Appareil Respiratoire

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

Dyspnée

 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