major_airway_obstruction

major_airway_obstruction - Major Airway Obstruction...

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Major Airway Obstruction
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Introduction • Obstruction of major airways can result from a variety of disease processes and is a cause of significant morbidity and mortality • Increasing no. of pts. with lung cancer develop complications of prox. endobronchial disease – 20-30% pts with lung cancer develop complications (Atelectasis, Pneumonia, Dyspnea) – Upto 40% lung cancer death may be attributed to loco- regional disease –W i th use of Artificial airways such as ETT, incidence of iatrogenic complications is also increasing
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ETIOLOGY Infections: Ac. Epiglottitis Laryngo tracheo bronchitis Ludwig’s Angina Ac. Tonsillitis with/without Retropharyngeal abscess Bacterial bronchitis TB Angioedema: Exposure to Drugs [Narcotics, Aspirin, NSAID, ACE(-)] C1 esterase deficiency.
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Tumors: Pharynx Larynx – Haemangioma Ca Supra glottic regions Glottic regions Sub-glottic regions Trachea & Bronchi Adenoid Cystic Ca Sq. Cell Ca Secondary inv.- Bronchogenic Ca Laryngeal, Esophageal. Thyroid Malignancies.
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Trauma: Facial [Crush Injuries, # Mandible] Laryngeal Tracheobronchial injuries Inhalational Injuries Vascular Causes: Innominate Artery syndr. Thoracic Aorta aneurysms Double aortic arch Foreign Body Aspiration:
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Neuromuscular Disorders: Myasthenia gravis Motor neuron diseases Iatrogenic Causes: Vocal cord granuloma Glottic stenosis Vocal cord Paralysis Tracheal Stenosis
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Miscellaneous Causes: Collagen vascular diseases Relapsing Polychondritis RA Sjogren’s Syndr. Tracheal abnormalities Tracheobronchiomegaly Saber sheath Trachea Tracheobronchopathia Osteochondroplastica
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C/F: Mild Airflow Obstr Asymptomatic Dyspnea, Noisy breathing [wheeze, stridor] Post-obstr Pneumonia, Collapse, U/L wheeze Hoarseness of voice Exertional dyspnea: Tracheal diameter-8mm Stridor /Dyspnea at rest: Tracheal diameter-5 mm Physiological assessment • Diameter of lumen < 8 mm : Produce abnormal flow-volume loops. Initial effort dependent portion affected in CAO
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Type Example Flow characteristic FEF / FIF 50% 50% Variable Vocal Cord palsy Increased > 2 Extra-thoracic Glottic Stricture Obstn.during Tumors inspiration resulting inspiratory flow. Variable Malignant tumors, Forced Expiration ~ 0.3 Intrathoracic Tracheomalacia Increases obstruction Fixed Extra Or-Intrathoracic Goitre Fixed flow with ~ 1 Post-intubation Inspiration and Stricture Expiration Spirometry should not be done in CAO, Resp. distress Induce Resp. failure
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Radiology: •CXR : – Rarely diagnostic – Tracheal deviation can be identified •CT S c an : – Provide much more information – Document dynamic airway collapse – Multiplanar/3D reconstruction: • Better visualization • Whether lesions are intraluminal/Extrinsic to airways/features of both • Whether airways distal to obstr. are patent • Relationship to other structures such as vessels
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• Bronchoscopy: (Rigid/Flexible) – Helps in assessing obstr.
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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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major_airway_obstruction - Major Airway Obstruction...

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