulmonary oedema
fluid overload
back pressure from a failing left heart
osmotic or hydrostatic pressure changes
increased capillary permeability
what do barrel chested patients have
hyperinflation
what conditions do you commonly see hyperinflation in
COPD
asthma
CF
bronchiectasis
what is interstitial lung disease
a group of conditions that is characterised by fibrosing or scarring of the lung tissue
what would you see on a chest x ray of a patient with pulmonary fibrosis
reticular shadowing of the lung peripheries, which is more prevalent in the bases
the heart appears less distinct
often appears as ground glass
what are the differences between CT and MRI
CT is quicker
CT is cheaper
Ct is better at providing general images of tissues, organs and skeletal system.
MRI is thought to be more superior in regards to detail of image
what factors affect strength within the respiratory system
diminished CNS drive
muscle weakness
impaired peripheral nerve innervation
what factors affect the load within the respiratory system
chest wall abnormalities
crushed chest
fractured ribs
airway and lung abnormalities
name some conditions in which the efficiency of the respiratory muscles can be reduced
respiratory disease/thoracic deformities
severe obesity
ascites
pregnancy
cardiac disease
cerebral lesions
sepsis
