Dyspnea

ARIF SATRIA SUSILO TARIGAN

2208260076
Patofisiologi sesak napas
Differences Shortness of breath

Channel Pleura
Asthma, COPD, TB, Pulmonary Pleural effusion, pneumothorax, pulmonary edema
Thromboembolism

parenkim vascular
Pneumonia CHD, CHF, Pulmonary embolism
 ASTHMA

Asthma is an intermittent and reversible airflow

disorder that only affects the airways, not the alveoli

Etiology : - respiratory tract infections

- obesity
- genetic
- cigarette smoke
- emotional factors or stress
- use of aspirin, beta blockers
ASTHMA
 ASTHMA
Additional Complaints: Diagnostic examination results:
● Cough ● Inspection: Symmetrical chest movement, if it gets
● Increased Phlegm worse, chest retraction +
● Chest feels heavy ● Palpation: Stem Fremitus is normal
● Recurring Symptoms ● Percussion: normal
● Gets worse at night ● Auscultation: Expiratory wheezing +
● wheezing
 ASTHMA
X-ray:
● There was thickening of the bronchial walls
Laboratory: ● Bronchial dilatation
● Eosinophils increased (>4%) ● Cylindrical bronchiectasis from varicose veins
● Total Serum IgE level >100IU ● Mucoid impaction of the bronchi
● AGDA: PaCO2 > 45 mmHg ● There is air trapping
● Mosaic pulmonary ateunation pattern
Cypometry:
normal FEV/FVC >75% post bronchodilator
ASTHMA
Treatment
 ASTHMA
Form of providing education:
● Communication/advice during
Education for sufferers/families aims to: treatment.
• increase understanding (about asthma in general ● Lecture
• general and pattern of asthma itself) ● Exercise/training
• improve skills (ability in handling ● Supervision
• asthma) ● Discussion
• increase satisfaction ● Exchange of information (sharing
• increase self-confidence of information group)
• increasing compliance and independent handling. ● Presentation films/videos
● Leaflets, brochures, reading
books
● Etc
 COPD

COPD is a chronic inflammatory disease

characterized by persistent respiratory symptoms and
airflow limitation due to disruption of the alveoli.

Etiology : - respiratory tract infections

- obesity
- genetic
- cigarette smoke
- emotional factors or stress
- use of aspirin, beta blockers
COPD
 COPD
Additional Complaints: Diagnostic examination results:
● Cough ● Inspection: pursed lip breathing, barrel chest, pink
● Increased Phlegm puffer, blue bloater, use of assisted breathing muscles
● Chest feels heavy when ● Palpation: Stem Fremitus decreases, ICs widen
breathing ● Percussion: hypersonor, heart border <<
● Auscultation: vascular/decreased breath sounds,
rhoki+, prolonged expiration, heart sounds <<
 COPD
Laboratory:
● Increased monocytes (N: 2-11)
● Eosinophils increased (N: 0-5
● AGDA: PaCO2 increases (22-26), PO2
decreases (22-26)
X-ray:
Emphysema-hyperinflation
Hyperlucency
ICS widens
The diaphragm is horizontal
Bronchovascular-normal/
bronchovascular pattern
COPD
 Pulmonary embolism
Pulmonary embolism is an infarction of lung tissue
due to blockage of the pulmonary artery due to an
embolic event

Etiologi : migration of thrombus from other parts of

the body
Pulmonary embolism
 Pulmonary embolism
Additional Complaints:
● Pleuritic pain
● Cough
● Swelling of the lower limbs
● Bleeding cough
● Shivering
● Fever
● cyanosis
Diagnostic examination results:
● Inspection: cyanosis, pale
● Palpation: stem fremitus descends
● Percussion: Faint
● Auscultation: Rhonki +, Gallop
● Temperature >35 C
● Respiratory frequency >20x/i
● Pulse Frequency 100x/i
 Pulmonary embolism
Laboratory: Xray :
• AGDA  PCO2 <35 mmHg
•
● Cardiomegaly
Plasma D-Dimer levels increase
• Leukocytes increase ● The presence of Kerley B lines in the
• Troponin increases interlobes
● Bilateral infiltration with butterfly
pattern
Pulmonary embolism
 Pneumonia
Etiology :

Pneumonia is a common acute respiratory

infection that attacks the alveoli and distal
bronchial tree of the lung.

