Emphysema

Lower respiratory tract infections in childhood can also cause COPD

Congenital alpha₁-antitrypsin deficiency can lead to lung tissue destruction and cause emphysema But more common in Northern European ancestry

Coughing up phlegm and shortness of breath are synonymous with COPD.

①Repeated cough

② Coughing up phlegm

③Wheezing

④Shortness of breath after activity (signature symptom)

barrel chest

Bilateral voice tremor is weakened (because there is too much air and water in the lungs, and the pleura is thicker)

The lungs are too unvoiced, the heart dullness boundary is narrowed, and the liver dullness boundary is decreased.

widening of kronig gorge

Reduced breath sounds and prolonged expiratory phase Dry rales and dry and wet rales can be heard coexisting

Pulmonary function tests

There is too much gas in the lungs. If the pleura ruptures when coughing, pneumothorax will occur.

The patient first experienced sudden chest pain and then developed dyspnea.

X-rays and EKGs, and general supportive care

If you have a lot of underlying diseases and difficulty breathing, sedatives cannot be used to avoid suppressing breathing.

If there is no impairment of consciousness, mechanical ventilation is generally not required

beta agonist

M receptor blockers

V/Q imbalance (mainly leading to hypoxia, and in severe cases, CO₂ retention)

Impaired diffusion (resulting in hypoxia)

Smoking causes neutrophil activation and damages pulmonary elastic fibers → difficulty in expiration → increased alveolar residual air at the end of expiration → intrapulmonary pressure is greater than atmospheric pressure, resulting in long-term exertion of respiratory muscles → respiratory muscle fatigue

The first thing to check is whether it is COPD, so first we need to check FEV₁/FVC Then we need to look at the size of FEV₁/predicted value, which is used to classify the severity.

Graduation

mMRC classification

Group

Level I

Level II

Level III

①Treat the primary disease, such as infection

②Inhaled bronchodilators

③Oral or intravenous glucocorticoids, expectorant, and mechanical ventilation if necessary

Pulmonary embolism: an emboli formed elsewhere travels to the pulmonary artery, mainly from deep vein thrombosis of the lower limbs Pulmonary thrombosis: emboli that form in situ in the lungs

Trauma/fracture, smoking, arteriovenous puncture [These 3 reasons must be remembered, I have taken the test many times]

Bedridden for a long time

Age (an independent risk factor)

Two major symptoms

Two major signs

Sudden chest pain, hemoptysis, difficulty breathing, but only seen in 20% of patients

Elevated D-dimer represents hyperfibrinolysis and indicates thrombosis. D-dimer positivity does not diagnose pulmonary embolism Negative D-dimer can rule out pulmonary embolism

PaO₂↓, PaCO₂↓ (tachypnea, hyperventilation, PaCO₂↓), pH↑

CT pulmonary angiography is a non-invasive examination and is the preferred examination for pulmonary embolism (filling defect)

Great diagnostic value for pulmonary embolism

The gold standard for pulmonary embolism

Bed rest, nasal cannula for oxygen

Types

anticoagulant therapy

Thrombolytic therapy