3. An Estimation Of Streams Of Air Of

3. An estimation of streams of air of type a loop-volume (analogue 1 = FEV1) Graphic record of simultaneously received Lung volume for the first second of the forced exhalation can be It is useful to full representation about a condition of pulmonary function, but Most precisely this indicator reflects a condition of obstruction of the top Respiratory ways. 4. Diffuzionnaja function of lungs. The condition of this function depends on qualities alveolar and capillary Surfaces of membranes, and as from a condition blood and Conditions of blood circulation limits of a small circle. This indicator Allows to estimate an effective alveolar exchange of oxygen and Carbonic gas with the external air environment. 5. Gases blood (the arterial!). Kislotno-alkaline balance and alveoljarno-arterial gradient on To oxygen can be calculated as And - (a gradient in room air) Can be estimated approximately as (150 - pCO2*1.25) - arterial pO2. This gradient And should be less than 9 for age of the patient of 20 years, And for age of 80 years - less than 24.

Haemodynamic Definition PAH Includes: - Average Pressure Pulmonary

Haemodynamic definition PAH includes: - average pressure pulmonary Arteries> 25 mm Hg; pulmonary capillary pressure of jamming (PCW), size left pressure or it is final Pressure left =15 mm Hg the item; and PVR> 3 units Wood'a. Research of function of expansion of vessels of a small circle of blood circulation ( vasodilator function) for patients with IPAH should be executed in The specialised centres with application calcium channels Long action for the future therapy. Contra-indications for the such The test obvious signs insufficiency of heart are Or haemodynamic instability. 6. The general scheme of treatment of patients from the Russian Academy of Sciences includes Diet, obligatory inoculations, vaccination and pregnancy prevention. Application operated therapies (Warfarin) It is recommended to all patients with IPAH. are used for Symptomatic treatment of overload RV in volume. Treatment by oxygen Recommend only at oxygenation of blood less than 90 %. 7. Courses intravenous (epoprostenol) improve physical patients, haemodynamics and Survival at IPAH illness forms that allows to recommend Exclusive choice of such treatment for the most difficult Patients.

2.7. A Minimum Quantity Of The Information For

2.7. A minimum quantity of the information for end of gathering of the anamnesis. 2.8. The general survey and a condition estimation. 2.8.0 Survey and heads and necks. 2.8.1 Person as an illness mirror. 2.8.2 Examples of skin signs on some illnesses. 2.8.3 Conditions of a hypodermically-fatty fabric and indexes of weight of a body. 2.8.4 Estimation of a condition of kostno-myshechno-articulate system. 2.8.5 Survey and the top finitenesses. 2.8.6 Survey and a thorax. 2.8.7 Perkussija of a thorax. 2.8.8 Auscultation of a thorax. 2.8.9 Surveys and kinds a stomach. 2.8.10 Definition of the sizes of a liver and a spleen . 2.8.11 Definition of the sizes of bodies of a belly cavity by other methods. 2.8.12 Survey and the bottom finitenesses. 2.8.13 Research of a rectum and glands 2.9. A fever syndrome, the theory and practical questions. 2.9.0 Types of fevers. 2.9.1 Inspection of patients at a fever of not clear origin. 2.9.2 Medicinal fevers. 2.10 Features of diagnostics of diseases at elderly patients.

P> 3 Mm 11111 Assignment Negative P In

P> 3 mm 11111 assignment Negative P in V1 QRS at wide S the Deviation axes in right S> R in I . R in V5 - V6 it is lowered in . V1 rs, Rs or rS Modern lines in diagnostics, preventive maintenance and asthma treatment On August, 30th, 2007 NAEPP have let out recommendations to a substantiation of the clinical diagnosis and treatment of a bronchial asthma. (EPR-3) The reconsidered criteria and Principles of a substantiation of the diagnosis of an asthma include and modernise Similar principles on conducting patients with an asthma the published Accordingly in 1991, 1997 and 2002 also represent new strategy For the control of signs of a current and asthma treatment. By this time Prevalence of a bronchial asthma in the USA makes approximately 22 One million person, including 6.5 million children and teenagers is younger 18 Years, and death rate from an asthma and its complications are estimated as in 4000 cases in Year. Under the aegis of NHLBI (national institute of health of the USA), the skilled group of 18 experts collected by committee NAEPP, Leads strict, regular annual selection and the review of the medical Literatures, the best offers and accessible recommendations in principles The control and treatment of patients with a bronchial asthma.

