Caso clinico fisiologia pulmonar
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Transcript of Caso clinico fisiologia pulmonar
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CASO CLINICO
HGE
FISIOLOGIA PULMONAR Y VENTILACION UNIPULMONAR
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ETAPAS DE LA RESPIRACION
Intercambio de aire entre la atmósfera y los alvéolos pulmonares: VENTILACIÓN
Intercambio de O2 y CO2 entre el aire del alveolo y la sangre
Transporte de gases en la sangre (circulación pulmonar y sistémica)
Intercambio de O2 y CO2 entre la sangre y las células
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VALORACION PREOPERATORIALo mas relevante en estos pacientes son las
comorbilidades asociadas. Riesgo/Beneficio.Inicia con la valoración inicial de la HC, con énfasis:
Capacidad Funcional.Limitación en la vida diaria. Comorbilidades.Historia Cigarrillo o exposición ambiental.EPOC
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• Examen Físico (signos de enfermedad cardiovascular o pulmonar) Edema, hepatomegalia, cianosis, distal o central,
tórax en tonel, tercer o cuarto ruido o galope, desdoblamiento o reforzamiento del segundo ruido HTP – Falla Cardiaca.
Clasificar obstrucción y distorsión de la vía aérea: Lesión laríngea alta, Obstrucción mediotraqueal, Obstrucción traqueal baja y bronquial.
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BUN/ALBUMINA
• The National Veterans Administration Surgical Quality Improvement Program
- Albumina sérica < 3 g/dL- BUN > 30 mg/dL
…predictores estadísticamente significativos de complicaciones respiratorias
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• Cirugías cercanas al diafragma • (abdominal alta <CRF 65% por 9 días con
microatelectasias, shunt e hipoxemia)
• TORACOTOMÍA Y LAPAROTOMÍA SON DE ALTO RIESGO
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EVALUACION PULMONAR
• Principios: No hay un único test de FR con suficiente sensibilidad – Especificidad para predecir resultado en todo paciente de Cx. pulmonar.
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PREDECIR DESATURACION DURANTE AISLAMIENTO PULMONAR
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ANATOMIA TDL
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TDL DERECHO VS IZQUIERDO“El bronquio NO operado debe ser intubado”Anomalías anatómicas del LSDTDL izquierdos para “todas” las cx excepto:- Bronquio izquierdo con anatomía
distorsionada- Neumonectomía izquierda- Disrupción del árbol traqueobronquial
izquierdo- Transplante unipulmonar izquierdo
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CAMBIOS FISIOLOGICOS CON LA Cx
1. Disfunción diafragmática2. Disminución de la CRF3. Disminución de la CPT4. Disminución del volumen corriente5. Aumento de la frecuencia respiratoria6. Aumento de la diferencia alvéolo-arterial O2
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