Foundations of Osteopathic Medicine Ch. 59
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| First goal in a patient presenting with dyspnea | Stablize both respiratory and hemodynamics
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| Initial workup for dyspnea includes | Chest xray, EKG, arterial blood gas, complete blood count and differential, serum electrolytes, creatinine and blood urea nitrogen
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| Differential for dyspnea | COPD, Brochiectasis, Pulmonary embolism, pneumonia, congestive heart failure
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| COPD xray and blood results | Hyperinflation of the lungs and increased leukocytosis
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| Work of breathing | The definable amount of energy required to produce a negative intrathoracic pressure
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| Hyperinflation of the lungs places the muscles at risk of | Fatigue
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| Compliance | Ease with which tissues are stretched during inhalation
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| Recoil | The elastic ability of the lung parenchyma to passively contract during exhalation (affected by parenchyma)
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| Total thoracic compliance includes | Lung tissue and chest wall
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| Emphysema | When adjacent alveoli sacs coalesce forming larger tertiary spaces, resulting in less area available for gas exchange
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| Muscle hypertropy can alter the biomechanics and cause | Somatic dysfunction
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| Respiratory dysfunction leads to | Reduces compliance of the bony thorax, alters respiratory biomechanics and increases work of breathing
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| Lung disease often presents with Somatic dysfunction in the | Thoracic spine and ribs
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| Reducing the work of breathing during exercise has been shown to | Improve exercise tolerance of chronic lung patients
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| Improving thoracic compliance will reduce respiratory muscle workload and may decrease the likelihood of | Fatigue in both acute and chronic lung disease conditions
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| Barrel chest does what to respiratory muscles? | Prevents muscles during inspiration from returning to their full resting length during exhalation
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| Muscles receive most of their blood during | Their resting or diastolic phase
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| Increasing tone during contraction leads to | Increased pressure within the muscle which shunts blood away from arterioles
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| Muscles operating on anaerobic respiration are how many times less productive | 15 times
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| Increased muscle tone can be identified on a physical exam by | Increased muscle tone, tenderness or bogginess
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| OMT in respiratory disease is aimed at | Increasing length and decreasing resting tone
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| Restoration of the length and vertical orientation of the diaphragm is known as | Doming the diaphragm
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| Low pressure circulatory system | Gradients maintained by the cervicothoracic, thoracolumbar and pelvic diaphragms that aid in fluid movement through the venous and lymphatic systems
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| The thoracic duct empties into the | Junction of the internal jugular and brachiocephalic vein
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| 35-60% of the thoracic duct drainage is in response to | Respiratory movements
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| All initial lymphatics have anchoring filaments and will therefor respond significantly to | Respiratory movements to the degree at which they occur in the area
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| Restoring a greater excursion of the thorax will improve the body's ability to move | Lymph, which leads to an increase in local drainage, and increase in delivery of antigen and an increased transport of antibiotics
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| Cranial nerve involved with bronchospasm and mucous production | Vagus
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| Vagal reflex somatic dysfunction is found most often in | C2, occiupitomastoid suture, or cranial base
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| Sensory ganglion of the vagus nerve is located | Within the jugular foramen adjacent to the occipitomastoid suture
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| Significant treatment areas for asthma patients | Right T4-5 and right 4th/5th ribs
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| Pneumonia is often accompanied by (Somatic dysfunction) | A local reduction in rib excursion (leading to barrel chest)
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| Barrel chest is most likely due to the innervation in the | Parietal pleura
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| Bronchitis somatic dysfunction and innervation | T1-T5, Sympathetic innervation
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| Malnutrition common in COPD | Protein/Caloric
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| Shortness of breath and cost of medication can lead to high | Stress
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| Most important behavioral change in COPD | Stop smoking
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| First target of OMT in respiratory patients | Ribs, thoracic spine and diaphragm to reduce mechanical restrictions
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| Second target of OMG in respiratory patients | Autonomic nervous system, start with indirect and go to direct
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| Follow-up time for OMT in respiratory patients | 1-4 months
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