It is divided into acute and chronic
Reflects the dependence of the development of right ventricular cardiac decompensation (pulmonary heart) in severe diseases of the bronchopulmonary system (Euler-Lillestrand reflex). Chronic
Stage 1 - purely pulmonary (respiratory failure is observed, pulmonary hypertension is formed) Stage 2 - pulmonary + compensated right ventricular heart failure (right ventricular hypertrophy develops against pulmonary hypertension)
Stage 3 - pulmonary + decompensated right ventricular heart failure (congestion in a large circle
of blood circulation).
SYMPTOMS:
Expansion of the boundaries of the relative dullness of the heart to the right
accent 2 tones over the pulmonary trunk
Signs of congestive right ventricular heart failure
pulmonary hypertension according to ultrasound
Adult respiratory distress syndrome (RDSV) is an acute respiratory failure that occurs with acute lung injuries of various etiologies, with the obligatory development of non-cardiogenic pulmonary edema (interstitial, then alveolar). A synonym is shock lung.
Etiology: sepsis, shock, chest injuries, aspiration of water or stomach contents, pneumonia, inhalation of irritating and toxic substances, prolonged exposure to high altitude, venous fluid overload, severe metabolic disturbances, massive blood transfusions, autoimmune diseases.
RDSV develops after a latent period - a period of exposure to the etiological factor (about 24 hours). Etiological factors lead to the accumulation of active white blood cells and platelets in the pulmonary capillaries and interstitial lung tissue, the release of biologically active substances.
The acute phase. There is pulmonary edema, hypoventilation, microatelectases, impaired diffusion of oxygen and carbon dioxide. It ends with recovery or transition to the subacute phase. The subacute phase is characterized by the presence of interstitial and bronchoalveolar inflammation.
The chronic phase is characterized by the development of interstitial fibrosis (already from the 2nd week of the disease).
The clinical picture.
Acute respiratory failure: severe shortness of breath, diffuse cyanosis, participation of auxiliary muscles in the act of breathing, tachycardia, hypoxia, hypercapnia.
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2. Lowering blood pressure.
3.Symptoms of interstitial pulmonary edema: decreased elasticity of the chest, dullness of percussion sound, more in the posterior - lower parts of the chest, hard breathing, there may be dry wheezing.
With the appearance of alveolar pulmonary edema - moist rales, crepitus, cough with foamy pink sputum.
Syndrome of acute pulmonary heart and pulmonary hypertension (pressure in the pulmonary artery rises (> 30/15 mm Hg), but unlike cardiogenic pulmonary edema, the normal pressure is pulmonary wedge jamming (<15 mm)).
Multiple organ failure. Metabolic acidosis (pH <7.3).
X-ray - pronounced interstitial pulmonary edema, bilateral shadows of irregular cloud shape.
2.1. TEST TASKS
(Choose one or more correct answers)
Indicate the most characteristic changes in the chest with the syndrome of fluid accumulation in the pleural cavity:
a decrease in half of the chest, its retraction and lag during breathing
an increase in half the chest, smoothing of the intercostal spaces, chest lag during breathing
the chest is not changed, the lag of half of the chest during breathing
an increase in the anteroposterior and transverse dimensions of the chest, retraction of the intercostal spaces in the lower lateral sections on both sides
Indicate the most characteristic changes in the chest with emphysema:
the shoulder girdle is raised
the front-rear size is equal to the lateral
the ribs are horizontal
intercostal spaces narrow
intercostal spaces wide
Indicate the most characteristic changes in percussion sound with dry pleurisy:
absolutely dull (femoral) or blunted sound
clear pulmonary sound
tympanic sound
box sound
Indicate the most characteristic changes in percussion sound during hydrothorax:
absolutely dull (femoral) or blunted sound:
clear pulmonary sound
tympanic sound
box sound
Indicate the most characteristic changes in percussion sound in case of pulmonary tissue compaction syndrome of inflammatory origin:
absolutely dull (femoral) or blunted sound
clear pulmonary sound
tympanic sound
box sound
Indicate the most characteristic changes in percussion sound with pneumothorax:
absolutely dull (femoral) or blunted sound
clear pulmonary sound
tympanic sound with a metallic tint
dullness with a tympanic hue;
box sound
What changes with topographic percussion of the lower edge of the lungs can be obtained with hydrothorax:
displacement of the lower edge down and limitation of its mobility
displacement of the lower edge up and limitation of its mobility:
only the shift of the bottom edge up
only lower edge offset down
only the restriction of the mobility of the lower edge
The clinical sign of respiratory failure syndrome is:
cough with purulent sputum
shortness of breath and cyanosis
an increase in ESR and leukocytosis
The spirographic sign of obstructive respiratory failure is:
decrease in VC
Tiffno index less than 70%
increase in residual volume
The spirographic sign of restrictive respiratory failure is:
decrease in VC
decrease in the Tiffno index
increase in FEV1
2.2. Situational Tasks
Task 1
Patient A., 23 years old, upon admission to the hospital complained of severe shortness of breath, fever, heaviness in the right side, general weakness.
