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A nasty cough session 2 by Mind Map: A nasty cough session 2
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A nasty cough session 2

Step 6

Review session 1

Summary of step 5, smoking, related to respiratory disease, 15 % of smokers developed COPD, smoking is declining in UK, highest rate of smoking from age 20-24 in women, burden 197 billion, smoking damge is slow, cause paralyze of the cillia, smoking cough because there is no cillia morning cough, 1 out of two persistent smoker s developed any chronic respiratory diseases, cause acute respiratory diseases, cause chronic respiratory diseases, poor control of asthma, 4000 harmful component 48 f them are cancerous, contains polycyclic aramotic hudrocarbons, stimulate the release of enzymes from neotrophllis and macrophages, related to coronary heart disease, nicotine attract the neotrophills and macrophages which release the elastase, cause mucus secretion, that why smokers are more prone to get infection, mechanism, induce inflammation, IL-8 , LTB4, a1 antitrypsin reduces, oxidative stress could be a mechanisim, sputum analyzing, IS PRODUCTION OF MATERIALS FROM THE UPPER RESPIRATORY TRACT, amount , color, blood, duration ,((full history)), 4 types, serious, clear ,watery :: acute pulmonary edema, mucoid, clear and grey, :: COPD, purulent, greenish or yellowish :: infection, rusty, looked rust, due to bleeding, pnuomococcal pnuomonia, green means nuetrophills dead, enzyme called verdoperoxidase, yellow means active infection, shortness of breath, definition, undue awareness of breathing, causes, hyperventilation in emphysema, pulmonary embolism, lung or heart problem, pregnancy, chest deformatirs, classification MRC, 1 when excercise, doesn't indicate any dusea, 2 when hurring up, 3 walking for one mile, 4 when you move more than 100 meteres, 5 when you cannt leave the house, clinical indication, increase ventilation demands, decreased ventalatory capacity, increase airways resistance, decreade pu;monary complince, when you lie down associated with orthopnea, affernt receptors send signals to the medulla and the effernt signals to the respiratory muscles, should do the ABC, Chronic Obstructive Pulmonary Disease, chronic bronchitis and emphysema, causes, smoking exposure, 90% of COPD are smokers, dust and chmicals exposure, genes, a1 antitrypsin deficiency, very rare less than 1 %, symptoms, shortness of breath, productive cough, wheezing, goblet cells hyperatrophy, developes pulmonary hypertension, to diagnose we need spirometry, normally FEV1 80 %, before do it should look for signs, emphysema pink buffers, damge to the alveilar wall, chronic bronchitis, blue bloters high cardia out put, physical exmination rapid respiratory rate and the use of accsary muscles, hepatomegaly , wheezing, excacerbations will increase the dyspnea and other symbtoms caused by infections, hypertension and its effect on the respiratoy system, pulmonary hypertension failure of hypoxic kidneys to excertion of sapdium and water which developed the swollen ankle, more prone to developed pulmonary embolism

Report new knowledge

40 minutes

Step 8

Diagnostic decision

acute exacerbation of COPD with acute respiratory failure

Mechanism

chronic COPD and acute infections beacause of the smoking

Presentation

respiratory failure

dyspnea

wheezing

productive cough

swollen ankle

Supporting data

tests results, CXR, spirometry, 0.95/1.85, 51%, predictive value 2.2/2.7, oxygen, 86%, PH, 7.25, normal 7.35-7.45, PaCO2 60,mmHg, PaO2 90, normal more than 75, Hco3 29 mEq / liter, normal 24-26, Sa O2 99%, normal above 95, ECG, sinus tachycardia and no other problems, CBC, NORMAL, ELECTROLYTS, NORMAL, ESR, slightly elevated, sputum examination, muco purulunt, moderate moraxella catarrhalis

physical examination

10 minutes

Step 7

Inquiry plan and info gathering

History of presenting complain, started two weeks ago dry cough, rhinitis, productive cough before one weeks, half a cop, yellow sputum, wheezing at night, cant go out home, off to work, worsen breathlessness, in the last 24.48, not releaf by the drug, swollen ankle unable to walk, called ambulance, smokers cough, small amount of mucus, developed winter bronchitis

Previous medical / surgical history, didnt take the influnza vaccine, havent dignosed with asthma, hypertensive, no heart disease, no cholestrol measure, early menapause 42

Drug history / allergy, inalapril, twice a day, aspirin 100 mg, salbtmol, 4 times a day, for long times, when needed

Family history

Social / occupational history, born in australia, smokers 10 ciggarate per day started at 11, 25.5 packyeras, when not working she works in her garden and caree of her grandchildren, worked at clothing manufacture

Systemic review

Physical examination, 37.1 tempruter, BB 170/90, pulse 124, 20.8 BMI, 56 KG, 164 m, RR 30, using accesary muscles, audiable wheezing, oxygen mask, 6L per minute, astrecsis, redused chest expansion bi lateraly, resonant percusion, reduced lung sound in tensty through both lung feild but the character is normal, polyphonic sound, crackles both basis of lung no change with coughing, heat sound dull soft systolic flow murmers at LSE, mild bitting oedema bi laterally, the rest physical examination unremarkble

tests results, CXR, spirometry, 0.95/1.85, 51%, predictive value 2.2/2.7, oxygen, 86%, PH, 7.25, normal 7.35-7.45, PaCO2 60,mmHg, PaO2 90, normal more than 75, Hco3 29 mEq / liter, normal 24-26, Sa O2 99%, normal above 95, ECG, sinus tachycardia and no other problems, CBC, NORMAL, ELECTROLYTS, NORMAL, ESR, slightly elevated, sputum examination, muco purulunt, moderate moraxella catarrhalis

40 minutes

objectives for next session

manegment

prevention

types respiratory failure

moraxella catarrhalis

why patient is not fibril, and CBC is normal?