Aeromedical evacuation
Hoist Rescue
Sling single?
Double sling?
Stretcher?
Rescue basket?
Respiratory Function in Hoist Rescue:              ComparingSlings, Stretcher, and Rescue Basket        David   Murphy ,  ...
INTRODUCTION
INTRODUCTIONB) double sling   A) single sling
INTRODUCTIOND) rescue basket   C) stretcher
INTRODUCTION
INTRODUCTION
So what happens?                             INTRODUCTIONSuspention trauma and harness-hang syndrome∗ General feelings of ...
INTRODUCTIONSuspention trauma and harness-hang syndrome
INTRODUCTION
INTRODUCTION
INTRODUCTION
INTRODUCTION
INTRODUCTIONSever AsthmaWhen is a severe acute episodehappening?• Limited ability to speak• Pulsus paradoxus > 25mmHg• Pul...
Stepwise approach ( children)classificati    mild        Mild         Moderate     Severeon             Intermitte   persi...
Stepwise approach ( adult)classificati    mild        Mild         Moderate     Severeon             Intermitte   persiste...
Asthma classification
INTRODUCTION
INTRODUCTION                 >Rescue Basket (RB) Stretcher
INTRODUCTIONH0 & H1 thesisH1:Use of the RB would not be associated with impairment of spirometry in healthyvolunteersH0:Us...
METHODS
Winchsimulator
METHODSRandomized ,Controlled cross-over study
Hypothesis Testing: Case-Crossover StudiesRandomized ,Controlled cross-overstudy∗ Study of “triggers” within an individual...
METHODSRandomized ,Controlled cross-overstudy
METHODS
Table of Random NumbersSequence - randomization                           542-04-#38
METHODS
METHODS
METHODSEasyOne Diagnostic Spirometer
Pulmonary Function     Testing
Perform test
Types of Spirometers∗ Bellows spirometers:  Measure volume; mainly in lung function units∗ Electronic desk top spirometers...
Volume Measuring Spirometer
Flow Measuring Spirometer
Desktop Electronic Spirometers
Small Hand-held Spirometers
Actual PFT Performance Technique∗ Prepare the equipment – find a nurse who knows (or is  that nose?) what to do.∗ Patient ...
Actual PFT Performance Technique∗ The patient should place their mouth completely over  the mouthpiece, not inside it.∗ As...
Actual PFT Performance Technique∗ Once the patient has blown out as much as they can,  ask them to then inhale as deeply a...
Difinitions &Considerations
Lung Volumes and Capacities∗ There are four basic lung volumes:  ∗   Inspiratory reserve volume (IRV)  ∗   Tidal volume (T...
Lung Volumes
Normal Spirometry
Obstructive Pattern■ Decreased FEV1■ Decreased FVC■ Decreased FEV1/FVC      - <70% predicted■ FEV1 used to follow severity...
Obstructive Lung Disease — Differential               Diagnosis Asthma COPD   - chronic bronchitis   - emphysema Bronch...
Restrictive Pattern Decreased FEV1 Decreased FVC FEV1/FVC normal or increased
Restrictive Lung Disease —Differential               Diagnosis Pleural Parenchymal Chest wall Neuromuscular
Spirometry Patterns
Indications for          Pulmonary Function Testing∗ Patients 45 years old and older who have ever smoked.∗ Patients with ...
Indications for       Pulmonary Function Testing∗ Detecting pulmonary disease  ∗ Pulmonary symptoms – chest pain, orthopne...
Indications for           Pulmonary Function Testing∗ Assessing disease severity and progression  ∗ Pulmonary disease – CO...
Indications for       Pulmonary Function Testing∗ Pre-operative risk stratification  ∗ Thoracic surgery  ∗ Cardiac surgery...
Contraindications for PFTRelative contraindications for spirometry include hemoptysis ofunknown origin, pneumothorax, unst...
Normal Values∗ FVC is the total amount of air a person can exhale,  usually measured in six seconds.  ∗   80 – 120% of pre...