"The Smoking Termination - Unique, The Best Method

"The smoking termination - unique, the best Method and the most profitable way of reduction of risk of development COPD or Stops of its progression, "doctor Selli (the professor of University has told In Boston, Massachusetts). COPD - the term ordinary describing Chronic bronchitis and emphysema of lungs. It, as a rule, slowly The progressing illness of lungs characterised by gradual loss Functions of lungs and first of all with a tobacco smoking. A victim of it Voluntary suffering have the inflammatory answer in Bronchial tubes and a lung fabric in reply to harmful particles or gases from a smoke Cigarettes. Signs of an obstructive syndrome of lungs can include cough, or allocation even before function Lung starts to decrease. Features of the case record and researches of patients with an obstructive syndrome of lungs As much as possible full case record, lives, Family tree and research of the patient - corner stones The diagnosis an obstructive syndrome of lungs. An obstructive syndrome apnoe-gipopnoe Obstructive syndrome apnoe-gipopnoe (=OSAH) It is characterised by episodes of blocking of the top site of the air Lines and occurrence of barriers to a stream of air during a dream.

The Largest A Bosom (sinus Maxillaris) Settles Down

The largest a bosom (sinus maxillaris) settles down in a body of the top jaw and opens in Average nasal course. The steam room has the form truncated three- is more often or Tetrahedral pyramid; size left and right bosoms At one person can be various. In to a bosom Distinguish four additional deepenings, or bays (malar, Frontal, palatal and alveolar), which depending on degree bosoms can change its form and topographical Parity with surrounding fabrics. The frontal bosom (sinua frontalis) is in Frontal bone, has the form of a trihedral pyramid with the basis turned From top to bottom. It is divided by a partition not always occupying the median Position, on two parts; there are also additional partitions. Walls Frontal bosom sometimes have bone ledges and crossbeams, degree bosoms it is various. The bosom is informed with an average nasal Course. The frontal bosom can sometimes be absent. Klinovidnaja bosom (sinus sphenoidalis), located in a body bones, it is divided Partition on right and left (more often not identical) parts (in the separate Cases there are some partitions).

Now It Analyses Confirm DNA: Ours The Most

Now it analyses confirm DNA: ours The most distant ancestors were natives of East Africa and in each of Us are traces of "black" blood. According to the data which have been received Collective of the researchers, the headed E.Simonsom, The professional-anthropologist from the American University Djuka, considerable Brain development, and, hence, and intelligence, has come in a course Evolutions of people later, than considered earlier. A brain (a skull It is found in Egypt) it has appeared less assumed. lived On coast of Nile about 300 million years ago! All of them concern to To "generation" of the general primogenitors of modern people (and monkeys), but this The kind of the first beings has appeared a deadlock branch of evolution of the person, Is, among nowadays existing its animal descendants is not present. People (as nowadays Existing reasonable, and a number of the died out kinds) belong to Evolutionary branch including gibbons, orangutans, gorillas and Chimpanzee. About 40 million years ago from them monkeys have separated New World, for example Capuchins, , and .

