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Nastiti Kaswandani
Dyspnea approach
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
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 classification
pathophysiology, anatomic, disorders
EXTRA thorax
INTRA thorax INTRA thorax FLOW disorders
VOLUME disorders
EXTRA thorax
Dyspnea classification
pathophysiology, anatomic, disorders
EXTRA thorax
INTRA thorax INTRA thorax FLOW disorders
VOLUME disorders
EXTRA thorax
Thymus hyperplasia
Vascular Rings
Secondary Tracheomalacia (Extrinsic) Compression disorder Collection of congenital vascular anomalies that encircle and compress the esophagus and trachea
Dyspnea classification
pathophysiology, anatomic, disorders
EXTRA thorax
INTRA thorax INTRA thorax FLOW disorders
VOLUME disorders
EXTRA thorax
asthma
bronchiolitis
vascular ring
solid foreign body aspiration lymph node enlargement pressure clinical: expiratory effort
Bronchiolitis
Dyspnea classification
pathophysiology, anatomic disorders
EXTRA thorax
INTRA thorax INTRA thorax FLOW disorders
VOLUME disorders
EXTRA thorax
Dyspnea classification
pathophysiology, anatomic disorders
EXTRA thorax
INTRA thorax INTRA thorax FLOW disorders
VOLUME disorders
EXTRA thorax
Dyspnea classification
pathophysiology, anatomic, disorders
EXTRA thorax
INTRA thorax INTRA thorax FLOW disorders
VOLUME disorders
EXTRA thorax
Dyspnea classification
pathophysiology, anatomic disorders
EXTRA thorax
INTRA thorax INTRA thorax FLOW disorders
VOLUME disorders
EXTRA thorax
Clinical approach
symptomatology pathophysiology
pathology treatment
dyspnea evaluation
etiology treatment ~ etiology
Dyspnea
clinical approach - 1
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
Dyspnea
clinical approach - 2
next step : PHYSICAL EXAMINATION 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 - 3
Routine blood examination Pulse oximetry Imaging diagnostic: CXR, ultrasound, Blood gas analysis Pulmonary function test Electrocardiography, echocardiography Rhinoscopy, laryngoscopy, bronchoscopy
Dyspnea
clinical approach - 4
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 classification
maybe oxygen is not needed
EXTRA thorax
INTRA thorax INTRA thorax FLOW disorders
VOLUME disorders
EXTRA thorax