Normal Values∗ FEV1/FVC ratio is the percentage of FVC that can be  expired in one second.  ∗ 75 – 80% is normal  ∗ 60 – 8...
Normal Values∗ FEF25-75 reflects small airway function  ∗ >80% is normal  ∗ 60 – 80% reflects mild obstruction in the smal...
Spirometry Interpretation: So   what constitutes normal?∗ Normal values vary and depend on:  ∗   Height  ∗   Age  ∗   Gend...
PFT Interpretation
PFT Interpretation∗ Three steps in interpretation  ∗ Is the test valid?  ∗ Interpret the test  ∗ Classify severity of dise...
Validity∗ The test is valid is you have good patient effort and  the three tests performed are internally consistent.∗ You...
Acceptability Criteria1 - good start of test : sharp take off2- Meet end-of-test criteria3- free from artifacts:   -Cough ...
Reproducibility CriteriaAfter 3 acceptable spirograms been obtained Are the two largest FVC within 150ml of each other? ...
Interpretation of SpirometryStep 1. Look at the Flow-Volume loopStep 2. Look at the FEV1 (Nl ≥ 80% predicted).Step 3. Look...
Normal Values∗ FVC is the total amount of air a person can exhale,  usually measured in six seconds.  ∗   80 – 120% of pre...
Normal Values∗ FEV1/FVC ratio is the percentage of FVC that can be  expired in one second.  ∗ 75 – 80% is normal  ∗ 60 – 8...
Normal Values∗ FEF25-75 reflects small airway function  ∗ >80% is normal  ∗ 60 – 80% reflects mild obstruction in the smal...
PFT InterpretationAssess FVC, FEV1, and FEV1/FVC ratio.FVC and FEV1 normal, with a normal FEV1/FVC ratio: Normal Test  ...
Measurements Obtained from the FVC             Curve∗ FEV1---the volume exhaled during the first second of the  FVC maneuv...
Spirometry Interpretation:  Obstructive vs. Restrictive Defect∗ Obstructive Disorders   ∗ Restrictive Disorders  ∗   FVC n...
Spirometry Interpretation: What           do the numbers mean?∗ FVC                              FEV1∗ Interpretation of %...
Actual       Predicted   % PredictedFVC        4.0          4.5         88FEV1       3.4          4.2         89FEV1/FVC  ...
Actual      Predicted   % PredictedFVC        2.0         4.0         50FEV1       1.8         3.7         47FEV1/FVC   90...
Actual    Predicted   % PredictedFVC        4.0       4.5         88FEV1       2.4       4.2         58FEV1/FVC   60      ...
Acceptable and Unacceptable  Spirograms (from ATS, 1994)
PFTs
Normal vs. Obstructive vs. Restrictive
Variable Effort
Early Glottic Closure
Cough
Flow-Volume Loops
Flow-Volume Loops
Special Techniques∗ Beta Agonist Challenge∗ Methacholine Challenge∗ DLCO
Beta Agonist Challenge∗ Perform this when there is a suspicion that the  obstructive defect may be reversible –> asthma.∗ ...
Methacholine Challenge∗ If you have a suspicion that the patient might have Exercise-  induced bronchospasm (EIB), then re...
Diffuse capacity of carbon monoxide in                 the lung DLCO∗ After performing the standard PFTs, the patient then...
Diffusing Capacity Decreased DLCO                 Increased DLCO                                  (>120-140% predicted) ...
paired T test    The paired t-test will show whether the differences observed in the 2 measures will be       found reliab...
ANOVA:One wayIf we have data measured at the interval level, wecan compare two or more population groups interms of their ...
Honestly significant difference test (HSD) When you do multiple significance tests, thechance of finding a "significant" d...
