dyspnea.ppt
description
Transcript of dyspnea.ppt
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Diagnostic Approach of Dyspnea in
Children
Nastiti Kaswandani
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symptom (subjective) VS sign (objective)
symptom: sensory experience (sensation), that only could be feel and judge by the patient psychologic disturbances
sign: respiratory distress, patient breath with difficulties, involvement of additional respiratory muscle physiologic disturbances
Dyspnea approach
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Acute VS Chronic(sudden onset) (long standing)
acute: often resolves with treatment of the underlying condition
chronic: usually result in progressive dysfunction, severe disability, and eventual death
the lecture focus on acute dyspnea
Dyspnea approach
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Chest and Respiratory System
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Obstruction of proximal / larger airway
Obstruction of distal / smaller airway
Respiratory center disorders
Extra-pulmonary disorders
Lung compliance disorders
Lung parenchyma disorders
FLOW disorders
VOLUME disorders
EXTRA thorax
INTRA thorax
EXTRA thorax
INTRA thorax
Dyspnea classification pathophysiology, anatomic, disorders
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Obstruction of proximal / larger airway
Obstruction of distal / smaller airway
Respiratory center disorders
Extra-pulmonary disorders
Lung compliance disorders
Lung parenchyma disorders
FLOW disorders
VOLUME disorders
EXTRA thorax
INTRA thorax
EXTRA thorax
INTRA thorax
Dyspnea classification pathophysiology, anatomic, disorders
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rhinitis with nasal obstruction, nasal polyp cranio-facial malformation OSAS tonsil-adenoid hypertrophy laringo-tracheo-malacia larynx papilloma diphtheria croup, epiglottitis thymus hypertrophy
• clinical: inspiratory stridor• age : infant – below five
Extra-thorax FLOW disorders Obstruction of proximal / larger airways
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Thymus hyperplasia
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Vascular Rings Secondary Tracheomalacia (Extrinsic)
Compression disorder Collection of congenital
vascular anomalies that encircle and compress the esophagus and trachea
Diagnostics seen on MRI and echocardiograph
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Obstruction of proximal / larger airway
Obstruction of distal / smaller airway
Respiratory center disorders
Extra-pulmonary disorders
Lung compliance disorders
Lung parenchyma disorders
FLOW disorders
VOLUME disorders
EXTRA thorax
INTRA thorax
EXTRA thorax
INTRA thorax
Dyspnea classification pathophysiology, anatomic, disorders
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asthma bronchiolitis vascular ring solid foreign body aspiration lymph node enlargement pressure
• clinical: expiratory effort• age: infants, below five age – bronchiolitis
Intra-thorax FLOW disorders Obstruction of distal / smaller airways
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Bronchiolitis
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Obstruction of proximal / larger airway
Obstruction of distal / smaller airway
Respiratory center disorders
Extra-pulmonary disorders
Lung compliance disorders
Lung parenchyma disorders
FLOW disorders
VOLUME disorders
EXTRA thorax
INTRA thorax
EXTRA thorax
INTRA thorax
Dyspnea classification pathophysiology, anatomic disorders
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Lung Parenchyma Disorder pneumonia (infection, aspiration) atelectasis pulmonary edema near drowning sepsis
clinical: inspiratory effort
Intra-thorax VOLUME disorders
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Obstruction of proximal / larger airway
Obstruction of distal / smaller airway
Respiratory center disorders
Extra-pulmonary disorders
Lung compliance disorders
Lung parenchyma disorders
FLOW disorders
VOLUME disorders
EXTRA thorax
INTRA thorax
EXTRA thorax
INTRA thorax
Dyspnea classification pathophysiology, anatomic disorders
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pneumothorax, pneumomediastinum cardiomegaly, heart failure (perfusion) pleural effusion (incl’ empyema, hematothorax) hernia diaphragmatica diaphragmatica eventration intra-thorax mass (non pulmonary) chest trauma (rib fracture, lung contusion) thorax deformity (pectus excavatum, scoliosis)klinis : inspiratory effort
Intra-thorax VOLUME disorders Extra-pulmonary disorders
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Obstruction of proximal / larger airway
Obstruction of distal / smaller airway
Respiratory center disorders
Extra-pulmonary disorders
Lung compliance disorders
Lung parenchyma disorders
FLOW disorders
VOLUME disorders
EXTRA thorax
INTRA thorax
EXTRA thorax
INTRA thorax
Dyspnea classification pathophysiology, anatomic, disorders
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neuromuscular disorders (CP, GBS, MG) gastritis, peptic ulcer extreme obesity peritonitis, appendicitis, acute abdomen aerophagia, meteorismus ascites hepato-splenomegali abdominal solid tumor clinical: inspiratory constraint
Extra-thorax VOLUME disorders Lung compliance disorders
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Obstruction of proximal / larger airway
Obstruction of distal / smaller airway
Respiratory center disorders
Extra-pulmonary disorders
Lung compliance disorders
Lung parenchyma disorders
FLOW disorders
VOLUME disorders
EXTRA thorax
INTRA thorax
EXTRA thorax
INTRA thorax
Dyspnea classification pathophysiology, anatomic disorders
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anemia metabolic acidosis CNS infections: meningitis, encephalitis
encephalopathy (typhoid, DHF, metabolic) psychologic (anxiety, usually adolescent) poisoning: salycylate, alcohol trauma capitis CNS disease sequelae
clinical: deep rapid breathing
Extra-thorax VOLUME disorders Respiratory center disorders
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Clinical approach
symptomatology
pathophysiology
pathology
treatment
dyspnea
evaluation
etiology
treatment ~ etiology
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first step : ANAMNESIS identity: age, sex, etc dyspnea:
acute, chronic, recurrent degree of dyspnea how long has been dyspneic timing of dyspnea: at rest, at activity, day or night triggers, factors make worse / better response to therapy
underlying cardiopulmonary / neuromuscular disease
associated symptoms: chest pain, cough, wheezing other signs & symptoms
80% of cases can be diagnosed
Dyspnea clinical approach - 1
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next step : PHYSICAL EXAMINATION inspiratory : nasal flaring, retraction
(supra sternal, intercostal, subcostal, epigastrium), chest indrawing (retraksi arkus kosta)
expiratory : prolonged expirium, wheezing, abdominal muscle contraction
respiratory examination: respiratory rate; stridor, symmetry of breath sound & on percussion; rales; sign of heart failure
other holistic examination
Dyspnea clinical approach - 2
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further step : SUPPORTING EXAMINATION
Routine blood examination Pulse oximetry Imaging diagnostic: CXR, ultrasound, Blood gas analysis Pulmonary function test Electrocardiography, echocardiography Rhinoscopy, laryngoscopy,
bronchoscopy
Dyspnea clinical approach - 3
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last step : TREATMENT
based on etiology first aid: give O2, before we can
identify the etiology; since most cases need it
other cases, does not need O2 (see next)
Dyspnea clinical approach - 4
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Obstruction of proximal / larger airway
Obstruction of distal / smaller airway
Respiratory center disorders
Extra-pulmonary disorders
Lung compliance disorders
Lung parenchyma disorders
FLOW disorders
VOLUME disorders
EXTRA thorax
INTRA thorax
EXTRA thorax
INTRA thorax
Dyspnea classification maybe oxygen is not needed
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Memahami sesakjangan setengah-setengah
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