Dyspnea1 - Dr. Rajneesh.A.R Junior resident Internal...

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Unformatted text preview: Dr. Rajneesh.A.R Junior resident Internal medicine Definition Causes Mechanisms Approach Management options A subjective experience of breathing discomfort that is comprised of qualitatively distinct sensations that vary in intensity. The experience derives from interactions among multiple physiological, psychological, social and environmental factors and may induce secondary physiological and behavioural responses. The American Thoracic society breathing is difficult, laboured or uncomfortable subjective awareness of need for increased respiratory effort ventilatory demands > ventilatory capacity Classification by severity by aetiology whether exertional or at rest by mode of onset and progression Mechanical interference with ventilation Weakness of the respiratory pump Increased respiratory drive Increased wasted ventilation Psychological dysfunction Obstruction to airflow- asthma, endobronchial tumour Stiff lungs interstitial fibrosis, LVF Resistance to expansion of chest wall/diaphragm- kyphoscoliosis, obesity, abdominal mass Absolute - neuromuscular diseases Relative - muscle at a mechanical disadvantage hyperinflation, pneumothorax, effusion Increased respiratory drive hypoxemia of any cause, CO, Hb Metabolic acidosis Stimulation of intrapulmonary receptors Capillary obstruction (emphysema, ILD) Large vessel obstruction (PE, vasculitis) Psychological dysfunction Anxiety Depression Somatization Alleged respiratory injury Dyspnea is a perception an urge to breath/ air hunger a sense of excessive effort a/w breathing Dyspnea depends to a large extent on the degree to which respiratory related neurons in the brainstem are stimulated NIV in COPD- reduces the work of breathing and the efferent neural activity to respiratory muscles Afferent Receptor CNS RS Chemoreceptors Mechanoreceptors Lung receptors Best Clin Pract 2006 length-tension inappropriateness Campbell & Howell, 1963 disassociation between the force or tension generated by the respiratory muscles and the lung volume generated by that force. neuromechanical dissociation dissociation between the motor command and the mechanical response of the respiratory system. Prim Care Clin Office Pract 2006 CONDITION MECHANISM Asthma sense of effort Stimuln of irritant R in airways Neuromuscular disease sense of effort COPD sense of effort Hypoxia, Hypercapnia Dynamic airway compression Mechanical ventilation Afferent mismatch Factors assoc with underlying condition Pulmonary embolism Stimulation of pressure receptors...
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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Dyspnea1 - Dr. Rajneesh.A.R Junior resident Internal...

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