RESULTS
DISCUSSION
DISCUSSION
DISCUSSION
DISCUSSION
DISCUSSION
DISCUSSION
DISCUSSION
DISCUSSION
DISCUSSIONAir Turbulance
DISCUSSIONMajor sources of noise generated by a helicopter
DISCUSSION
DISCUSSIONStatic Spirometry
DISCUSSIONDynamic Spirometry
DISCUSSION
DISCUSSIONBody Plethysmography
DISCUSSIONBody Plethysmography
DISCUSSIONhelium dilution
DISCUSSION
DISCUSSION
DISCUSSION
THANKS FOR   YOURATTENTION    134
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
Respiratory function in hoist rescue111
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  • Early effects are from distributative shock, and develop within a few minutes. Timings are given in a later slide. The fainting process is instant – a test performed by the Suspensiontrauma.info medical staff asked fit and uninjured students to hang in a harness and count upwards, paying them money if they counted highest and remembered the number. They fainted almost between one number and the next, and of 50 volunteers only two remembered a number, but both were wrong.
  • Case cross over studies are the newest form of epidemiologic design.
  • Image source: http://en.wikipedia.org/wiki/Main_Page
  • Image source: http://www.spirxpert.com/index.html
  • Image source: http://www.spirxpert.com/index.html FEV1 is decreased out of proportion to FVC, which causes the ratio to decrease as well.
  • This is not a complete list, just some of the most common diseases that should be on your differential for obstructive lung disease.
  • Image source: http://www.spirxpert.com/index.html FEV1 decreases in proportion to decrease in FVC, so ratio remains normal or even slightly increased
  • Restrictive lung disease is made up of intrinsic lung disease (causes inflammation and scarring (interstitial lung diseases) or fill the airspaces w/ debris, inflammation (exudate); extrinsic causes are chest wall or pleural diseases that mechanically compress the lung and prevent expansion. Neuromuscular causes decreases ability of respiratory muscles to inflate and deflate the lungs.
  • Height varies directly with vc VC increases with age up to age 20 years then becomes inversely proportion to age Women usually with lower vc than men
  • Pulmonary vascular disease = pulmonary emboli, pulmonary HTN. Low DLCO is also a major predictor of desaturation during exercise.
  • Respiratory function in hoist rescue111

    1. 1. Aeromedical evacuation
    2. 2. Hoist Rescue
    3. 3. Sling single?
    4. 4. Double sling?
    5. 5. Stretcher?
    6. 6. Rescue basket?
    7. 7. Respiratory Function in Hoist Rescue: ComparingSlings, Stretcher, and Rescue Basket David Murphy , Alan Garner , and Rod Bishop From CareFlight NSW, Northmead, NSW, Australia. Aviation, Space, and Environmental Medicine x Vol. 82, No. 2 x February 2011 CareFlight NSW, Northmead, NSW, Australia
    8. 8. INTRODUCTION
    9. 9. INTRODUCTIONB) double sling A) single sling
    10. 10. INTRODUCTIOND) rescue basket C) stretcher
    11. 11. INTRODUCTION
    12. 12. INTRODUCTION
    13. 13. So what happens? INTRODUCTIONSuspention trauma and harness-hang syndrome∗ General feelings of unease ∗ Dizzy, sweaty and other signs of shock ∗ Increased pulse and breathing rates∗ Then a sudden drop in pulse & BP∗ Instant loss of consciousness∗ If not rescued, death is certain ∗ From suffocation due to a closed airway, or from lack of blood flow and oxygen to the brain.