THE MAINTENANC Introductio 1. The Historical Inquiry On

THE MAINTENANC Introductio 1. The historical inquiry on an origin of the person and formation of types of a constitution. 2. Classification of types of a constitution, feature of characters and behaviour. 3. A choice of the partner in a constitution for a continuation of the family. 3.0 Some rules of a choice of the candidate in husbands. 3.1 Separate recommendations for choice nominees in the wife. 4. Communication of a constitution, properties of character and behaviour of the person. 4.0 Evropeoidnaja race. 4.1 Mongoloidnaja race. 4.2 Value of wrinkles on a forehead 5. Influence of illnesses on character of the person. 5.0 Person as a mirror of illnesses of the person. 5.1 Definition of longevity on a constitution and other signs. 6. Features of manual patterns, lines on palms and possible properties of character. 6.0 Dermatoglifika and syndromes of illnesses. 7. Other ways of revealing of features of character and behaviour of the person. 7.0 Analysis of handwriting and feature of character.

This The Category Of Illnesses Includes Not Only

This The category of illnesses includes not only a bronchial asthma, sharp and Chronic a bronchitis, an emphysema, illness, but also Some kinds of a pneumonia, alpha-antitripsinovye of a condition and deficiencies, , and (cystic fibrosis). Exhaled stream of air at any of these Conditions it is reduced. The leading mechanism of changes of volume and speed Stream of exhaled air there can be a spasm of bronchial tubes, an inflammation Mucous bronchial tubes, increase in internal volume of a thorax and-or Reduction of volumes easy and air lines because of loss Elasticity of a lung. Use of lower threshold of the normal Indicators for FEV1/FVC the relation offered Global The initiative of Obstructive Illness of the Lung (GOLD) while has a number Lacks of a scientific substantiation also does not include a number of patients from both The ends of an age scale. Thus young patients by criteria GOLD Sometimes concern to "normal", when signs of an obstructive syndrome Are present. In the senior age group at a number of patients at Carrying out the obstruction of respiratory ways, when comes to light No barrier to air stream is present.

Thus Often There Is A Symptom "the Plentiful

Thus often there is a symptom "the plentiful One-stage "allocation . Superfluous allocation and Exhausting cough - frequent signs of a bronho-alveolar cancer (=). Foamy with a pink shade, - a hypostasis sign Lungs, with rusty inclusions, - the certificate Pneumonia. Other characteristics of cough - a cough Sound Low tone it is usually connected with the basic changes of the main things air Lines-throats, a trachea and the main bronchial tubes. Barking cough or a croup with Illnesses of a throat. Sudden, type of exclamations paroxysms of cough with Whooping cough. Night cough - with warm insufficiency, bronchial Asthma and a reflux. If food intake often causes Fits of coughing, - search for a diaphragm hernia, or a reflux. Radiological researches The direct And lateral roentgenogram of a thorax The roentgenogram () bosoms CT a thorax Laboratory tests (, IgE, , tests For definition of collagenic vascular illnesses, , infections) Tests according to pulmonary functions (, tests with , etc.

Thus, For Example, A Syndrome Chronic Obstruction Of

Thus, for example, a syndrome Chronic obstruction of lungs (= illness, = COPD), described in 21st The textbook on to researches of patients (the edition with 1957 on 1998 ), it is defined by means of 40 various signs. But recommended For use in practice receptions and symptoms for diagnosing COPD are very seldom accompanied by instructions of their accuracy, sensitivity Or specificity. Besides, one of these qualitative researches Signs and the symptoms, based on two groups of doctors of universities, Has shown that excessive hobby only criteria COPD results in 12 % in the erroneous diagnosis. It is thus revealed that only 4 parametres (1 - Pulmonary the anamnesis, 2 - a low arrangement of a palatal uvula, 3 - A tobacco smoking with the experience at 40 summer patients and 4 - age in more than 44 years) were as much as possible specific and important in diagnosing COPD. Total (99 %) patients with all 4-mja signs had Positive results, unlike 12 % of patients which had no Any of these signs.

