In critical care medicine the invasive life saving techniques are often employed and when all goes well such interventions will be withdrawn to all for normal physiology to resume. Identifying this point for safe withdrawal for the resumption of normal respiratory function is of utmost importance.
In critical care medicine the invasive life saving techniques are often employed and when all goes well such interventions will be withdrawn to all for normal physiology to resume. Identifying this point for safe withdrawal for the resumption of normal respiratory function is of utmost importance.
This is an amazing article giving brief clinical application of PFT.
Bedside PFT are best explained here.
Bedside PFT references most of times are incomplete and inadequate
COURTSEY -DEPARTMENT OF ANESTHESIA, MAMC and LOK NAYAK HOSPITAL, NEW DELHI
Lung volumes and lung capacities refer to the volume of air in the lungs at different phases of the respiratory cycle.
The average total lung capacity of an adult human male is about 6 litres of air.[1]
Tidal breathing is normal, resting breathing; the tidal volume is the volume of air that is inhaled or exhaled in only a single such breath.
The average human respiratory rate is 30–60 breaths per minute at birth,[2] decreasing to 12–20 breaths per minute in adults.[3
PULMONARY FUNCTION TESTS PLAY A VERY IMPORTANT ROLE IN ESTIMATING THE FUNCTION OF LUNGS ESPECIALLY IN ASTHAMA AND COPD, One of the frequent reasons patients see their primary care physicians is for the symptom of dyspnea. Among the objective tests to quantify this symptom is the pulmonary function test
PULMONARY FUNCTION TESTS - LAB DATA INTERPRETATIONLincyAsha
PULMONARY FUNCTION TESTS
LAB DATA INTERPRETATION
CLINICAL PHARMACY PRACTICE
M.PHARMACY
PHARMACY PRACTICE
1ST YEAR
Pulmonary function tests are a series of tests performed to examine a patient’s respiratory system and identify the severity of pulmonary impairment.
These tests are performed to measure a patient’s lung volume, capacity, flow rate and gas exchange.
This allows medical professionals to obtain an accurate diagnosis and determine the best course of medical intervention for the patient.
In general there are two types of lung disorders that these tests can be used to assess
Obstructive lung diseases
Restrictive lung diseases
1.OBSTRUCTIVE LUNG DISEASES
It include conditions that make it difficult to exhale air out of the lungs
This results in shortness of breath that occurs from narrowing and constriction of the airways and causes the patient to have decreased flow rates. Eg. COPD, Asthma
2.RESTRICTIVE LUNG DISEASES
It include conditions that make it difficult to fully fill the lungs with air during inhalation.
When the lungs aren’t fully able to expand it causes the patient to have decreased lung volumes. Eg. Pulmonary fibrosis, interstitial lung disease
Pulmonary function tests would be indicated for the following:
On healthy patients as part of a routine physical exam
Evaluate signs and symptoms of lung disease
Diagnosis of certain medical conditions
Measure current stage of disease and evaluate its progress
Assess how a patient is responding to different treatments
Determine patient’s condition before surgery to assess the risk of respiratory complications
Screen people who are at risk of pulmonary disease
Determine how much a patient’s airways have narrowed due to disorders
In certain types of work environments to assess the health of employees.
Additionally PFTs may be indicated for the following
Chronic lung conditions
Restrictive airway problems
Asthma
COPD
Shortness of breath
Impairment or disability
Early morning wheezing
Chest muscle weakness
Lung cancer
Respiratory infections
STATIC LUNG VOLUMES
Lung volume is the amount of air breathed by an individual under a specific condition.
1.Tidal Volume (TV)
It is the volume of air inspired or expired during normal breathing at rest.
2.Inspiratory Reserve Volume (IRV)
It is the volume of air inspired with maximum effort over and above the normal tidal volume.
3.Expiratory Reserve Volume (ERV)
It is the volume of air expired forcefully after a normal respiration.
4.Residual Volume (RV)
It is the volume of air remaining in the lungs after a forceful expiration
STATIC LUNG CAPACITIES
1.Inspiratory capacity (IC)
It is the amount of air a person can inspire forcefully after a normal respiration.