    14. 14. INTRODUCTIONSuspention trauma and harness-hang syndrome
    15. 15. INTRODUCTION
    16. 16. INTRODUCTION
    17. 17. INTRODUCTION
    18. 18. INTRODUCTION
    19. 19. INTRODUCTIONSever AsthmaWhen is a severe acute episodehappening?• Limited ability to speak• Pulsus paradoxus > 25mmHg• Pulse >110/min• RR >25-30/min• Flow rates <50% predicted• O2 saturation <91-92%• Some consider flow rates < 35% predictedto be life-threatening
    20. 20. Stepwise approach ( children)classificati mild Mild Moderate Severeon Intermitte persistent persistent persistent ntMinor < 1/week 1-3 /week 4-5/week Continuousymptoms sexacerbati < 1/month 1 /month 2-3/month > 4on/ /monthnocturnalPEF >80% >80% 60-80% < 60%betweenattacks Step 1 Step 2 Step 3 Step 4
    21. 21. Stepwise approach ( adult)classificati mild Mild Moderate Severeon Intermitte persistent persistent persistent ntMinor < 2 /week 2-3 /week 4-5 /week Continuousymptoms sexacerbati <2 2-3 4-5 >5on/ /month /month /month /monthnocturnalPEF >80% >80% 60-80% < 60%betweenattacks Step 1 Step 2 Step 3 Step 4
    22. 22. Asthma classification
    23. 23. INTRODUCTION
    24. 24. INTRODUCTION >Rescue Basket (RB) Stretcher
    25. 25. INTRODUCTIONH0 & H1 thesisH1:Use of the RB would not be associated with impairment of spirometry in healthyvolunteersH0:Use of the Stretcher would not be associated with impairment of spirometry inhealthy volunteers
    26. 26. METHODS
    27. 27. Winchsimulator
    28. 28. METHODSRandomized ,Controlled cross-over study
    29. 29. Hypothesis Testing: Case-Crossover StudiesRandomized ,Controlled cross-overstudy∗ Study of “triggers” within an individual∗ ”Case" and "control" component, but information of both components will come from the same individual∗ ”Case component" = hazard period which is the time period right before the disease or event onset∗ ”Control component" = control period which is a specified time interval other than the hazard period
    30. 30. METHODSRandomized ,Controlled cross-overstudy
    31. 31. METHODS
    32. 32. Table of Random NumbersSequence - randomization 542-04-#38
    33. 33. METHODS
    34. 34. METHODS
    35. 35. METHODSEasyOne Diagnostic Spirometer
    36. 36. Pulmonary Function Testing
    37. 37. Perform test
    38. 38. Types of Spirometers∗ Bellows spirometers: Measure volume; mainly in lung function units∗ Electronic desk top spirometers: Measure flow and volume with real time display∗ Small hand-held spirometers: Inexpensive and quick to use but no print out
    39. 39. Volume Measuring Spirometer
    40. 40. Flow Measuring Spirometer
    41. 41. Desktop Electronic Spirometers
    42. 42. Small Hand-held Spirometers
    43. 43. Actual PFT Performance Technique∗ Prepare the equipment – find a nurse who knows (or is that nose?) what to do.∗ Patient should be seated with nose clip in place.∗ The patient needs to practice the exercise before actually performing the test. Have the patient breath in and out deeply several times.∗ Ask the patient to breath in as deeply as they can.
    44. 44. Actual PFT Performance Technique∗ The patient should place their mouth completely over the mouthpiece, not inside it.∗ Ask the patient to blow out as fast and as quick as they can for at least six seconds. Enthusiatically coach the patient – jump, shout, get down, hoot and holler… “Blow, blow, come on, blow more, you can do it!”
    45. 45. Actual PFT Performance Technique∗ Once the patient has blown out as much as they can, ask them to then inhale as deeply as they can.∗ Repeat the whole test three times. The goal is to get a reproducible result that is consistent.∗ You may need to repeat the test more than three times in order to obtain an internally valid test.