In The Presence Of Bone Defect In Area

In the presence of bone defect in area Lateral walls bosoms its mucous membrane can To adjoin to a firm cover of a brain with area a sine, an optic nerve, an internal carotid. Clinically developmental anomalies are not shown, however at an inflammation of bosoms Nose they not seldom can promote development in orbital and Intracranial complications. Diseases. Inflammatory diseases of bosoms of a nose: - Sinusitis (sinusitis) can be sharp and chronic. (The Antritis, Sfenoidit, Frontit, Etmoidit) see. Allergic diseases of bosoms Arise, as a rule, against an allergic rhinitis (the allergic , ). In a clinical picture prevail Rhinitis symptoms. (The Rhinitis, allergic) see. Pneumosine - a bosom stretching (more often Frontal) air, arising when any Formation (for example a polyp or a mucous membrane) In a mouth plays a role of the valve passing air only in Bosom. In some cases the pneumosine can be caused atypically Proceeding at children's age a frontal bosom. Clinically The pneumosine can be shown by local morbidity in area Defeats, - bosom increase.

) At Research Of Streams Of Air As One

) At research of streams of air as one of the major functions of lungs should consider 1. The maximum forced volume of an exhalation for 1 second (FEV1) which should be repeated three times in 2-3 minutes. 2. To estimate lung volumes, the core from Which is (= TLC), thus if TLC <80 % follows To consider the reasons diseases of lungs. And at TLC> 120 % - presence of the diseases leading to an emphysema. Increase RV (Residual volume) and increase in parity RV/TLC mean Obstructive conditions. 3. An estimation of streams of air of type a loop-volume (analogue 1 = FEV1) Graphic record of simultaneously received Lung volume for the first second of the forced exhalation can be It is useful to full representation about a condition of pulmonary function, but Most precisely this indicator reflects a condition of obstruction of the top Respiratory ways. 4. Diffuzionnaja function of lungs. The condition of this function depends on qualities alveolar and capillary Surfaces of membranes, and as from a condition blood and Conditions of blood circulation limits of a small circle.

Pulmonary Pressure Upon An Exhalation And A Breath

Pulmonary pressure upon an exhalation and a breath Always lower at patients with fatness and hypoventilating Syndrome. Fatness considerably increases work of breath and manufacture because of the reduced interface of work of walls of a thorax And respiratory muscles. Excessive inquiries on oxygen from Respiratory muscles conducts to increase in efforts of breath and can To provoke and show others, connected with breath and warm Activity, illnesses. Despite the aforementioned physiological Infringements, the most important factor in development of a syndrome of hypoventilation at Fatness, possibly. Defect of the central mechanisms of interface in To respiratory control system of biomechanics. It is shown that at the such Patients speed of the answer to inhalations 2, or both is reduced These the answer simultaneously. Defects and thorax deformations At patients with deformations and uglinesses the chest Walls hypoventilation develops again in relation to the reduced To interface of work of a thorax to the changed respiratory volumes Lungs.

(LISTEN - To The Internet Of The Reference

(LISTEN - to the Internet of the reference to the sound Files in illustrations). Plevro-perikardialnye noise - Meets at Pneumonia pleurisy, heart attack of a lung, uraemia, tumour with germination in Pericardium, etc. Arise at simultaneous defeat of a pleura and Pericardium. Plevro-perikardialnye noise differ following signs : 1. It is audible at a breath delay (= ); 2. Amplifies at an exhalation; 3. It is localised in the field of absolute dullness. Maneuvers with breath and cough on a miscellaneous influence On , listened over area of lungs. Deep breaths and Intensity and timbre can temporarily change cough. (Listen under the reference cough in the end of the book). For example, The centres at and are constant And with cough do not vary. At stagnant warm insufficiency sounds can temporarily disappear after deep breaths or after Cough. Change of position of a body of the patient. At Warm insufficiency it is listened more often in Departments of lungs. Such is a serious symptom so Named chronic hypostasis of lungs and always demands the emergency Medical actions.