She got sick acutely, a week ago. Initially, a small dry cough appeared, stitching pains in the right side during breathing, aggravated by deep inhalation, as well as coughing, sweating, headaches, body temperature increased to 37.7 ° C. I took aspirin on my own, without effect. Dyspnea joined and began to intensify, body temperature increased to 38.3 ° C. Stitching pains in the chest gave way to a feeling of heaviness in the right side.
During the examination, the doctor found moderate cyanosis, an increase in the volume of the right half of the chest with smoothness of the intercostal spaces, lag during breathing of the right half of the chest. The respiratory rate was 35 per minute. To the right below the angle of the scapula, voice trembling is not performed. With percussion, a blunt sound zone with an arcuate upper boundary is determined on the right, the upper point of which is along the rear axillary line. During auscultation over the area of dullness, breathing is not heard, above dullness is breathing with a bronchial tinge.
What can be caused by the patient’s chest pain?
The presence of what syndromes can be established in a patient based on complaints and data from an objective study?
What diseases can cause the patient's clinical picture?
Task 2
Patient M., 30 years old, went to the clinic with complaints of fever up to 37.7 ° C, cough with a moderate amount of light sputum, general weakness, sweating.
He fell ill 3 days ago when, after hypothermia, a runny nose, hoarseness, a feeling of soreness behind the sternum appeared, as well as a dry cough, which then became moist.
On examination, palpation and percussion of the chest, no changes were detected, however, upon auscultation, the doctor found harsh breathing, a significant amount of scattered dry (mainly bass) rales and a small amount of moist, inaudible, small bubbling rales.
What can be caused by the appearance of hard breathing in a patient?
What syndromes can be determined in a patient based on existing complaints and changes found?
For which disease is the clinical picture described most often observed?
Task 3
An ambulance doctor was called to the patient, 28 years old, for a sudden onset and lasting for several hours an attack of suffocation with difficulty exhaling, coughing with sputum that could hardly be separated. Repeated use of the inhaler (β-adrenostimulator berotek) gave only a temporary effect. Such attacks bother the patient for 5 years, sometimes provoked by the smell of gasoline, flowering plants. In childhood, she often suffered from colds, repeatedly suffered acute pneumonia.
On examination: the patient sits in bed, resting his hands on his knees, moderate cyanosis is determined. In the distance, noisy wheezing is heard. The face is puffy; neck veins swell. The auxiliary muscles are involved in the act of breathing. The chest is barrel-shaped, voice trembling is evenly weakened. Respiratory rate - 28 per minute. With percussion of the chest - a box sound, the downward movement of the lower boundaries of the lungs is determined. During auscultation, evenly weakened breathing with elongated exhalation, a large number of common dry wheezing, are heard.
What syndromes can be distinguished in a patient based on existing complaints and objective research data?
What disease can cause the indicated clinical picture?
What complication can develop in this patient?
Task 4
Patient L., 17 years old, came to the clinic with complaints of fever up to 37.7 ° C, sweating, a small dry cough, pain in the right side, aggravated by deep breathing and coughing, as well as when standing on the left side. Sick for 3 days.
At the age of 16, a turn of the Mangu test was detected.
On examination, a superficial nature of breathing was noted, a lag of the right half of the chest during breathing, some restriction of mobility of the lower edge of the right lung, a noise of friction of the pleura along the middle axillary line to the right were found.
What syndromes can be distinguished in the clinical picture of the disease?
What may be associated with increased pain when standing on the left side?
What disease can a patient possibly have?
Task 5
Patient J., 25 years old, called a doctor at home on the 2nd day of illness. Ill acutely. Against the background of complete health after hypothermia (went skiing), chills suddenly appeared, noted an increase in temperature to 39.5 ° C, stitching pains in the right side when breathing, headaches, dry cough, general weakness. He took aspirin, but the temperature continued to remain high. The next day, the cough intensified, and a ―rusty‖ sputum appeared.
During the examination, a serious condition of the patient was found. It was noted: a blush on the cheeks (more on the right), herpetic eruptions on the lips. Respiratory rate - 35 per minute. There was a delay in breathing in the right half of the chest. To the right below the angle of the scapula, amplification of vocal trembling, the blunt-tympanic nature of percussion sound were determined, weakened vesicular breathing, increased bronchophony, crepitus were heard.
What syndromes can be identified on the basis of existing complaints and objective research?
What can be associated with crepitation in a patient?
The presence of a disease can be assumed in the patient?
Task 6
Patient K., 43 years old, rigger at a construction site, has been abusing alcohol for a long time, and does not eat well. Re-called the doctor to the house on the 10th day of illness. The disease was preceded by hypothermia on the background of alcohol intoxication. The day after that, the temperature rose to 37.8 ° C, a cough with a moderate amount of sputum, shortness of breath appeared. I went to the doctor. Suspected and then X-ray confirmed right-sided lower lobe pneumonia. The patient refused hospitalization. It was prescribed antibiotic treatment on an outpatient basis, which the patient took irregularly. No improvement was noted. Chills, cough, general weakness persisted. On the 10th day of the disease noted the release of a large amount (300 ml) of sputum "full mouth" with an unpleasant odor.