    46. 46. Difinitions &Considerations
    47. 47. Lung Volumes and Capacities∗ There are four basic lung volumes: ∗ Inspiratory reserve volume (IRV) ∗ Tidal volume (TV) ∗ Expiratory reserve volume (ERV) ∗ Residual volume (RV)∗ In various combinations, these lung volumes then form lung capacities.∗ E.g., Vital capacity = IRV + TV + ERV
    48. 48. Lung Volumes
    49. 49. Normal Spirometry
    50. 50. Obstructive Pattern■ Decreased FEV1■ Decreased FVC■ Decreased FEV1/FVC - <70% predicted■ FEV1 used to follow severity in COPD
    51. 51. Obstructive Lung Disease — Differential Diagnosis Asthma COPD - chronic bronchitis - emphysema Bronchiectasis Bronchiolitis Upper airway obstruction
    52. 52. Restrictive Pattern Decreased FEV1 Decreased FVC FEV1/FVC normal or increased
    53. 53. Restrictive Lung Disease —Differential Diagnosis Pleural Parenchymal Chest wall Neuromuscular
    54. 54. Spirometry Patterns
    55. 55. Indications for Pulmonary Function Testing∗ Patients 45 years old and older who have ever smoked.∗ Patients with prolonged or excessive cough or sputum production.∗ Patients with a history of exposure to lung irritants.
    56. 56. Indications for Pulmonary Function Testing∗ Detecting pulmonary disease ∗ Pulmonary symptoms – chest pain, orthopnea, cough, phlegm production, dyspnea, wheezing ∗ Physical findings – Chest wall problems, cyanosis, clubbing, decreased breath sounds ∗ Abnormal labs/x-rays – ABG, Chest X-Ray
    57. 57. Indications for Pulmonary Function Testing∗ Assessing disease severity and progression ∗ Pulmonary disease – COPD, Cystic fibrosis, Interstitial lung disease, Sarcoidosis ∗ Cardiac disease – CHF, Congenital heart disease, Pulmonary hypertension ∗ Neuromuscular disease – Amyotrophic lateral sclerosis, Guillain- Barre syndrome, Multiple sclerosis, Myasthenia gravis
    58. 58. Indications for Pulmonary Function Testing∗ Pre-operative risk stratification ∗ Thoracic surgery ∗ Cardiac surgery ∗ Organ transplantation ∗ General surgical procedures∗ Evaluating disability and impairment
    59. 59. Contraindications for PFTRelative contraindications for spirometry include hemoptysis ofunknown origin, pneumothorax, unstable angina pectoris,recent myocardial infarction, thoracic aneurysms, abdominalaneurysms, cerebral aneurysms, recent eye surgery (increasedintraocular pressure during forced expiration), recent abdominalor thoracic surgical procedures, and patients with a history ofsyncope associated with forced exhalation.
    60. 60. Normal Values∗ FVC is the total amount of air a person can exhale, usually measured in six seconds. ∗ 80 – 120% of predicted is a normal value ∗ 70 – 80% demonstrates mild reduction/restriction ∗ 50 – 70% demonstrates moderate reduction ∗ <50% demonstrates severe reduction∗ FEV1 is the amount of air a person can exhale in one second. ∗ 80 – 120% of predicted is a normal value
    61. 61. Normal Values∗ FEV1/FVC ratio is the percentage of FVC that can be expired in one second. ∗ 75 – 80% is normal ∗ 60 – 80% demonstrates mild obstruction ∗ 50 – 60% demonstrates moderate obstruction ∗ <50% demonstrates severe obstruction
    62. 62. Normal Values∗ FEF25-75 reflects small airway function ∗ >80% is normal ∗ 60 – 80% reflects mild obstruction in the small airways ∗ 40 – 60% reflects moderate obstruction ∗ <40% reflects severe obstruction
    63. 63. Spirometry Interpretation: So what constitutes normal?∗ Normal values vary and depend on: ∗ Height ∗ Age ∗ Gender ∗ Ethnicity
    64. 64. PFT Interpretation
    65. 65. PFT Interpretation∗ Three steps in interpretation ∗ Is the test valid? ∗ Interpret the test ∗ Classify severity of disease if present
    66. 66. Validity∗ The test is valid is you have good patient effort and the three tests performed are internally consistent.∗ You may notice a learning curve in that the latter tests are better performed than the former.∗ Make sure that the tests are maximal effort. You need to be really aggressive in coaching your patient.