On Today The Most Frequent Choice In Such

On Today the most frequent choice in such cases, - a choice for transplantation Lung in the USA it is transplantation only one lung. Thus in All surgical procedures there is a potential risk pulmonary and Warm complications and it should be carefully considered and considered. Risk factors of type of a long tobacco smoking, the general status of health, Age, fatness and weight COPD should be attentively estimated also as also they are connected with the increased risk of postoperative complications. The reasons of aggravations approximately thirds heavy COPD, as a rule, are precisely unknown, but is more often they contact Infections, anatomic defects a tree and with Pollution of the air environment. Patients with aggravations of current COPD Test sudden appreciable strengthening and the increased short wind, strengthening Rattles, consolidations, in breasts, increase in production in a saliva, Cough, change of colour and properties , fevers, etc. Besides, Patients can often test a tachycardia, , an indisposition, Sleeplessness, weariness, depression, etc.

Insomnia At The Elderly Can Be Strengthened Stimulators,

Insomnia at the elderly can be strengthened Stimulators, type of caffeine which breaks a dream continuity, conducts To frequent awakenings also increases a dream waiting time. Follows To remember that the sharp termination of reception of caffeine can cause the excessive Drowsiness, irritability and depression. Nicotine as causes Fragmentation of a dream and insomnia. Often enough cause of infringement of structure Dream simultaneous use of many medicines acts. Usually At ageing comes to light a little diseases. Many The medicines ordered for patients of the senior groups can It is adverse to influence a dream, to stimulate insomnia and to cause Essential and numerous symptoms . Patients not seldom Use various schemes of treatment, vitamins and grassy broths and Still it is a lot of that another. Changes of architecture of a dream at persons of advanced age Increase Reduction Dream, waiting time REM in percentage Awakenings and 1 stage of switching * Efficiency c * Stage 1 and 2 ** Dream percent in a phase slow - waves Napping Amplitude of a dream in a phase slow - waves Advanced (phase) c Elderly patients not seldom have also a syndrome .

3.4 Urinogenital System (section 6 See) Http://www.davita.com/articles/ckd/; Http://kidney.niddk.nih.gov/kudiseases/ 2.3.5

3.4 Urinogenital system (section 6 see) http://www.davita.com/articles/ckd/; http://kidney.niddk.nih.gov/kudiseases/ 2.3.5 Other systems and bodies http://www.pkdcure.org/ 2.5 Preliminary forecast of a condition of the patient. After section "Complaints at receipt" The doctor should solve following questions: * conditions (The short-term forecast).* Definition conducting (=) a syndrome. ** Drawing up of the preliminary plan of sequence diagnostic and Medical actions. 2.6 General principles of gathering of the anamnesis and dialogue with the patient. Some councils about rules of dialogue with the patient: Speak accessible sick of language. Do not abuse terms. Give clear instructions and questions. Avoid ambiguous questions. Do not promise the impossible. Check, whether the patient has correctly understood you. Do not hesitate to repeat the important questions if see that the patient has not understood you. You should be assured that at the patient does not remain not resolved questions.

Auscultation. Vezikuljarnoe Breath Is Heard On All The

auscultation. Vezikuljarnoe breath is heard on all the chest To cage, in the bottom departments of a thorax it is transferred and heard more Soft than bronchial breath. The exhalation in these zones is slightly shorter and There is no pause between a breath and an exhalation. Intensity of sounds Breath above in departments of lungs in vertical position The patient in comparison with the top shares of lungs. Any casual sounds At healthy patients it is not listened. The term "Bronchial breath" - The term designating increase of a timbre of a sound phenomenon of breath. The occurrence reasons: 1) consolidation of a pulmonary fabric; 2) presence in Lung of smoothly wall cavity connected with bronchial tubes; 3) the opened , etc. breath Sounds listened on a course Traheo-bronchial tree are called as bronchial. These sounds are audible And over a lung fabric where they are imposed on sounds Breath. A unique place where the traheo-bronchial tree is close to To wall of a breast by an alveolar fabric, bronchial breath also is not surrounded It is listened brightly.