IC = TV+IRV
2.Functional Residual Capacity (FRC)
It is the amount of air that remains in the lungs at the end of normal respiration.
FRC = ERV+RV
3.Vital Capacity (VC)
It is the maximum volume of air exhaled forcefully from the lungs after a maximum inspiration.
4.Total Lung Capacity
Pulmonary function tests (PFTs) are noninvasive tests that show how well the lungs are working. The tests measure lung volume, capacity, rates of flow, and gas exchange. This information can help your healthcare provider diagnose and decide the treatment of certain lung disorders.
Journal club covid vaccine neurological complications ZIKRULLAH MALLICK
the risks of adverse neurological events following SARS-CoV-2 infection are much greater than those associated with vaccinations, highlighting the benefits of ongoing vaccination programs.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. • Pulmonary function tests have been used traditionally in
the preoperative assessment before any major surgery.
• GOALS OF PFT
– Determination of any significant impairment of lung
function.
– Degree and severity of impairment
– Characterize any pulmonary dysfunction physiologically
as obstructive or restrictive
3. – Identify the site of airway obstruction
– Evaluate the risk of procedures on lung
– To assess prognosis and response to bronchodilator
therapy
– Evaluate airway hyper-reactivity .
4. To identify patients at increased risk of morbidity and
mortality, undergoing pulmonary resection
To wean patient from ventilator in icu.
Medicolegal- to assess lung impairment as a result of
occupational hazard.
Epidemiological surveys- to assess the hazards to
document incidence of disease
5. Patients with chronic pulmonary disease.
Smoker.
Patients with dyspnoea on exertion ( noncardiac).
Patients with chest wall and spinal deformities.
Morbidly obese patients.
Age > 70 years.
Patients undergoing upper abdominal surgeries.
Patients undergoing thoracic surgeries.
Presence of respiratory symptoms such as cough
and wheeze.
Patients requiring PFT
6. Limitations of tests:
The maneuver is highly dependent on patient cooperation and
effort, and is normally repeated at least three times to ensure
reproducibility.
Since results are dependent on patient cooperation, FEV1 and
FVC can only be underestimated.
Spirometry can only be used:
On children old enough to comprehend and follow the
instructions given (typically about 4-5 years old), and
Only on patients who are able to understand and follow
instructions - thus, this test is not suitable for patients who are
unconscious, heavily sedated, or have limitations that would
interfere with vigorous respiratory efforts.
7. Where are PFTs done?
In the clinic
At the bedside.
PFTs done at the bedside are called bedside PFTs.
PFTs done in the clinic are done using various types of
spirometers.
8. Various types of bedside PFTs performed are as
follows:
1. Snider’s match blowing test
2. Forced expiratory time
3. Seberese’s single breath count
4. Seberese’s breath holding test
5. Cough test
6. Debono’s whistle test
7. Wright’s peak flow meter
8. Spirometry with pocket sized spirometer
9. 1. Snider’s Match Blowing test
Mouth wide open
Match held at 6 inches or 15 cm distance
Chin supported
No head tilting
• No head movement
• No air movement in the room
Match stick and mouth at the same level
10. Can not blow out a match
MBC < 60 L/min
FEV1 < 1.6L
Able to blow out a match
MBC > 60 L/min
FEV1 > 1.6L
11. Modified Snider’s test
3 inches MBC > 40 L/min
6 inches MBC > 60 L/min
9 inches MBC > 150 L/min
2. FORCED EXPIRATORY TIME
After deep breath, exhale maximally and forcefully & keep
stethoscope over trachea & listen.
NORMAL FET : 3-5 SECS.
FET < 3 Sec (Restrictive lung )
FET > 6 sec (Obstructive lung )
12. 3. SEBERESE’S SINGLE BREATH COUNT
Patients is asked to take a deep breath followed by counting
1,2,3……….. till the time he cannot hold breath .