    67. 67. Acceptability Criteria1 - good start of test : sharp take off2- Meet end-of-test criteria3- free from artifacts: -Cough or glottis closure during the first second of exhalation -Variable effort , submaximal effort -Leak -Obstructed mouthpiece -Have a satisfactory exhalation 6 s of exhalation
    68. 68. Reproducibility CriteriaAfter 3 acceptable spirograms been obtained Are the two largest FVC within 150ml of each other? Are the two largest FEV1 within 150ml of each other?If both of these criteria are met, the test session may be concluded.If both of these criteria are not met, continue testing until Both of the criteria are met with analysis of additional acceptable spirograms; OR a total of eight tests have been performed
    69. 69. Interpretation of SpirometryStep 1. Look at the Flow-Volume loopStep 2. Look at the FEV1 (Nl ≥ 80% predicted).Step 3. Look at FVC (Nl ≥ 80%).Step 4. Look at FEV1/FVC ratio (Nl≥ 75%).Step 5. Look at FEF25-75% (wide normal range)
    70. 70. Normal Values∗ FVC is the total amount of air a person can exhale, usually measured in six seconds. ∗ 80 – 120% of predicted is a normal value ∗ 70 – 80% demonstrates mild reduction/restriction ∗ 50 – 70% demonstrates moderate reduction ∗ <50% demonstrates severe reduction∗ FEV1 is the amount of air a person can exhale in one second. ∗ 80 – 120% of predicted is a normal value
    71. 71. Normal Values∗ FEV1/FVC ratio is the percentage of FVC that can be expired in one second. ∗ 75 – 80% is normal ∗ 60 – 80% demonstrates mild obstruction ∗ 50 – 60% demonstrates moderate obstruction ∗ <50% demonstrates severe obstruction
    72. 72. Normal Values∗ FEF25-75 reflects small airway function ∗ >80% is normal ∗ 60 – 80% reflects mild obstruction in the small airways ∗ 40 – 60% reflects moderate obstruction ∗ <40% reflects severe obstruction
    73. 73. PFT InterpretationAssess FVC, FEV1, and FEV1/FVC ratio.FVC and FEV1 normal, with a normal FEV1/FVC ratio: Normal Test FVC low, FEV1 low or normal, and a normal to high FEV1/FVC ratio:-- Restrictive lung diseaseFVC low or normal, FEV1 low, and a low FEV1/FVC ratio: Obstructive lung disease
    74. 74. Measurements Obtained from the FVC Curve∗ FEV1---the volume exhaled during the first second of the FVC maneuver∗ FEF 25-75%---the mean expiratory flow during the middle half of the FVC maneuver; reflects flow through the small (<2 mm in diameter) airways∗ FEV1/FVC---the ratio of FEV1 to FVC X 100 (expressed as a percent); an important value because a reduction of this ratio from expected values is specific for obstructive rather than restrictive diseases
    75. 75. Spirometry Interpretation: Obstructive vs. Restrictive Defect∗ Obstructive Disorders ∗ Restrictive Disorders ∗ FVC nl or↓ ∗ FVC ↓ ∗ FEV1 ↓ ∗ FEV1 ↓ ∗ FEF25-75% ↓ ∗ FEF 25-75% nl to ↓ ∗ FEV1/FVC ↓ ∗ FEV1/FVC nl to ↑ ∗ TLC nl or ↑ ∗ TLC ↓
    76. 76. Spirometry Interpretation: What do the numbers mean?∗ FVC FEV1∗ Interpretation of % predicted: Interpretation of % predicted: ∗ 80-120% Normal ∗ >75% Normal ∗ 70-79% Mild reduction ∗ 60%-75% Mild obstruction ∗ 50%-69% Moderate reduction ∗ 50-59% Moderate obstruction ∗ <50% Severe reduction ∗ <49% Severe obstruction ∗ <25 y.o. add 5% and >60 y.o. subtract 5
    77. 77. Actual Predicted % PredictedFVC 4.0 4.5 88FEV1 3.4 4.2 89FEV1/FVC 85 82 112FEF25-75 Normal
    78. 78. Actual Predicted % PredictedFVC 2.0 4.0 50FEV1 1.8 3.7 47FEV1/FVC 90 82 112FEF25-75 Restrictive Pattern
