appareil respiratoire
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Appareil Respiratoire
• Examen Clinique
• Examens paracliniques
Professionnels et habitatAsthme, eczema, rhinite et médicts, aliments
+++
:Tabagisme en PA
•Ronflement, somnolence
Sèche, grasse, quinteuse
Muqueuse, purulente, muco-p, purulente
Effort, repos
•Dysphagie, dysphonie
HémoptysieConduite à tenir diagnostique
(
O2 + réparation masse sanguine + GLYPRESSINE 1
Expectoration muqueuse
expectoration muco-
purulente
Expectoration purulente
Expectoration séreuse
Moule bronchique Hémoptysie
Expectoration
•FR: Polypnée, bradypnée
État de conscience, agitation, confusion
Cicatrices, déformations, cyphoscoliose
Bulleux ou sous crépitants
•SpO2
http://www.med.ucla.edu/wilkes/lungintro.htm
Type Temps Caractère Site respiratoire
RONCHUS I + E Grave, Mobile Bronche
SIBILANT i + E Aigu, Mobile Bronche
SOUS CREPITANT
I + e Bulleux, Humide
Bronchiole
CREPITANT I (fin) Fin, sec Alvéole
FROTTEMENT I + E Superficiel, 0 en apnée
Plèvre
SOUFFLE TUBAIRE
I + e Intense, Rude Parenchyme condensé
SOUFFLE PLEURETIQUE
i + E Voilé, Lointain Pleurésie
Signes immédiats de gravité
• Troubles de la conscience
• Polypnée extrême ou bradypnée avec pauses respiratoires
• Cyanose, sueurs, hypotension
Ponction sous scanner
8 steps8 steps
http://bronchoscopy.org/
Step 1: nose to larynxStep 1: nose to larynx
The scope is The scope is advanced from the advanced from the nose to the larynx . nose to the larynx . This step includes This step includes local anesthesia. local anesthesia.
From the head
Click HERE to view video
Click to continue
Step 2: larynx to subglottisStep 2: larynx to subglottis From the larynx the From the larynx the
trachea is entered to trachea is entered to the subglottic area. the subglottic area. If If from the head:from the head: once once the vocal cords are the vocal cords are passed the scope is passed the scope is slightly flexed slightly flexed downwards. downwards. If from If from the front:the front: once the once the vocal cords are passed vocal cords are passed the scope is slightly the scope is slightly flexed upwards. flexed upwards. From the front
Click to continue
Click HERE to view video
Step 3: Follow the curve to the Step 3: Follow the curve to the carinacarina
The Trachea is not The Trachea is not a “straight pipe”; It a “straight pipe”; It deviates deviates posteriorly and posteriorly and slightly to the right slightly to the right when approaching when approaching the main carina.the main carina.
From the head
Click to continue
Click HERE to view video
Step 4a: Carina to left main Step 4a: Carina to left main bronchusbronchus
From the neutral From the neutral position the LMB is position the LMB is entered just by twisting entered just by twisting the wrist to the left and the wrist to the left and advancing for 1 -2 cm.advancing for 1 -2 cm.
From headFrom head
Click to continue
Click HERE to view video
Step 4b: Carina to right main Step 4b: Carina to right main bronchusbronchus From the neutral From the neutral
position the RMB is position the RMB is entered just by twisting entered just by twisting the wrist to the right the wrist to the right and advancing the and advancing the scope for 1 -2 cm. scope for 1 -2 cm.
From headFrom head
Click to continue
Click HERE to view video
Step 4c: Left-right-neutral Step 4c: Left-right-neutral
From the neutral position From the neutral position the left and right main the left and right main bronchi are entered bronchi are entered alternatively just by alternatively just by twisting the wrist and twisting the wrist and advancing the scope for advancing the scope for few cm.few cm.
From headFrom head
Click to continue
Click HERE to view video
Step 5a: Down-up-left main Step 5a: Down-up-left main bronchusbronchus
The scope is slowly The scope is slowly advanced the pulled advanced the pulled back up the LMB back up the LMB while always while always keeping it in the keeping it in the middle of the middle of the airway lumen.airway lumen.
From the frontFrom the front
Click to continue
Click HERE to view video
Step 5b: Down-up right main Step 5b: Down-up right main bronchusbronchus
The scope is slowly The scope is slowly advanced down the advanced down the RMB to RLL and RMB to RLL and pulled back upwards pulled back upwards while always keeping while always keeping it in the middle of it in the middle of the airway lumen. the airway lumen.
From the frontFrom the front
Click to continue
Click HERE to view videoClick HERE to view video
Exploration de la plèvre
• Ponction pleurale
Trocard de Boutin ou d’Abrahms
• Drainage thoracique
Trocard de monod, drain monté, introducteur
• Thoracoscopie
Ponction pleurale
• Anestheésie locale
• aseptie
Drainage thoracique
Thoracoscopie
Exploration fonctionnelle respiratoire
Spirométrie
Boucle débit-volume
Explorations fonctionnelles respiratoires
• Boucle débit volume ou spirométrie
VEMS, CV, VEMS/CV• CPT• RVA• Gaz du sang PaO2, PaCO2, pH, RA, SaO2• Test métacholine• Épreuve d’effort• Polysomnographie
polysomnographie
Abcés
Pneumonie
Pneumonie
pneumonie
pleurésie
pneumothorax
cancer
emphysème
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