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Noisy Breathing - Coggle Diagram

- - - - Pulmonary ventilation
      - Transport of respiratory gases in the blood
      - External respiration
      - Internal or cellular respiration
  - - - diaphragm & inspiratory intercostals contract
        
        thorax expands
        
        intrapleural pressure becomes more subatmospheric
        
        transpulmonary pressure increase
        
        lungs expand
        
        alveolar pressure subatmospheric
        
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    - - diaphragm & inspiratory intercostals stop contracting
        
        chest wall recoils inward
        
        intrapleural pressure moves back toward perspiration value
        
        transpulmonary pressure moves back toward perspiration value
        
        Lungs recoil
        
        alveolar pressure increase
        
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- - - - Examples:
        
        Bronchitis
        
        COPD
        
        Asthma
    - - Examples:
        
        Laryngitis
        
        Medicines such as ACE inhibitors
        
        Irritants such as air pollution, dust or smoke
- - - - parainfluenza
    - - corynebacterium diphtheria
  - - - barking cough and stridor
    - - recovery
    - - upper respiratory infection
- - - - function:
        
        humidifies , warms , filter inspired air
        
        Pseudo-stratified ciliated columnar epithelium
    - - laryngolpharynx
        
        connects both pharynx and larynx
      - oropharynx
        
        Connects oral cavity to pharynx
      - Nasopharynx
        
        Connects nasal cavity to pharynx
    - - hollow tube guid the inspired air to pass from pharynx to trachea
  - - - Right lung
        
        3 Lobes
      - Left lung
        
        2 Lobes
      - inside the lung
        
        Main bronchus
        
        Subdivides:
        
        lobar bronchi
        
        segmental bronchi
        
        Terminal bronioles
        
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- - - - cytokine release
        
        TH2 development
        
        releases cytokines:
        
        IL-3 + IL-4
        
        Class-switching of B-cells to IgE secreting plasma cells
        
        IL-4 + IL-5
        
        mast cell & basophil activation
        
        binding of IgE to FcER1
        
        IL-13
        
        Goblet cell hyperplasia
        
        GM-CSF + IL-5
        
        Eosinophil stimulation & recruitment
        
        TH1 inhibition
  - - - allergen binds to primed mast cells & basophils --> degranulation
        
        release of histamine, serotonin, proteoglycans, proteases
        
        bronchoconstriction, vasodilation, mucus secretion, inflammation and edema
        
        release of leukotrienes
        
        phospholipid bilayer degraded through lipo-oxygenase pathway
    - - eosinophil activation & release of:
        
        Major basic protein
        
        apoptosis & epithelial damage
        
        Eosinophil cationic protein
        
        Lysosomal tissue damage
        
        TGF-beta
- - - - infections
      - cold weather
      - drugs
      - excersise
      - exposure to chemicals/smoke
- - - - Endoscopic laser excision
    - - Voice therap
      - Re-innervation
      - Observation
      - Injection a filler material
      - Tracheotomy
  - - - Conservative: oxygen + hydration
      - Antipyretics
      - Steriods: Dexamethasone & Nebulized Budesonide
    - - Supraglottoplasty or Tracheotomy
    - - an airway emergency in children
      - we should be manage with co-operation with Anesthetics & Otolaryngology
- - - - if:
        
        FEV1/FVC lower than 80%
        
        obstructive
        
        because FEV1 much more lower than FVC
        
        FEV1/FVC higher than 80%
        
        restrictive
  - - - tap against the thorax
        
        dullness
        
        hyper resonance
        
        normal resonance
    - - listen to the breath sound using stethoscope
        
        Normal sound
        
        Crackle
        
        Wheezing
        
        Bronchial breath sound
        
        Rhonchi
        
        Stridor
    - - fremitus
        
        place hand on the patient back and feel the vibration when they talk
      - pectoriloquy
        
        sounds over the chest on the stethoscope
- - - - Beta2-adrenergic agonists
        
        SABA
        
        Albuterol
        
        Levalbuterol
        
        LABA
        
        Formoterol
        
        Salmeterol
      - Muscarinic antagonists
        
        SAMA
        
        Ipratropium
        
        LAMA
        
        Acilidium
        
        Tiotripium
        
        Umecilidium
      - Leukotrine antagonists
        
        Montelukast and Zafirlukast
        
        Zileuton
      - Phosphodiesterase inhibitor
        
        Theophylline
    - - Anti-IgE antibodies (Omalizumab)
      - Corticosteroids
        
        Flunisolide
        
        Beclomethasone dipropriante BDP
        
        Fluticason propriante
      - Cromoglycate