Pulmonary

Increase in the amount of air entering the alveoli leading to hypocapria. (PaCO2 < 35 mm Hg)

• Decreased delivery of air to the alveoli
• Insufficient to provide oxygen and remove caron dioxide (PaCO2 >45 mm Hg).
• Decreased rate and depth of respiration.

Causes myasthenia gravis, sleep apnea, chest trauma, morphine

Undissolved embolus that occludes blood vessels of lungs

• Virchow's triad -
• venous stasis / sluggish blood flow
• hypercoagulability
• damage to the venous wall (intimal injury)

• Thrombotic (blood clots develop in venous system, eg. legs)
• Fat (fat emboli ex. bone / fractures)
• Amniotic Fluid (seen in pregnancy)
• Air (from venous access ex. IV)
• Others

• Dyspnea
• Chest Pain (or on inspiration)
• anxiety
• Tachycardia
• Tachpnea
• Dizziness
• Hemoptysis (Expectoration of blood)

• Prevention
• 1. compression stockings during and after surgery
• 2. intermittent leg compressions
• 3. early mobilization
• Anticoagulants - Heparin, Enoxaparin(Lovenox), Warfarin (Coumadin)
• Thrombolytics: Streptokinase, tissue plasminogen (TPA), anistreplase (Eminase)
• Umbrella filter (Mobin Uddin), filter in inferior vena cava

• Shock
• Respiratory Failure
• Cardiac and Respiratory Arrest

• Hyperinflation of alveoli
• Destruction of alveolar walls & capillary walls
• Loss of Alveolar Walls leads to narrowed airways (Bronchioles)
• p. 552

• Cigarette Smoking, Air Pollution
• Recurrent Infection
• Heredity (alpha 1-antitrypsin deficiency)
• Aging

• Dyspnea / Pursed Lip breathing
• Use of intercostal and accessory muscles
• Underweight
• Barrel Chest
• "Pink Puffer"
• Cough is minimal
• Hyposemia (late sign)

Hyperplasia of mucus secreting glands in tracheobronchial tree, increase in goblet cells, decrease in cilia, narrowing of small airways, impaired alveolar macrophages = increase in bronchial infections

• Productive Cough (winter)
• Usually heavy set or normal weight
• "Blue-bloater"
• Dyspnea
• Hypercapnia

• Reversible airway obstruction
• Airway inflammation
• Increased airway responsiveness
• Allergic and Non-Allergic (or Extrinsic / Intrinsic)

• Allergens
• Tobacco Smoke
• Exercise (Running, jogging, tennis)
• Weather changes (cold weather)
• Respiratory Infections
• Nose & Sinus Problems
• Drug and food additives
• Severe GERD
• Emotional Stress

• Dry Cough
• Wheezing
• SOB / Dyspnea
• Complaints of "Chest Tightness"
• Severe attacks - no audible wheezing
• "Silent chest" - ominous sign of impending respiratory failure

• Status asthmaticus
• 1. severe life-threatening attack refractory to usual treatment
• 2. think respiratory failure
• Atelectasis
• Pneumonia
• Spontaneous Pneumothorax
• Respiratory failure, Respiratory arrest

• Upper Respiratory Infection
• Tracheal intubation
• Aging
• Incompetent immune system

• Impaired mucociliary mechanism (smoking, pollution)
• Decreased cough and epiglottal reflexes (aspiration)
• Inhalation of microbes (Mycoplasma Pneumoniae)

• Community Acquired (CAP)
• Hospital Acquired (HAP)
• Bacterial
• Viral
• Atypical

inflammatory reaction in the alveoli and insterstitium of lung, usually caused by an infectious agent

Fever, cough, chills, purulent sputum, back pain or pleuritic chest pain, h.a., myalgia, fatigue, sore throat, tachypnea, tachycardia, dyspnea, rales (crackles) over affected lung, abnormal CXR, hypoxemia

• H & P
• CXR
• Sputum Culture
• Elevated WBC

• Oxygen
• Antibiotics
• Analgesics
• Antipyretics
• Fluids (IV or oral)
• Caloric Intake
• Rest

• Caused by Mycobacterium Tuberculosis
• Impaired immune systems (HIV, Diabetes, corticosteriod users)

• Inhaled bacilli pass down the bronchial system to implant themselves on bronchioles or alveoli
• Multiply with no initial resistance
• Can continue to multiply within phagocytes

• Parenchymal component - necrotic nodule becomes fibrotic and calcified
• Lymph - found in lymph nodes

• Low grade fever
• Cough
• Night Sweats
• Fatigue
• Weight Loss
• Malaise
• Anorexia
• Malnourished, ill-looking