The disease is broadly divided into

community-acquired pneumonia (CAP) or
hospital-acquired pneumonia (HAP, which
includes ventilation-associated pneumonia
(VAP)
Pneumonia
 Pneumonia
Additional Complaints: Diagnostic examination results:
● Breathing >30 times / minute
● Fever ● Systolic blood pressure < 90 mmHg
● Shivering ● Temperature <35 C or > 40 C
● Sweating ● Pulse >125 x/minute
● Cough with bloody phlegm
● Pleurisy pain
 Pneumonia
Laboratory :
• AGDA  PH 7.35
• Sodium < 130 mEq/liter
• Hematocrit <30%
• PO2 <60 mmHg
Xray :
● Infiltrate until consolidated with air
bronchogram
● Bronchogenic spread
● Interstitial and cavity images
 Pneumonia

INITIAL PROCEDURE
Outpatients:
1. healthy: Azithromycin 500 mg orally 1x1
2. Comorbid: Levofloxacin 750 mg orally or Amoxicillin/Clavulanate orally 2gr 2x1
Non-ICU inpatients: Levofloxacin 750 mg orally or IV or Ceftriaxone 1-2gr IV + Azithromycin
orally or IV 1gr 1x1
ICU inpatients: Ceftriaxone 2 gr IV + Azithromycin or Levofloxacin 750 mg orally
Patients suspecting Pseudomonas infection: Meropenem 1gr IV 3x administration +
Ciprofloxacin 400mg IV 2x administration or Levofloxacin 750mg IV
Patients suspecting MRSA infection: Linezolid 600mg IV 2x administration or Vancomycin
15mg/kgBB 2x administration
 Pneumothorax
Pneumothorax is the accumulation of air or gas in the pleural
cavity

Etiology:
1. Spontaneous pneumothorax
- Primary pneumothorax: occurs without underlying lung
disease
- Secondary pneumothorax: complications of previous lung
disease

2. Traumatic pneumothorax
Occurs as a result of traumatic injury

3. Pneumothorax due to pressure

Excessive pressure on the lung causes it to collapse
Pneumothoraks
 Pneumothoraks
Additional Complaints: Diagnostic examination results:
● Inspection: asymmetric chest wall movement
● Sharp pain when inhaling ● Palpation: stem fremitus descends
● Chest feels narrow ● Percussion: hypersonor
● Tired easily ● Auscultation: vesicular disappeared
● Cyanosis
● Tachycardia
 Pneumothoraks
Laboratory : Xray :
● Pleura line +
• Mild Leukocytes ● Hyperlucency
• AGDA: PO2 increases, ● The mediastinal heart is pushed
PCO2 decreases towards healthy lungs
● The diaphragm is pushed down

Treatment :
• Needle thoracocentesis : ICS II Linea midclavicularis

• Chest tube/WSD : ICS V Linea midaxillaris

 Pleura effusion

Pleural effusion is a buildup of fluid in the pleural space which

is located between the visceral and parietal surfaces
Etiology:
1. Viruses and mycoplasma
The types of viruses are: echo virus, rickettsia, mycoplasma,
chlamydia.
2. Pyogenic bacteria
streptococcus pneumonia, streptococcus mileri, staphylococcus
aureus, hemopillus, E.coli. Anaerobes: bacteroides spp
3. TB
Occurs due to complications of pulmonary TB through torn
subpleural foci or through lymph flow.
Pleura effusion
 Pleura effusion
Additional Complaints: Diagnostic examination results:
● Inflammation can result in
● Cough friction rub
● Pleurisy pain ● bronchial breath sounds.
● Heavy feeling in the chest ● Focal fremitus weakens
● Weight loss ● On percussion, Ellis Damoiseu
● cyanosis was deaf.
 Pleura effusion
Laboratory :

