leacture 2 interpret lab data dr aminai ahm.pdf
- 1. Interpreting Clinical & Laboratory data PREPARED BY Dr. AMANI AHMED,MD SENIOR SPECIALIST OF INTERNAL MEDICINE
- 2. Our course schedule A. Bed side patient assessment B. Interpreting clinical & laboratory data C. Interpreting the ECG D. Analysis & monitoring of Gas exchanges E. Pulmonary function testing F. Review of thoracic imaging
- 3. BLOOD TEST: FULL BLOOD COUNT: Measure amount of HB /heamatocrit level specific WBC Polycythemia __ secondary polycythemia ( COPD pHTN) Inflammation/infection
- 4. Blood gas analysis ABG ---PaO2 & PaCO2 give information on acid base balance taken directly from redial artery
- 5. - To assess for severe asthma & CF & COPD - To assess O2 requirement - To measure the acid base status of pt with HF , K.F , uncontrol dm , sleep disorder , severe infection & after drug over dose - To assess pt who are receiving therapeutic TrT ( ventilation) Pao2 >11kpa Paco2 ~ 4.7 - 6kpa Ph 7.35-7.45
- 6. Swab test: To differentiate between viral & bacterial inf Covid testing PCR extraction RNA from virus from nose & throat swab Rapid AB dectection test
- 7. Sputum culture --- best time to collection at early morning ( as sample to be more concentrated) - Blood steaked lung cancer - Rusty pneumonia - Brown chronic bronchitis - White allergic bronchitis - Foamy white /frothy pink pul edema ** MORE ACCURATE TEST ( BAL)
- 8. Allergen testing : skin pick test look for specific antigen responses and sensitivity to common allergens
- 9. HOW WE READ THE X- RAY: PAPER N ABCDE Patient Information--- name, gender, DOB, date & time /clinical hx /previous image Inspiration--- full inspiration anterior rib should 6 above diaphragm7 penetrate the diaphragm & if 7 above diaphragm -- hyperventilation Penetration--- spinal vertebra through the heart shadow Exposed area see all lung zone Rotation at middle of clavicle NG tube location CHEST X-RAY:
- 12. AIRWAY--- TRACHEA & MAIN BRONCHUS BREATHING--- LUNG ZONE {WHITE (COLLOPSEUNIFORM OPACITY /TRACHEA DEVIATION TOWORD THE AFFECTED SIDE EFFUSSIONUNIFORM OPACITY/ TRACHEA DIVATION AWAY FROM AFFECTED SIDE CONSOLIDATIONLOCATED PATCHY OPACITY WITH AIRBRONCHOGRAM) DARK (COPD HYPERINFLATION/FLAT DIAPHRAM /STRECHED HEART PNEUMOTHORAXINCREASE RADIOLUCENT/SHERNKEN LUNG MARKERINGS) LINETOO MANY LINE *RETICULAR SHADAWING (FABROTIC LUNG DISEASE , PUL EDEMA)} THE HILA VESSELES/LN/LT HIGHER THAN RT--- -LN (SARCODIOSIS-TB-LYMPHOMA)
- 15. Circulation Aortic, pulmonary, LA ,LV ,RT heart border__ Rt heart border loss (in Rt middle lobe consolidation) ,LT heart border loss (LT upper lobe pathologylingula) ,LT lower lobe pathology (LT heart border visible) Heart size/ Thoracic size <0.5 ---- if >0.5 =cardiomegaly Diaphragm Rt higher than LT , costophrenic angle , below the diaphragm ( stomach gas). Every thing else soft tissue & bone( clavicle, scapula ,humerus, rib )& medical equipment (pacemakers, central line).
- 17. LUNG FUNCTION TEST: Purpose of PFT: Diagnostic of symptomatic disease Screening for early /asymptomatic disease Prognostication of known disease Monitoring response to treatment
- 18. As a diagnostic tool , help classify diffuse lung disease into: Obstructive lung disease asthma, COPD ,bronchiectasis, CF Restrictive lung disease ILD, chest wall ,obesity, neuromuscular disease Pul. Vascular disease PPH, chronic thromboembolism
- 19. FUNCTION OF PUL.SYSTEM TESTED BY PFT: AIRWAY SMALL /LARG PARENCHYMA ALVEOLI/INTERSTITIUM PUL .VASCULTURE
- 20. TYPES OF PFT Standard : Spirometry flow volume loop ( responsible for dx of obstructive lung disease) Lung volume (responsible for dx of restrictive lung disease) DLco inconjection with other tests is responsible for suggesting the possibility of pul. vascular disease. Specialized: ABG Exercise oximetry rest /activity 6 minutes walk test not helpful for dx of any specific disease, but can be used for prognosis & determined of response of trt . Peak flow measure maximum expiratory air flow that can be delivered in single breath typically used to give the severity of asthma exacerbation
- 21. LUNG VOLUME
- 22. TLC Total lung capacity: the volume in the lungs at maximal inflation, the sum of VC and RV. 4-6 L TV Tidal volume: that volume of air moved into or out of the lungs during quiet breathing . 300-500 ml RV Residual volume: the volume of air remaining in the lungs after a maximal exhalation. 1200 ml ERV Expiratory reserve volume: the maximal volume of air that can be exhaled from the end-expiratory position 700-1200 ml IRV Inspiratory reserve volume: the maximal volume that can be inhaled from the end-inspiratory level.3300 ml IC Inspiratory capacity: the sum of IRV and TV FRC Function residual capacity: amount of air remaining in lungs at the end normal exhalation 2200 ml VC Vital capacity: the volume of air breathed out after the deepest inhalation.
- 23. INTERPRETATION LUNG VOLUME increased RV & TLC other within normal obstruction All lung volume decreases restriction Increase RV & decrease VC & increased TLC pseudo restriction
- 24. SPIROMERY Is a specific test to assess lung function: -FVC volume of air that breath out following maximal inspiration within sec & 75% should be blown out in 1st second ( FEV1) FEV1/FVC calculate ratio & represent the proportion of persons VC they are able to exhale in first second of forced expiration
- 26. Values measured by Spirometry Major FEV1 FVC FEV1/FVC Ratio Flow volume loop Minor Peak expiratory flow rate The highest forced expiratory flow measured with a peak flow meter Forced Expiratory Flow 2575% (the flow of air coming out of the lung during the middle portion of a forced expiration at discrete times. The usual discrete intervals are 25%, 50% and 75%) Maximal voluntary ventilation ( maximum amount of air that can be inhaled & exhaled within 1 min) Response to bronchodilation
- 27. Interpretation of Spirometry FEV1 FVC FEV1/FVC ratio Obstruction lung disease Normal or decreased Normal or decreased Decreased <70% Restrictive lung disease Normal or decreased decreased Normal or increased >=70%