Respirology

Dyspnea, PFTs, blood gases, and the failing lung.

Presentations

Dyspnea Hemoptysis

Ward cases

Breathless on the flat

A 68-year-old referred with a year of worsening breathlessness and an unhelpful chest radiograph.

Sudden breathlessness on the fourth post-operative day

A 66-year-old becomes acutely breathless walking to the bathroom after a hip replacement.

Too breathless to finish a sentence

A 68-year-old with severe COPD arrives grey and drowsy after three days of a chest cold getting the better of him.

Ready to go home, until the gas

A 71-year-old with COPD, day 4 of an exacerbation, is 'much better' and listed for discharge. The morning oxygen saturation is 94 percent on 2 litres, and she is sleepy.

Interpretation drills

Blood gasThe blue-lipped regular Blood gasThe asthmatic whose gas 'normalized'Blood gasThe retainer who got worse PFTSevere COPD physiology PFTILD physiology PFTA mixed defect PFTIsolated low DLCO FluidThe effusion that needs a drain AlgorithmPleural effusion pathway CompareAsthma vs COPD

Illness scripts

Pulmonary embolism

Tools & pathways

CalculatorAnion gap (with albumin correction)CalculatorWinter's formula CalculatorCalculated osmolality & osmolar gap CalculatorLight's criteria AlgorithmAcid-base disorders AlgorithmPleural effusion

Medications

drugInhaled bronchodilators

From the library

Frontal chest radiograph showing right lower zone consolidation — Right lower lobe pneumonia: consolidation at the right base with the hemidiaphragm silhouetted. Fever, cough and crackles have a picture.Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest: None Mikael Häggström, M.D.Consent note: Wri, via Wikimedia Commons · CC0 · source

Frontal chest radiograph showing a large left pleural effusion with a meniscus — A large left pleural effusion: homogeneous opacity with a meniscus rising laterally, the costophrenic angle long gone. Dull to percussion, and the pH question follows.Clinical_Cases: I made the photo myself, licensed under Creative Commons license., via Wikimedia Commons · CC BY-SA 2.5 · source

Lung ultrasound showing a normal A-line reverberation pattern — Normal lung ultrasound: horizontal A-line reverberations of a well-aerated lung.The POCUS Atlas (thepocusatlas.com) · CC BY-NC 4.0 · source

Lung ultrasound in viral pneumonia with an irregular pleural line and vertical artifacts — Viral pneumonia on lung ultrasound: irregular pleura with confluent vertical artifacts.COVID-19 Lung Ultrasound Dataset (Born et al.) · CC BY 4.0 · source