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This page contains notes from Respiratory rotation.

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Anatomy

Breathing patterns

  • Normal: equal time in and out
  • Obstructive: Prolonged expiration eg asthma, COPD
  • Bradypnoea - slow respiratory rate
    • Drug induced respiratory depression
    • Diabetic coma (nonketotic)
    • Increased ICP
  • Kussmaul's breathing (fast and deep)
    • Metabolic acidosis
    • Exercise
    • Anxiety
  • Biot's/Ataxic
    • (irregular with long apnoeic period)
    • drug-induced respiratory depression
    • increased icp
    • brain damage, especially medullary
  • Cheyne-Stokes Breathing
    • Changing rates and depths with apnoeic periods
    • Drug-induced respiratory depression
    • Brain damage (especially cerebral)
    • CHF
    • Uraemia
  • Apneustic (prolonged inspiratory pause)
    • Pontine lesion

Common differential diagnoses

Dyspnoea

  • Acute dyspnoea (minutes/hours)
    • Cardiac
      • IHD
      • CHF exacerbation
      • LVF with pulmonary oedema
      • Cardiac tamponade
  • Pulmonary causes
    • Upper airway obstruction (anaphylaxis, foreign body)
    • Airway disease (asthma, COPD exacerbation, bronchitis)
    • Parenchymal lung disease (ARDS, pneumonia)
    • Pulmonary vascular disease (PE, vasculitis)
    • Pleural disease (pneumothorax, tension pneumothorax)
    • Respiratory control (metabolic acidosis, ASA, toxicity)
  • Psych
    • Anxiety/psychosomatic
  • Chronic dyspnoea (weeks-months)
    • Cardiac causes
      • Valvular disease
      • Decreased CO
    • Respiratory causes
      • Parenchymal lung disease (interstitial disease)
      • Pulmonary vascular disease (pulmonary HTN, vasculitis)
      • Pleural disease (effusion)
      • Gas exchange (infection, emphysema, fibrosis, etc)
      • Airway disease - asthma, COPD
    • Haematologic causes
      • Severe anaemia
    • Neuromuscular and chest wall disorders
    • Deconditioning, obesity, pregnancy

Chest pain

  • Nonpleuritic
    • Pulmonary
      • Pneumonia
      • PE
      • Neoplastic
    • Cardiac
      • MI
      • Myocarditis/pericarditis
    • Oesophageal
      • GERD
      • Spasm
      • Oesophagitis
      • Ulceration
      • Achalasia
      • Neoplasm
      • Oesophageal rupture
    • Mediastinal
      • Lymphoma
      • Thymoma
    • Subdiaphragmatic
      • PUD
      • Gastritis
      • Biliary colic
      • Pancreatic
    • Vascular
      • Dissecting aortic aneurysm
    • MSK
      • Costochondritis
      • Skin
      • Breast
      • Ribs
  • Pleuritic
    • Pulmonary
      • Pneumonia
      • PE
      • Pneumothorax
      • Haemothorax
      • Neoplasm
      • TB
      • Empyema
    • Cardiac
      • Pericarditis
      • Dressler's syndrome
    • GI
      • Subphrenic abscess
      • Pancreatitis
    • MSK
      • Costochondritis
      • Fractured rib
      • Myositis
      • Herpes zoster

Pulmonary function tests

Cystic fibrosis

  • Intranet --> PPG
    • Read about CF: 1. The condition 2. Antibiotics
  • IV Tobramycin
    • 6am 30 minute infusion
    • Level @ 4-6 hours post dose. Do this level yourself
    • Write the time exactly on the pathology form
    • Level comes back - fill out the tobra form: dose/wt/ht/Cr
    • Fax the form to the number provided on the form (Drug Information) and they will tell you the next dose
    • Tobra levels are done in the red tubes
  • Variable dose medications: Tobramycin, Pred, Gent