Normal - 30-40 Counts
Indicates vital capacity
Shows trend of deteriorating or improving pulmonary
function in pre op & post op patients
13. 4. SEBARESE ‘S BREATH HOLDING TEST
Subject is asked to take a normal tidal inspiration and hold
breath
(N) ≥ 40 Sec
< 15 Sec is a C/I for elective surgery
25- 30 SEC - 3500 ml VC
20 – 25 SEC - 3000 ml VC normal value of
15 - 20 SEC - 2500 ml VC VC = 3100- 4800 ml
10 - 15 SEC - 2000 ml VC or
5 - 10 SEC - 1500 ml VC 60- 70ml/kg
14. 5. COUGH TEST
DEEP BREATH F/BY COUGH
ABILITY TO COUGH
STRENGTH
EFFECTIVENESS
INADEQUATE COUGH IF:
FVC <20 ML/KG
FEV1 < 15 ML/KG
PEFR < 200 L/MIN.
VC ~ 3 TIMES TV FOR EFFECTIVE COUGH.
A wet productive cough / self propagated paraoxysms of
coughing – patient susceptible for pulmonary
Complication.
15. 6. DEBONO WHISTLE BLOWING TEST:
MEASURES PEFR.
Patient blows down a wide bore tube at the end of
which is a whistle, on the side is a hole with adjustable
knob.
As subject blows → whistle blows, leak hole is
gradually increased till the intensity of whistle
disappears.
At the last position at which the whistle can be blown
the PEFR can be read off the scale.
17. 7. WRIGHT’S PEAK FLOW
METER.
: Measures PEFR (Peak Expiratory
Flow Rate)
Values < 200 L/ min in surgical
candidates suggest impaired
cough efficiency
(N) Males – 450 – 700 L/min
Females – 300 – 500 L/min
Zones
Green – Good control
Yellow – Caution
required
Red - Emergency
18. 8. SPIROMETRY WITH POCKET SIZED
SPIROMETERS
• VC & FEV1 Can be readily performed
19. What is spirometry ??
Spirometry is a measure of airflow and lung volumes
during a forced expiratory maneuver from full inspiration.
How to do it ??
- Stand or sit up straight (The patient places a clip over the
nose )
- Inhale maximally
- Get a good seal around mouthpiece of the spirometer
Blow out as hard AND as fast as possible and count for at
least 6 seconds.
- Record the best of three trial
21. PFT DONE USING SPIROMETERS
There are 2 primary kind of spirometers:
1. Primary volume measuring spirometers (PVM)
2. Primary flow measuring spirometers (PFM)
Procedure:
Generally, the patient is asked to take the deepest
breath they can, and then exhale into the sensor as hard
as possible, for as long as possible.
It is sometimes directly followed by a rapid inhalation
(inspiration), in particular when assessing possible
upper airway obstruction.
22. Sometimes, the test will be preceded by a period of quiet
breathing in and out from the sensor (tidal volume), or
the rapid breath in (forced inspiratory part) will come
before the forced exhalation.
During the test, soft nose clips may be used to prevent air
escaping through the nose.
Filter mouthpieces may be used to prevent the spread of
microorganisms, particularly for inspiratory maneuvers.
23. Primary volume measuring spirometers
A volume-time curve is generated, showing volume (liters)
along the Y-axis and time (seconds) along the X-axis
Flow is measured indirectly:
Flow = volume (lit.)/ time(sec)
They work by displacing or collecting volume of air in a
chamber of some kind.
Examples:
Water sealed spirometers
Dry seal spirometers
Bellows spirometers
Rotor spirometer.
26. Forced Vital Capacity (FVC):
It is the maximum volume of gas that can be expired, when the
subject tries to expire as forcefully and rapidly as possible
after a maximal inspiration to total lung capacity.
Most common PFT measured
It assesses deep breathing and effective cough
Values <15 ml/kg– increased post-op pulmonary complication
FEV1 (forced expiratory volume in 1 sec)
This is the amount of air that you can forcibly blow out in one
second, measured in liters.
Along with FVC it is considered one of the primary indicators
of lung function.
27. Volume Time Graph (spirogram)
The volume is plotted against the time, it displays the
expiration.
28. FEV1/FVC:
This is the ratio of FEV1 to FVC.
In healthy adults this should be approximately 75–80%.
This value is critically important in the diagnosis of
obstructive and restrictive diseases
29. FEF 25-75% (forced expiratory flow
25–75%)
This is the average flow of air coming
out of the lung during the middle
portion of the expiration.
