1. Respiratory system E. Picard Pediatric pulmonary unit Shaare Zedek Medical Center Jerusalem

2. Respiratory system Introduction All the structures involved in exchange of Oxygen and CO2 between blood and atmosphere All the structures involved in exchange of Oxygen and CO2 between blood and atmosphere

3. Respiratory system (anatomy) Nose, Sinuses, Pharynx, Larynx (vocal cords), Trachea, Bronchi, Bronchioli, Lungs Nose, Sinuses, Pharynx, Larynx (vocal cords), Trachea, Bronchi, Bronchioli, Lungs

4. Respiratory system (anatomy)

5. 2 lungs: 3 lobes in right and 2 lobes in left 2 lungs: 3 lobes in right and 2 lobes in left

6. Respiratory system

7. Respiratory system (physiology) Alveoli: Gaz exchange Alveoli: Gaz exchange

8. Respiratory system (physiology) In atmosphere: PO 2 : 150 mmhg In atmosphere: PO 2 : 150 mmhg PCO 2 : 0 mmhg. PCO 2 : 0 mmhg. In arterial blood: PO 2 : 100 mmhg In arterial blood: PO 2 : 100 mmhg PCO 2 : 40 mmhg PCO 2 : 40 mmhg In venous blood: PO 2 : 40 mmhg In venous blood: PO 2 : 40 mmhg PCO 2 : 46 mmhg PCO 2 : 46 mmhg

9. Resp system: clinical approach (anamnesis) Pregnancy, delivery, nutrition Pregnancy, delivery, nutrition Familial history: (CF, Asthma, Cigarettes) Familial history: (CF, Asthma, Cigarettes) Cough (Age of onset, Time, Type, Trigger) Cough (Age of onset, Time, Type, Trigger) Other systems: Skin, E.N.T, C.N.S., G.I., C.V.S. Other systems: Skin, E.N.T, C.N.S., G.I., C.V.S.

10. Resp system: clinical approach (inspection) Pectus excavatum: Marfan, Ehler-Danlos, OAD

11. Resp system: clinical approach (inspection) Pectus carrinatum: (pigeon breast) thoracic index AP/Lat >1 could be associated with CHD

12. Resp system: clinical approach (inspection) Allergic shiners: (bluish lower eyelid)

13. Resp system: clinical approach (inspection) Atopic dermatitis

14. Nasal Polyp

15. Resp system: Adenoids

16. Resp system: clinical approach (inspection) Dyspnea: (retractions, alae nasi, grunting) Tachypnea: 0-2 years 40/mn, 2-6 years 25-30/mn, 6-10 years 20- 25/mn, 10-13 years 15-20/mn, Adults 12- 14/mn.(D.D: fever, anemia, metabolic acidosis, anxiety) Cyanosis: V/Q mismatch, low fio2, diffusion impairment, alveolar hypoventilation (CNS,Muscle), Rt to Lt shunt intrapulmm or cardiac, CHF with low mixed venous 02

17. Resp system: clinical approach Palpation: Fremitus increased in consolidation, decreased in effusion or atelectasis. Palpation: Fremitus increased in consolidation, decreased in effusion or atelectasis. Percussion: Dullness, Tympanism. Percussion: Dullness, Tympanism.

18. Resp system: clinical approach(auscultation) Inspirium/expirium Inspirium/expirium Grunting: adduction of v. cords to generate PEEP Grunting: adduction of v. cords to generate PEEP Discontinuous sounds: fine crackles (late insp, Edema..) coarse crackles (early insp and exp, COPD) Discontinuous sounds: fine crackles (late insp, Edema..) coarse crackles (early insp and exp, COPD) Continuous sounds: wheezes (expiratory) or rhonchus (inspiratory: obstruction of a larger airway by secretions). Continuous sounds: wheezes (expiratory) or rhonchus (inspiratory: obstruction of a larger airway by secretions).

19. Resp system: complementary exams Laboratory: CBC, Astrup, Pulse oxymetry Laboratory: CBC, Astrup, Pulse oxymetry

20. Resp system: complementary exams Pulmonary function tests: Lung volumes

21. איך נבדיל בין מחלה חסימתית לרסטריקטיבית TLC RV/ TLC FVC FEV1 FEV1 /FVC SGAWDLCOחסימתית רסטרקטיבית

22. Resp system: complementary exams Flexible bronchoscopy Flexible bronchoscopy: Information on the airways, broncho- alveolar lavage, lung biopsy. Flexible bronchoscopy: Information on the airways, broncho- alveolar lavage, lung biopsy.

23. Resp system: radiography Chest X-ray Chest X-ray Nasopharynx Nasopharynx Barrium swallow Barrium swallow Ct scan Ct scan

24. Resp system: Chest x-ray Symmetry Symmetry Bone and Bone and soft tissue soft tissue Trachea Trachea Diaphragm Diaphragm Heart, Mediast Heart, Mediast Lungs Lungs

25. Resp system: Chest x-ray Alveolar pattern: confluent shadow, air bronchogram Alveolar pattern: confluent shadow, air bronchogram Interstitial pattern: Linear form (lymph, infl, infect, fibrosis, edema), Nodular, Ground glass, Honeycomb Interstitial pattern: Linear form (lymph, infl, infect, fibrosis, edema), Nodular, Ground glass, Honeycomb

26. Resp system: Chest x-ray

28. Chest radiograph

29. Resp system: CT scan

30. Barrium swallow