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atopic asthma

COPD

anaphylatic reaction

lung cancer

respi infection -acute bronchitis, bronchiolitis

TB

pneumonia

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nasal flaring- widening of nasal- compensatory mechanism- more air intake

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19-year-old farmer

- expose to irritant- cause cough

-herbicides-can cause respi & skin cancer

-trigger inflammation , mucus production, hypersensitivity reaction ( asthma)

emergency department

- very important CRITICAL- acute not chronic

cough, loud wheezing, shortness of breath

and nasal flaring

-respi distress -obstruction of airway cause wheezing sound

particularly breathless while talking

- exacerbating factor- need more effort to breath-SOB- can be seen in COPD, AR, infection

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Malaise-general feeling of discomfort

Whistling-wheezing(narrowing of the airways)

Sinusitis-Inflammation of sinus cavities

Atopic disease-tendency to get the particular disease due to genetics

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1)dyspnoea

began during the daytime, which aggravated by modest dust

inhalation-Farmer exposed to pesticides/dust

-obstruction of the airway

-Dust act as allergen cause bronchospam/hypersensitivity

2)tightness in his chest and shortness

of breath were so severe that he had to eventually seek medical help-Significant pressure in the chest/inflammation causing reduced lung function

3) patient is now very uncomfortable, even at rest-Significant resp problems since it is caused by

4) he has had a productive cough with greenish yellow

sputum, mild fever, malaise, and fatigue-(green/yellow)-due to content of mucus that has immune cells/bacterial infection.White sputum(healthy).

(green/yellow appearance)-presence of myeloperoxidase

-mild fever which is the inflammatory response of the patient.

-malaise is non specific and caused by various disease.Can be caused by metabolic disorder.

6)He denies previous lung problems except for mild “whistling” in his chest, which has occurred off and on during the past several years

whistling-asthma,bronchiolitis

mild,intermittent

exposure to allergens causing on and off symptoms

7) denies the use of any prescription medications and any

previous episodes of dyspnoea, sinusitis, or allergies

not diagnosed by any problems and did not take any medication to treat the problem

did not take any ACEi

can exclude drug induced asthma such as aspirin

8)non-smoker and his family history is negative for lung

disease and atopic diseases-probably does not have COPD

no atopic-occur later

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non-atopic asthma

COPD

anaphylatic reaction

lung cancer

respi infection -acute bronchitis, bronchiolitis

TB

pneumonia(bacterial infection)

atelectasis

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1)Vital sign

bp,resp rate,temp,heart rate,oxygen saturation

2)Physical examination

tripod position,cyanosis,increased resp rate

chest examination(anterior/posterior) diameter-increase indicates asthma

3)Lung auscultation

4)FBC-increase in WBC we can conclude that he has infection

5)Urine analysis

detect the presence of strp pneumonia

6)Chest X- ray-detect the change in lungs

check for lung collapse

7)Sputum/blood culture test

8)Mantoux test-tb

9)Spirometry-detect the severity of shortness of breath

10)ECG-to rule out cardiac involvement(if normal)

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-diaphoretic - excessive sweating

-paradoxical pulse - abnormal drop - drop more than 25mm hg -

- resonance - low pitch hollow sound in lung tissue

-SCM - assist in forced inhalation

- mild abdominal paradox - chest wall goes opposite of the normal

- polyphonic - diff pitch

-

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SOCRATES

-site: chest tightness location

-onset: when the pain start, sudden/regularly

- characteristic: sputum colour

- radiation: location

-associated symptom: fever,

-timing: night/morning, during sleeping /working

-exacerbating factor: *while talking, specific position-tripod

-severity: rate

past med history

- occur before-for asthma

- take ACE inhibitor-show same symptom

-SOB?

-vaccine?

-allergy to

-previous hospitalization/surgery

social history

-type of herbicides

-pollen, dust expose?

-lifestyle-smoker? alcohol intake

-expose to TB-visit?

family history

-same symptom other fam member

-hypertension,DM

-cancer

-any same allergy reaction, asthma,

travel history

-where?

-time of exposure- how long the stay?

-how long in flight

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-patient is alert but restless and in moderate respiratory distress - mental status is okay - no neurological distress

-mild diaphoretic - due to fever - as a compensatory mechanism

- sitting up on the edge of the bed - facilitate the breathing - tripod

- vital signs -temperature -slight increase - indicate infection

High HR, increase respiratory rate - compensatory mechanism - due to inadequate of O2 supply

BP - normal

- paradoxical pulse - sudden drop -small airway - more negative pressure inside - reduce venous return - reduce CO -systolic pressure drop

-nasal wing flare - more inhalation by widening

- SCM tensed - more workload

-Chest examination revealed increased anteroposterior diameter with decreased expansion during breathing - reflects hyper-inflated lung - deformity which lung in expanded size

-resonance to percussion moderately increased bilaterally-occur due to air trapping and hyperinflation - incerase of resonance

- mild abdominal paradox with respiratory efforts - main reason is due to hyperinflation - when we exhale the lung does not go inward - diaphragm doesnt function properly - accessory muscle lift up the rib cage when inhaling

- Respiratory rate was rapid with prolonged

expiratory phase - mucus obstruct the airways, hard for expiration- prolonged expiratory phase - increase breathing

- polyphonic wheezing heard over entire chest

during inhalation and exhalation - polyphonic obstruct small airways - bronchiole - asthma or copd

-focus on respi only

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non-atopic asthma

respi infection -acute bronchitis, bronchiolitis

pneumonia(bacterial infection)

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- CXR - to rule out pneumonia - confirm hyperinflation

- spirometry

- sputum test - pneumonia

- ABG - arterial blood gas

- FBC

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1. nasal cannula - devices use to deliver o2 to he patient

2. salbuutamol MDI - short acting bronchodilator drugs, convenient for sudden attack, meter dose inhaler(adequate dose then)

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1. Moderate hyper-expansion with no evidence of

infiltrates - occur inn air traping or over inflation lung, no abnormal substance like pus, fluid accumulate within lung parenchyma- no infection lung tissue(not pneumonia)

2. PaO2 - hypoxemia, low O2 in blood, H+ ion normal (pH not altered much then )(due to PaCO2 normal)-insufficient oxygen supply- mucus deposition cause difficulties gas exchange

3. FEV and FVC low- obstructive type lung disease

4. Peak expiratory flow 140 liters/minute- exhale low air(obstruction)(air trap)

5. Full blood count - within normal range( not infection related)

6. diagnosed with asthma

exacerbated by acute bronchitis and started on oxygen via nasal

cannula, which improved oxygen saturation from 87% to 97%.-(preexisting condition of asthma, worsen by acute bronchitis)(show improvement o2 saturation)

7. salbutamol by nebulizer-saba receptor antagonist- relaxing the airways smc-

8. patient was discharged on oral antibiotics and fluticasone- ab to trea infection, fluticasone-corticosteroid to reduce the airways inflammation, (salmetarol is LABA ( long bronchodilator effect)

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asthma secondary to acute bronchitis