• Neutrophils increase
• The pleural puncture is cloudy,
yellowish/blood red in color
 Pleura effusion
Xray :
● Pleura line +
● Compressive atelectasis (partial lung
collapse)

Laboratory :
• Neutrophils increase
• The pleural puncture is cloudy,
yellowish/blood red in color
 Pleura effuson
INITIAL PROCEDURE
1. Thoracynthesis
a. To remove pleural fluid
b. Obtain specimens for analysis
c. Eliminates dyspnea

2. Insertion of a chest tube or drainage, this is done if thoracentesis

causes pain, protein and electrolyte depletion.

3. Medicines: Giving antibiotics if the causative agent is a germ or

bacteria.
Bronchodilator Pharmacology
• Beta 2 Agonist

Pharmacodynamics: Pharmacokinetics:

• Minimally absorbed from the

gastrointestinal tract
• Does not cross the blood-brain
barrier
• Extensively metabolized in the liver
to inactive metabolites
• Excreted rapidly in urine and feces
Bronchodilator Pharmacology
preparation :
Short Acting Long Acting
Bronchodilator Pharmacology
• Antikolinergik

Pharmacodynamics : Pharmacokinetic:
Cholinergic antagonists such as
ipratropium bromide are usually
administered by inhalation. This drug is
absorbed by the respiratory tract and
provides a long-lasting bronchodilation
effect. The duration of effect depends
on the dose and formulation of the
drug. Drug metabolism occurs primarily
in the liver, and the drug is excreted
primarily in the urine.
• Examples of drugs: Ipratropium
bromide, tiotropium bromide.
Bronchodilator Pharmacology
• Metilsaklin
Pharmacodynamics :
Methylxanthine, like theophylline,
works as a bronchodilator by several
mechanisms, including increasing the
activity of the adenylate cyclase
enzyme and inhibiting the
phosphodiesterase enzyme. This
causes relaxation of the smooth
muscles of the bronchi and blood
vessels in the lungs, thereby expanding
the airways and increasing air flow to
the lungs.
Example of a drug: Theophylline.
Pharmacokinetic :
Methylxanthines such as theophylline
can be given orally, intravenously, or in
suppository form. After oral
administration, the drug is absorbed by
the digestive tract and reaches the
lungs via the bloodstream. The half-life
of the drug varies depending on the
dose and patient condition. Metabolism
primarily occurs in the liver, and the
drug is excreted primarily in the urine.
Example of a drug: Theophylline.
Bronchodilator Pharmacology
• Adrenalin

Pharmacodynamics :
• For emergencies
• Subcutaneous injection dose of
0.01 mg/kgBB
• Rapid onset
• Works to reduce bronchospasm
and vasodilation
• Maximum dose 0.05 mg
 Referance
1. Mosenifar Z. Chronic Obstructive Pulmonary Disease (COPD). Medscape.
2020. https://emedicine.medscape.com/article/297664-overview
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[Updated 2021 Dec 10]. In: StatPearls. Treasure Island (FL): StatPearls
Publishing; 2022 January
3. Paru, P., & Kronik, O. (2003). ( ppok ) 1973 - 2003. 1973–2003.
4. Hood Alsagaff,Abdul Mukty.2008.Dasar-dasar Ilmu Penyakit
Paru.Surabaya:Penerbit Erlangga
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Erlangga
6. Perhimpunan Dokter Paru Indonesia. Pedoman Diagnosis dan Tatalaksana
Asma. 2021.
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Handayani D. Pneumonia komunitas. Pedoman Diagnosis dan
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