Earliest indicator to get deranged in
obstructive airway disease.
Unlike FEV1 which is dependent on
patient’s efforts, it is independent of
patients efforts.
It represents flow through the small (<2
mm) airways.
N ormal value is 100 +/- 25% of
predicted
Approx 4.7L/sec
30. RESTRICTIVE Vs OBSTRUCTIVE
VALUE RESTRICTIVE OBSTRUCTIVE
DEFINITION Proportional decrease in all
lung volumes
Small airway obstruction to
expiratory flow
FVC N or slightly increased
FEV1 N or slightly
FEV1 / FVC NORMAL
FEF 25-75% NORMAL
FRC N or increased (gas trapping)
TLC
Mid VC flow NORMAL
N or increased (gas trapping)
31. Spirometry Interpretation: What do
the numbers mean?
FVC
Interpretation of %
predicted:
80-120% Normal
70-79% Mild reduction
50%-69% Moderate
reduction
<50% Severe reduction
FEV1
Interpretation of %
predicted:
>75% Normal
60%-75% Mild obstruction
50-59% Moderate
obstruction
<49% Severe obstruction
32. FEF 25-75%
Interpretation of %
predicted:
>79% Normal
60-79% Mild
obstruction
40-59% Moderate
obstruction
<40% Severe
obstruction
FEV1/FVC
Interpretation of
absolute value:
80 or higher
Normal
79 or lower
Abnormal
33. Primary Flow Measuring Spirometers
A flow-volume loop is generated, which graphically depicts
the rate of airflow on the Y-axis and the total volume
inspired or expired on the X-axis.
PFMs measure flow directly by using a pneumotachometer.
Volume = flow rate (l/sec)*time (sec)
3 primary types of pneumotachometer
Differential pressure pneumotachometer
Thermal anemometers
Ultrasonic sensor spirometers
35. The contour of the loop assists in the diagnosis
and localization of airway obstruction as different
lung disorders produce distinct ,easily recognized
pattern.
36.
37. ASTHMA :- Peak expiratory flow reduced so
maximum height of the loop is reduced
Airflow reduces rapidly with the reduction in the lung
volumes because the airways narrow and the loop
become concave
FVC may be
FEV1/FVC <50%
RV is markedly increased (400%)
38. EMPHYSEMA :- Airways may collapse during forced
expiration because of destruction of the supporting
lung tissue causing very reduced flow and a
characteristic (dog-leg) appearance to the flow
volume curve
39. Flow volume loop in Restrictive lung disease :
Full lung expansion is prevented by fibrotic tissue in
the lung parenchyma and the FVC is reduced.
Both FEV1 and FVC may be reduced because the lungs are
small and stiff ,but the peak expiratory flow may be
preserved or even higher than predicted leads to
tall,narrow and steep flow volume loop in expiratory
phase.
40. Fixed obstruction
1. Post intubation stenosis
2. Goiter
3. Endotracheal neoplasms
4. Bronchial stenosis
Maximum airflow is limited to a similar extent in both
inspiration and expiration
41. Variable extrathoracic obstruction:
1. Bilateral and unilateral vocal cord paralysis
2. Vocal cord constriction
3. Chronic neuromuscular disorders
4. Airway burns
• Forced inspiration‐ negative transmural
pressure inside airway tends to collapse it
• Expiration – positive pressure in airway
decreases obstruction
• inspiratory flow is reduced to a greater extent
than expiratory flow
42.
43. variable intrathoracic obstruction
1.Tracheomalacia
2. Polychondritis
3. Tumors of the lower trachea or main bronchus.
During forced expiration – high pleural
pressure – increased intrathoracic pressure ‐
decreases airway diameter. The flow volume
loop shows a greater reduction in the
expiratory phase
During inspiration – lower pleural pressure
around airway tends to decrease obstruction
44.
45.
46. CONTRAINDICATIONS
Hemoptysis of unknown origin
Pneumothorax
Unstable angina pectoris
Recent myocardial infarction
Thoracic aneurysms
Abdominal aneurysms
Cerebral aneurysms
Recent eye surgery (increased intraocular pressure
during forced expiration)
Recent abdominal or thoracic surgical procedures
History of syncope associated with forced exhalation