During the examination, a serious condition of the patient was found. The respiratory rate was 30 per minute. To the right in the subscapular region, a zone of increased voice trembling was identified. There, percussion was determined tympanic sound, and during auscultation, bronchial breathing and moist large-bubbling rales were heard.
What syndromes can be distinguished in a patient on the basis of the clinical picture and data from an objective study?
What disease can occur with the indicated clinical picture?
What complications can develop with this disease?
Task 7
Patient K., 62 years old, a driver by profession, underwent an annual preventive medical examination. When questioned, the doctor found that the patient smoked for 45 years at 20-25 cigarettes per day. For 30 years, he has been bothered by a cough with a small amount of sputum (several spitting during the day), which is allocated mainly in the morning when washing. Over the past 5-8 years, coughing has become unproductive, appears in the early morning hours and decreases only when 1-2 cigarettes are smoked. Dyspnea associated with physical exertion.
On examination, the doctor noted moderate cyanosis, a barrel-shaped chest. The respiratory rate was 24 per minute. The uniform attenuation of vocal trembling, the decrease in the maximum respiratory excursion of the chest, the box sound during percussion, the uniform attenuation of vesicular breathing (with an extended output), and a small number of scattered dry rales were determined.
What syndromes can be distinguished in a patient based on available data?
What do you expect to find with topographic percussion of the lungs?
What disease does the patient most likely have?
Task 8
The therapist was summoned to a surgical clinic for a consultation with patient N., 68 years old, operated on 5 days ago under general anesthesia (inhalation anesthesia) for an inguinal hernia. On the 2nd day after the operation, a cough appeared with the release of a small amount of mucous sputum. I tried to suppress the cough, as it was accompanied by increased pain in the surgical suture area, observed strict bed rest. On the 4th day, the temperature rose to 38.0 ° C, shortness of breath, sweating, general weakness joined, cough intensified, sputum became mucopurulent.
During the examination, the doctor found an increase in respiratory rate to 28 per minute, the lag of the left half of the chest, there was also an increase in vocal trembling, a section of blunting of percussion sound. During auscultation, harsh breathing was noted (in the blunting zone, bronchosicular breathing), sonorous, small bubbling rales were heard over the blunting zone.
What are the leading syndromes available to the patient.
What is the mechanism of formation of bronchovascular breathing?
What disease does the patient presumably have and what contributed to its occurrence?
Task 9
Patient K., 52 years old, complained of persistent cough with the release of a small amount of mucopurulent sputum, recent hemoptysis, shortness of breath during physical exertion, low-grade fever, sweating, decreased appetite, weight loss of 5 kg over the past 3 months, general weakness .
He works as an anesthetist. Smokes 20-25 cigarettes a day for more than 30 years. Coughing has been troubling for many years. Hemoptysis and fever appeared during the last month.
Upon examination, the doctor noted pallor of the skin. In the left axillary region, enlarged lymph nodes (the size of a walnut), dense-tuberous consistency, and inactive were determined. The left half of the chest is reduced in size, there is also a sharper retraction of the supraclavicular fossa. The left half of the chest lags somewhat when breathing. The respiratory rate is 24 per minute. In the suprascapular region on the left, blunting of percussion sound and a sharp weakening of vesicular breathing and voice tremor are determined.
What syndromes can be distinguished on the basis of available data?
What are the main diseases in which hemoptysis occurs.
What disease is the patient supposed to have?
Task 10
Patient Z., 56 years old, at the age of 5 suffered measles, complicated by severe pneumonia. Since that time, the cough with the release of mucopurulent sputum began to disturb. Deterioration of health was observed in the autumn-spring period, when the patient noted long periods of fever and increased coughing, and the amount of sputum increased to 50-100 ml per day. When standing, sputum disintegrated into 3 layers. Sometimes noted hemoptysis. Over time, dyspnea began to progress with physical exertion, general weakness. Over the past year, there were swelling on the face in the eyelids, as well as swelling of the legs.
On examination, a patient with asthenic constitution, low nutrition. The skin is pale, swelling under the eyes, pastes of the legs. Fingers have the form of ―drum sticks‖, nails - in the form of ―watch glasses‖. Respiratory rate - 24 per minute. When auscultation of the lungs - harsh breathing, scattered dry and wet small and medium bubbling rales. The liver protrudes from under the costal margin by 4 cm (along the midclavicular line), a densely elastic consistency. The lower pole of the spleen is clearly palpated. In a laboratory study, the serum albumin level was 25 g / l (N 40-50 g / l), the cholesterol content was 10.4 mmol / L (N 3.11-6.48 mmol / L). In urine tests, protein was found (daily loss of protein with urine - 14 g), hyaline and waxy cylinders, and renal epithelial cells.
What syndromes can be distinguished in a patient?
What disease does the patient suffer for many years?
What complication did the patient develop and how can it be confirmed?