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Respiratory disorders À la RNOH

Respiratory disorders À la RNOH. Obstructive airways disease Restrictive lung disease Infections Tumours. Restrictive lung disease. Reduced Total lung capacity Vital capacity Functional residual capacity. Preserved Airways resistance. Involvement of. Nerve supply. Chest wall.

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Respiratory disorders À la RNOH

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  1. Respiratory disorders À la RNOH

  2. Obstructive airways disease Restrictive lung disease Infections Tumours

  3. Restrictive lung disease Reduced Total lung capacity Vital capacity Functional residual capacity Preserved Airways resistance

  4. Involvement of Nerve supply Chest wall Polio Guillain Barre Cerebral palsy Spinal cord injury Scoliosis Kyphosis Obesity Lung parenchyma Muscles Muscular dystrophies SMA I.P.F. Connective tissue dis. C.F.

  5. Natural history Gradual decrease in VC, FRC Worsening pathology decrease in FRC, Atelectasis  work of breathing Nocturnal hypoventilation Daytime hypoventilation Recurrent chest infections Death

  6. Nocturnal hypoventilation  airways resistance  Intercostal tone Tidal volume  Resp. rate REM sleep Morning headaches Restless sleep Daytime sleepiness Enuresis Concentration/ memory difficulties schooling problems

  7. Restrictive respiratory disorders Symptoms Muscular dystrophies Cerebral palsy Scoliosis Spinal cord injury Nothing Dyspnoea on exertion Poor cough Sx Sleep disordered breathing Dyspnoea at rest Signs Underlying disease Respiratory rate Auscultation…Quiet Retained secretions Cyanosis Clubbing

  8. Investigations Bloods. Polycythaemia Blood gas Hypoxia Hypercarbia Chronic respiratory acidosis Early morning sample Chest Xray

  9. Lung function tests Sleep studies Oximetry Transcutaneous Co2 & O2

  10. Lung function tests Peak cough flow > 270 L/min

  11. Restrictive lung disease Two major problems I can’t breath I can’t or won’t cough

  12. Management…breathing Ventilate Invasively Non invasively

  13. Management…….Breathing Long term strategies Maintain range of chest wall movement Frog breathing Inspiratory muscle training Upper limb training

  14. Long term Ventilation When ? Symptomatic Nocturnal CO2 > 10 Kpa 5% study <88% How ? Non invasively Invasively Few hours per night/ all night During day During exacerbations

  15. Sputum

  16. Sputum Management Assisted coughs Re-Intubation Tracheostomy

  17. Emerson Cough assist Device In-Exsufflator

  18. Guidelines for use at RNOH

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