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Foundations of Osteopathic Medicine Ch. 59

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