    79. 79. Actual Predicted % PredictedFVC 4.0 4.5 88FEV1 2.4 4.2 58FEV1/FVC 60 82 76FEF25-75 2.2 4.4 50 Obstructive Pattern
    80. 80. Acceptable and Unacceptable Spirograms (from ATS, 1994)
    81. 81. PFTs
    82. 82. Normal vs. Obstructive vs. Restrictive
    83. 83. Variable Effort
    84. 84. Early Glottic Closure
    85. 85. Cough
    86. 86. Flow-Volume Loops
    87. 87. Flow-Volume Loops
    88. 88. Special Techniques∗ Beta Agonist Challenge∗ Methacholine Challenge∗ DLCO
    89. 89. Beta Agonist Challenge∗ Perform this when there is a suspicion that the obstructive defect may be reversible –> asthma.∗ Give the patient a beta agonist treatment (two puffs of an albuterol MDI or an albuterol nebulizer) and repeat the PFTs several minutes later. If you notice a 12% or more increase in FEV1, then you have diagnosed reversible airway disease/asthma.
    90. 90. Methacholine Challenge∗ If you have a suspicion that the patient might have Exercise- induced bronchospasm (EIB), then refer them to a pulmonary lab where they can do provocative testing with methacholine.∗ If the patient has a decrease in their FEV1/FVC ratio with the inhalation of methacholine, then you have diagnosed EIB.∗ Pretreat before exercise with albuterol or cromolyn.
    91. 91. Diffuse capacity of carbon monoxide in the lung DLCO∗ After performing the standard PFTs, the patient then inhales trace amounts of carbon monoxide.∗ CO traverses the alveolar capillary beds much more readily than CO2 or O2.∗ As such, most of the CO inhaled should be absorbed.∗ When it is not, this suggests pulmonary scarring consistent with pulmonary fibrosis. Search for a cause.
    92. 92. Diffusing Capacity Decreased DLCO  Increased DLCO (>120-140% predicted) (<80% predicted)  Asthma (or normal)  Obstructive lung disease  Pulmonary hemorrhage  Parenchymal disease  Polycythemia  Pulmonary vascular disease  Left to right shunt  Anemia
    93. 93. paired T test The paired t-test will show whether the differences observed in the 2 measures will be found reliably in repeated samples.
    94. 94. ANOVA:One wayIf we have data measured at the interval level, wecan compare two or more population groups interms of their population means using atechnique called analysis of variance, or ANOVA.
    95. 95. Honestly significant difference test (HSD) When you do multiple significance tests, thechance of finding a "significant" difference justby chance increases. Tukey´s HSD test is one ofseveral methods of ensuring that the chance offinding a significant difference in any comparison(under a null model) is maintained at the alphalevel of the test.
    96. 96. RESULTS
    97. 97. DISCUSSION
    98. 98. DISCUSSION
    99. 99. DISCUSSION
    100. 100. DISCUSSION
    101. 101. DISCUSSION
    102. 102. DISCUSSION
    103. 103. DISCUSSION
    104. 104. DISCUSSION
    105. 105. DISCUSSIONAir Turbulance
    106. 106. DISCUSSIONMajor sources of noise generated by a helicopter
    107. 107. DISCUSSION
    108. 108. DISCUSSIONStatic Spirometry
    109. 109. DISCUSSIONDynamic Spirometry
    110. 110. DISCUSSION
    111. 111. DISCUSSIONBody Plethysmography
    112. 112. DISCUSSIONBody Plethysmography
    113. 113. DISCUSSIONhelium dilution
    114. 114. DISCUSSION
    115. 115. DISCUSSION
    116. 116. DISCUSSION
    117. 117. THANKS FOR YOURATTENTION 134

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