Upload
rhirin-fardianti-atmayasari
View
221
Download
0
Embed Size (px)
Citation preview
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
1/86
dr Salim S Thalib
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
2/86
Respiration is controlled by areas of the brain
that stimulate the contraction of the diaphragm
and the intercostal muscles.
These areas, collectively calledRESPIRATORY CENTERS
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
3/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
4/86
Clustered neurons in the brain, located
bilaterally in the reticular formation of the brain
stem and from which nerve impulses are sent to
respiratory muscles.
Medullary Respiratory Centers
Pons Respiratory Centers
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
5/86
MEDULLARY RESPIRATORY CENTERS
Dorsal Respiratory Group
Inspiratory area
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
6/86
INSPIRATORY CENTER When fired they generates
rhythmic nerve impulses thattravel along the phrenic nerve
to diaphragm and intercostalnerves to excite externalintercostal muscles
As a result, these muscles willcontract and the thorax
expand, Volume increase
Pressure decrease
Air pushes into lungs
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
7/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
8/86
DRG then becomes dormant,
and expiration occurs passively
as the inspiratory muscle relax
and the lungs recoil.
This cyclic activity of the
inspiratory neurons repeats and
produce respiratory rate of 12
15 breaths per minute
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
9/86
MEDULLARY RESPIRATORY CENTERS
Ventral Respiratory Group
Expiratory area
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
10/86
VRG contain mix of neurons
Inspiratory
Expiratory (mainly)
Inactive during normal
respiration
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
11/86
Pontine respiratory group
A collection of neurons in the
reticular formation within the
pons
Transmit inhibitory impulses to
the inspiratory centers in
medulla
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
12/86
Factors influencing the respiratory center of the
brain
Pulmonary irritant reflexes
Receptors in the lung that respond to irritants
Activation of irritant receptors
Send signals to respiratory centers through vagal nerve
Modify respiratory rate and depth
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
13/86
Factors influencing the respiratory center of the
brain
The inflation reflexes
Stretch Receptors (baroreceptors) in visceral
pleurae that stimulated when lung are inflated
Activation of stretch receptors
Send inhibitory signals to medullary respiratorycenters through vagus nerve
End inspiration and allow expiration
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
14/86
Factors influencing the respiratory center of the
brain
Influence of higher brain centers
Hypothalamic controls
Activation of sympathetic centers in hypothalamus
Send signals to respiratory centers
Modify respiratory rate and depth
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
15/86
Factors influencing the respiratory center of the
brain
Influence of higher brain centers
Cortical controls - voluntary controls
Cerebral motor cortex
Send signals to motor neurons
Stimulate respiratory muscles(Bypassing the medullary center)
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
16/86
Factors influencing the respiratory center of the
brain
Chemical factors:
Oxygen (O2)
Carbon dioxide (CO2)
Hydrogen ion (H+)
Sensed by CHEMORECEPTORS
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
17/86
Factors influencing the respiratory center of the
brain
CHEMORECEPTORS
Central chemoreceptors
Located in bilaterally in medulla
Sensitive to the pH ECF
Peripheral chemoreceptors Located in great vessels of neck
sensitive to PO2, PCO2and pH
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
18/86
Influence of PCO2 and H+
Most potent and
most closely
controlled
Sensed by central
chemoreceptors
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
19/86
Influence of PCO2 and H+
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
20/86
Cells sensitive to arterial
PO2are found in:
Peripheral
chemoreceptors:
Aortic bodies
In arch of aorta
Carotid bodies
In common carotid artery
Influence of PO2
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
21/86
Under normal condition the
decline in arterial PO2 has a
slight effect on ventilation.
Arterial PO2must decrease
to less than 60 mm Hg
before O2level becomemajor stimulus for increased
ventilation.
Influence of PO2
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
22/86
Influence of arterial pH
changes in arterial pH can
modify respiratory rate
and depth even when CO2
and O2are normal
Act on peripheralchemoreceptors.
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
23/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
24/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
25/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
26/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
27/86
INTRUDUCTION
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
28/86
DEFINITION OFDYSPNEA
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
29/86
MECHANISM OFDYSPNEA
DYSPNEA
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
30/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
31/86
RESEPTOR PADA SISTEM RESPIRASI
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
32/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
33/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
34/86
Kapasitas residu paru
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
35/86
obstruksi paru
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
36/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
37/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
38/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
39/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
40/86
Composed of four general categories
Pulmonary
Cardiac
Mixed cardiac or pulmonary
non-cardiac or non-pulmonary
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
41/86
Cardiac Etiology
CHF
CAD
MI (recent or past history)
Cardiomyopathy
Valvular dysfunction
Left ventricular hypertrophy
Pericarditis
Arrhythmias
Congestive heart failure
Coronary artery disease
Miocard infarct
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
42/86
COPD with pulmonary HTN and/or cor
pulmonale
Deconditioning
Chronic pulmonary emboli
Pleural effusion
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
43/86
Metabolic conditions (e.g. acidosis)
Pain
Trauma
Neuromuscular disorders
Functional (anxiety,panic disorders, hyperventilation)
Chemical exposure
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
44/86
VENTILASI
DIFUSIPERFUSI
Airway
Alveol
Kapiler darah
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
45/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
46/86
Pulmonary Etiology
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
47/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
48/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
49/86
No VENTILASI
PERFUSI
Airway
Alveol
Kapiler darah
Bood flow
S UNT UNIT
PERFUSION WITHOUT VENTIL TION
Sumbatan
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
50/86
SHUNT UNIT
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
51/86
Akibat alveoli yang kolaps, darah yang
mengaliri tidak mengalami oksigenasi
Perfus ion w i thout vent i lat ion shun t
(direct r igh t-to- lef t shunt)
Ratio ventilasi-perfusi terganggu
hipoksemia
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
52/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
53/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
54/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
55/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
56/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
57/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
58/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
59/86
AIR FLUID LEVEL
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
60/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
61/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
62/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
63/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
64/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
65/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
66/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
67/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
68/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
69/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
70/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
71/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
72/86
Barking cough, stridor, hoarseness
Difficul breathing worsen at night
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
73/86
Steeple sign
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
74/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
75/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
76/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
77/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
78/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
79/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
80/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
81/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
82/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
83/86
Pengisian alveoli oleh eksudat /cairan
Ventilasi berkurang / tidak ada
Unit shunt
Hipoksemia
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
84/86
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
85/86
Questions ?
7/26/2019 Dyspnea Emergensi FK - 2012 PDF
86/86