Critical Diagnostic Thinking In Respiratory Care A Case-Based Approach

Gas exchanges are measured by arterial blood gas, carbon monoxide diffusion capacity and 131xenon scan.

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Recommended for nurses, respiratory therapists and medical students.

After completing this course, we recommend our second set of pulmonary problem solving cases.

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In the past few decades, there is an increase in the incidence of respiratory illnesses including asthma throughout the world.

Plethysmography and gas dilution techniques determine static lung volumes.

Plethysmography is an ideal method to assess lung volume, but is costly and time consuming(3).Spirometry measures the combination of lung volumes and provides adequate information about the physiological derangement of the lung.Hence, in clinical practice spirometry is the investigation of choice for the overall assessment of pulmonary function and is equated with PFT in day to day practice.Ventilation can be assessed by spirometry, peak flow meter, helium dilution method and body plethysmography.Perfusion can be assessed by radioisotope technetium scan, cardiac catheterization, and pulmonary arteriography.Auscultation skills are used as part of most of the cases as well as the assessment of the patient's blood pressure.These cases challenge each student ability to solve diagnostic and therapeutic issues based upon knowledge and patient assessment skills.Earlier, spirometers were of either rolling model or bellows type but the recent ones are electronic and fully automated using digital turbine and flow sensors that require no calibration.Though spirometry does not measure the individual lung volumes, it measures the forced vital capacity (FVC), which is a combination of tidal volume (TV) expiratory reserve volume (ERV) and inspiratory reserve volume (IRV).When respiratory muscles act additional reserve and additional volumes are accomplished (Table I). Lung volumes and capacities are shown by block diagram (left), spirographic tracing is depicted on the right.As diseases alter these lung volumes, measurement of it is helpful to diagnose pulmonary pathology. Spirometer Spirometers are instruments to conduct spirometry tests.

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