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WEEK 18:
The Breathless Patient
| Question | Answer |
|---|---|
| tachypnoea | rapid shallow breathing |
| cause of SOB | anything that reduces PaO2/ increases PaCO2 |
| ventilation | amount of air brought into alveoli |
| perfusion | amount of blood brought to alveoli for gas exchange |
| how does LVF (left ventricular failure) / mitral stenosis cause dyspnoea | slow or sudden pulmonary oedema increase pressure in pulmonary capillaries leading to transudate in lungs |
| causes of dyspnoea (4) | LVF/ mitral stenosis, chronic bronchitis, COPD, and asthma |
| how does chronic bronchitis cause dyspnoea | excess mucus production |
| how does COPD cause dyspnoea | overdistension (stretched too much) of alveoli distal to terminal bronchioles |
| how does asthma cause dyspnoea | asthma attacks- airway narrows |
| congestive heart failure (CHF) definition | unable to eject blood delivered to it by venous system leading to blood building up behind heart (LHF most common) |
| pulmonary congestion | in LHF when blood backs up in lungs |
| what happens when LHF leads to pulmonary oedema | increases hydrostatic forces in pulmonary vasculature |
| orthopnoea | breathlessness when lying down (linked to heart failure) |
| digital clubbing is a sign for (4) | lung cancer, bronchiectasis, pulmonary fibrosis, and cyanotic heart disease |
| central cyanosis | reduced O2 saturation of 80% in tongue and lips |
| letter for ventilation | V |
| letter for perfusion | Q |
| normal V/Q ratio | 0.8 |
| causes of hypoxaemia (4) | decreases inhaled PO2, respiratory acidosis, ventilation defect, and perfusion defect |
| how does ventilation defect cause hypoxaemia | alveoli are perfused but impaired O2 delivery to alveoli meaning pulmonary capillary blood has the same PO2 and PCO2 as venous blood returning from tissue (nothing is exchanged) |
| how does perfusion defect cause hypoxaemia | alveoli are ventilated but no perfusion of alveoli increasing pathologic dead space eg PE |
| where is perfusion and ventilation best | base of lung |
| increasing O2 inhaled in perfusion defect leads to what | increases PaO2 |
| embolism meaning | intravascular mass that travels + occludes blood vessels |
| most common cause of embolism | dislodged thrombus (thromboembolus) |
| pulmonary embolism** | most commonly caused by DVT and is clinically silent as lung has dual blood supply but usually are small and self resolve |
| symptoms of PE (3) | SOB, haemoptysis, and pleuritic chest pain |
| investigatory finding of PE (4) | pleural effusion, V/Q mismatch on scanning, CTPA shows filling defect, and lower limb ultrasound shows clot |
| large saddle embolus in pulmonary trunk | cause cardiac arrest as heart cannot pump blood to lungs |
| arterial blood gas monitoring gives (3) | pH, PaO2, and PaCO2 |
| pulse oximetry normal level | 94-99% |
| normal pH on ABG | 7.35-7.45 |
| normal PaO2 on ABG | 80-100mmHg (10.5-13.5kPa) |
| normal PaCO2 on ABG | 38-42mmHg (5.1-5.6kPa) |
Created by:
kablooey
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