By Hannahman, Mitchell, Cross
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Extra info for Medstudy The 13th Edition Internal Medicine Core Curriculum - Book 1
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When the plethysmograph is sealed, changes in lung volume are reflected by a change in pressure within the plethysmograph. Plethysmography tends to overestimate TLC because it measures all intrathoracic gas, including gas in bullae, cysts, stomach and oesophagus. The Weakness of the respiratory muscles causes a restrictive ventilatory defect with reduced TLC and VC. Comparison of the VC in the erect and supine position is useful because the pressure of the abdominal contents on a weak diaphragm typically causes a fall of around 30% in the supine VC.
Oximetry can reduce the need for arterial puncture, but arterial blood gas analysis is necessary to determine accurately the 36 History taking, examination and investigations PO2 on the plateau part of the oxyhaemoglobin dissociation curve, to measure carbon dioxide level and to assess acid–base status. you would expect given the level of ventilation (Pco2), or lower. This may be difficult to gauge, in which case the alveolar gas equation should be applied (Chapter 1). One can then determine if type I respiratory failure is present.
In right middle lobe collapse there may be little to see on a PA X-ray apart from lack of definition of the right heart border. This is a useful sign that helps to distinguish it from lower lobe collapse where the right border of the heart remains clearly defined. Left lower lobe collapse is manifest as a triangular area of increased density behind the heart shadow, often with a shift of the heart shadow to the left and increased transradiency of the left hemithorax because of compensatory expansion of the left upper lobe (Fig.
