Download - Dyspnea Final Yahoo
DYSPNEABy:
Christian Syukur 2013 - 061 – 114Paulus Aditya B. 2014 - 061 - 045
Advisor: dr. Febie Chriestya, Sp.PD, MSc.
KEPANITERAAN KLINIK DEPARTEMEN ILMU PENYAKIT DALAM FAKULTAS KEDOKTERAN UNIVERSITAS KATOLIK INDONESIA
ATMA JAYAPeriode 21 September 2015 – 28 November 2015
DefinisiPengalaman subyektif dari gangguan bernafas, yang terdiri dari sensasi yang memiliki intensitas yang bervariasi secara kualitatif (American Thoracic Society)
Mechanisms of Dyspnea
Chemoreceptors
Mechanoreceptors
Metaboreceptors
Respiratory centers(Respiratory drive)
Sensory cortex
FeedbackFeed-forwardError Signal
Motor Cortex
Ventilatory muscles
Dispnea intensity and quality
Corollary discharge
Assessing Dyspnea (Quality of Sensation)Descriptor Clinical Examples PathophysiologyChest tightness or constriction
Asthma, CHF Bronchoconstriction, interstitial edema (asthma, myocardial ischemia)
Increased work or effort of breathing
COPD, asthma, neuromuscular disease, chest wall restriction
Airway obstruction, neuromuscular disease (COPD, moderate to severe asthma, myopathy, kyphoscoliosis)
Air hunger, need to breathe, urge to breathe
CHF, COPD, asthma, pulmonary embolism, pulmonary fibrosis
Increased drive to breathe (CHF, pulmonary embolism, moderate to severe airflow obstruction)
Cannot get a deep breath, unsatisfying breath
Asthma, COPD, pulmonary fibrosis, chest wall disease
Hyperinflation (asthma, COPD) and restricted tidal volume (pulmonary fibrosis, chest wall restriction)
Heavy breathing, rapid breathing
Sedentary status in healthy individual / patient with cardiopulmonary disease
Deconditioning
DyspneaRespiraoty Disease
Cardiovascular Disease
Airways
Chest Wall
Lung Parenchym
Left Heart
Pulmonary Vasculature
Pericardium
Respiratory System DyspneaDisease of the Airways• Asthma• COPD
Disease of the Chest Wall• Kyphoscoliosis• Myasthenia Gravis• Guillain-Barre Syndrome
Disease of the Lung Parenchyma• Infections• Autoimmune Disorders
Cardiovascular System DyspneaDisease of the Left Heart• Coronary Artery Disease• Non-ischemic Cardomyopathies
Disease of the Pulmonary Vasculature• Pulmonary Hypertension• Pulmonary Thromboembolic Disease
Disease of the Pericardium• Constrictive Pericarditis• Cardiac Tamponade
Tatalaksana Dispneu
Goal •koreksi penyebab
O2 •saturasi istirahat ≤ 89%•saturasi ↓ saat aktivitas
Edema Paru
Tekanan hidrostatik dan onkotik
Level albumin ↓Kerusakan endotel Akumulasi Cairan
Edema Paru KardiogenikAbnormalitas jantung pe↑ tekanan vena pulmoner pe↑ tekanan hidrostatik cairan keluar dari pembuluh darah edema intersititial / alveolar
Tanda awal : exertional dyspnea dan orthopnea
Efusi Pleura
Ro thoraks: penebalan peribronkial, vaskularisasi yang lebih terlihat pada bagian atas paru, kerley B lines patchy alveolar filling infiltrat difus
Edema Paru Non-Kardiogenikkerusakan lapisan pembuluh darah pulmoner
Berkaitan: disfungsi surfaktan, pe↑ tegangan permukaan, kecenderungan alveoli kolaps
Membran hialin di alveoli, inflamasi fibrosis
Auskultasi: normal
Ro thoraks: infiltrat alveolar difus
CT-scan: edema alveolar heterogen
Bagaimana Membedakan edema paru kardiogenik dan non-kardiogenik ?
Kardiogenik Non-Kardiogenik
Riwayat Penyakit jantung kondisi tertentu
Pemeriksaan Fisik S3 gallop, pe↑ JVP, edema periferRales dan/atau wheezing
Normal pada fase awal
Radiografi Thoraks Perbesaran bayangan jantungRedistribusi vaskularPenebalan intersisialInfiltrat alveolar perihilerEfusi pleura sering
Ukuran jantung normalInfiltrat alveolar di seluruh lapang paruEfusi pleura jarang
Penyebab hipoksemia Mismatch ventilasi/perfusi Shunting intrapulmoner
Respon suplementasi O2 (+) (-)
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