Faisal with fever and respiratory distress

Anatomy of the pleura
1. What is pleura?
2. Pulmonary Ligament
3. Pleural cavity
4. Serous layers
  1. Parietal layer
    1. Layer of the pleura that lines chest wall & covers the mediastinum.
    2. Forms the pulmonary ligament.
    3. Supplied by branches of the internal thoracic, superior phrenic, posterior intercostal, and superior intercostal arteries
    4. Insenstive to pain, but sensitive to stretch
  2. Visceral layers
    1. Inner layer of the pleura that covers the lung & lines its fissures.
    2. Supplied by the bronchial arteries
    3. Very sensitive to pain.
  4. Neurovascular Supply
Physical Examination
1. Inspection
  1. ill-looking
  2. SOB
  3. Diaphoresis
  4. Chills/rigors
  5. Respiratory distress
  6. Cough
2. Palpation
  1. Decreased chest expansion or asymetry
  2. Lymphadenopathy
  3. Tactile fremitus
3. Percussion
  1. Dull
  2. Decreased diaphragmatic excursion auscultation
  3. Bronchial breath sounds in periphery
  4. Decreased air entry
  5. Crepitations
  6. Bronchophony -voice heard abnormally clearly over consolidated lung
  7. Egaphony - listen to patient's chest as they make "e" sound, if +'ve will hear an "a" sound
  8. Whispering pectoriloquay - pt whispers "1, 2, 3, 4", if clear then extreme consolidation
  9. Pleural friction rub
    1. AKA pleuritis => inflammation of the pleura with exudate formation
    2. It’s a symptom rather than a disease it self
  10. Lack of breath sounds in a certain area of the chest, which may mean that air is not entering an area of the lung.
4. Breathing sounds
  2. Abnormal Breathing sounds
5. Auscultations
Lab investigations
1. Differential diagnosis of fever
  1. Common cold
  2. Pharyngitis
  3. TB
  4. Lung abscess
  5. Bronchitis
  6. Acute sinusitis
  7. Influenza flue
  8. Epiglottitis
  9. Cryptoco-ccosis
  10. Cancer
  11. Whooping cough (pertussis)
2. X- ray findings
3. Sputum culture
  1. Thick mucus or phlegm that is expelled from the lower respiratory tract through coughing
  2. Bacterial sputum cultures detect the presence of disease-causing bacteria
  3. What Abnormal Results Mean ?
    1. Bronchitis
    2. Lung abscess
    3. Pneumonia
      1. What is it?
        An infection in one or both lungs. It can be caused by bacteria, viruses, or fungi. Bacterial pneumonia is the most common type in adults. Pneumonia causes inflammation in the air sacs in your lungs, which are called alveoli. The alveoli fill with fluid or pus, making it difficult to breathe.
      2. Epidemiology
        Etiology
      3. Risk factors
        In terms of age
        Children who are 2 years old or younger
        People who are age 65 or older
        Others
        Being hospitalized
        Chronic disease.
        Smoking.
        Weakened or suppressed immune system
      4. Classification
        Location acquired
        By area of Lung affected
        lobar pneumonia
        Only involves a single lobe
        Often due to Streptococcus pneumoniae
        Morphology
        X-ray
        Grossly
        Microscopically
        Multilobar pneumonia
        Involves more than one lobe
        Often causes a more severe illness
        Bronchial pneumonia
        Affects the lungs in patches around bronchi or bronchioles
        Morphology
        X-ray
        Grossly
        Microscopically
        Interstitial pneumonia
        Involves the areas in between the alveoli
        It may be called "interstitial pneumonitis."
        More likely to be caused by viruses or by atypical bacteria.
        Morphology
        X-ray
        Grossly
        Microscopically
        Etiological agents for each
        By cause
        Bronchiolitis obliterans organizing pneumonia
        Eosinophilic pneumonia
        Chemical pneumonia
        Aspiration pneumonia
        Dust pneumonia
        Necrotizing pneumonia
        Opportunistic pneumonia
        Double pneumonia (bilateral pneumonia)
      5. Signs & Symptoms
        Dry cough
        Chills
        Fever
        Headache
        Muscle aches
        Sore throat
        Weakness
        Nasal congestion
        Sweating
      6. Complications
        Abscess formation
        Empyema
        Fibrosis
        Bacteremic dissemination…meningitis, arthritis, endocarditis
      7. Treatment
        Ampicillin - Irreversible inhibitor of the enzyme transpeptidase, which is needed by bacteria to make the cell wall. It inhibits the third and final stage of bacterial cell wall synthesis
      8. Prevention
    4. Tuberculosis
    5. Flare up of chronic obstructive pulmonary disease (COPD) or cystic fibrosis
4. Blood culture
  1. Culture is positive for one of the following organisms:
    1. Streptococci (non-viridans)
    2. Anaerobic cocci
    3. Aerobic and facultative gram-negative rods
    4. Anaerobic gram-negative rods
    5. Yeast
    6. Negative growth does not rule out infection.
  2. Complete blood count
    1. Red blood cells, which carry oxygen
    2. White blood cells, which fight infection
    3. Hemoglobin, the oxygen-carrying protein in red blood cells
    4. Hematocrit, the proportion of red blood cells to the fluid component, or plasma, in your blood
    5. Platelets, which help with blood clott

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Faisal with fever and respiratory distress

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	Created by amna mohd about 7 years ago