Additional Sounds Which Occur In Lungs And Air

Additional sounds which occur in lungs and Air lines, are mentioned as "casual" and are always wrong (but Are not always essential). (See Table) Adventitious (Extra) Lung Sounds Crackles These are high pitched, discontinuous sounds similar to the sound produced by rubbing your hair between your fingers. (Also known as Rales) Wheezes These are generally high pitched and "musical" in quality. Stridor is an inspiratory wheeze associated with upper airway obstruction (croup). Rhonchi These often have a "snoring" or "gurgling" quality. Any extra sound that is not a crackle or a wheeze is probably a rhonchi. Additional sounds at auscultation of lungs High tonality, often faltering in the end of a breath Rattles, dry The damp The other Rattles They in general will highly become giving and "Musical" in quality. A scratch - rattle inspiratory, connected with top Barrier of an air line (groats). Rhonchi They often have "snore" or "gurgling" Quality. Any additional sound, which - not crackling or Rattle - it is probable rhonchi.

Thus Three Variants Of Changes Come To Light

Thus three variants of changes come to light Stream volume-: (1) time inside a chest barrier, (2) time (Variable) out of a chest barrier and (3) stable barrier of the top Parts of an air line. Repetition of the test and reception of the identical Results at each measurement it is important because attempts of patients To forge pathological reduction of a stream of air do not allow To repeat the previous kinds of curves . Examples of kinds inside Pulmonary obstruction include including the limited tumours bottom Parts of a trachea or the main bronchial tubes, and changes of the air The lines connected with , etc. (sm of illustration Media File). Time inside chest barriers To air stream come to light to signs of reduction of a stream of air in Current of the forced exhalations at preservation of a normal configuration Stream on a breath. This sign is observed in the form of a plateau curve - in Wide range of a curve of volume on an exhalation (a curve volume-stream). Reduction of speed of a stream of air in such cases follows because of Narrowings of an air line in a thorax and, partially because of infringements Stream of the air line, exceeding inside laminar pressure of a stream of an exhalation.

Therefore, PaCO2 Increase As From Reduction VA, And

Therefore, PaCO2 increase as from reduction VA, and at all kinds hypoventilation of lungs. As space And a surface of alveoluses and also can work not effectively ( The age, etc.) increase PaCO2 conducts illnesses of bronchial tubes to reduction Percentage of oxygen with the subsequent . Alveolar ventilation can decrease, when The physiological dead space of lungs increases (that is, VD/VT A parity). The physiological dead space increases, When ventilation of lungs increases and it leads to infringement Parities blood and volumes of a stream of alveolar air. Increase in physiological dead space at hyperventilation Does not correspond in classical representation about mechanisms of infringements Functions of breath at patients with an emphysema and COPD. Effect of occurrence of the physiological dead Spaces at alveolar hypoventilation can be expressed in Following equation: PaCO2 = (k) (VCO2)/VE (1 - VD/VT). In which VE There is an exhalation volume, and (1 - VD/VT) a ventilation part, directly Involved in a gas exchange.

After Specifications Of Complaints And Careful Estimation Of

After Specifications of complaints and careful estimation of the anamnesis, including risk factors, In the presence of basic symptoms conduct additional researches of an electrocardiogram And blood analyses. (electrocardiograms). Additional researches, for example level Warm and other tests are spent depending on history Illnesses of the patient: Stress tests; Echocardiography; Computerized cardiac angiography CT scan Coronary catheterization is more detailed than sm - Angina Heart Attack Chest pains at Heart is included in leaves. Precisely As well as at a pleurisy, pericardium leaves can undergo To inflammation and to cause a pain. This pain is more often felt as sharp because of The signs of an inflammation of leaves of a pericardium rubbing about an external surface Cardiac muscle. The most frequent reason is connected or With virus disease or it is unknown (). Inflammatory The illness nature ( an arthritis rheumatoid arthritis, system red ), nephritic insufficiency kidney failure And cancer process - conditions which can cause .

Heterozygotic Mutations Within BMPR2 Have Been Identified In

Heterozygotic mutations within BMPR2 have been identified in Family the LOG and in sporadic cases also could be connected with TGF-Ѓ A gene. the LOG involves usually three main things The factor which bring the contribution to narrowing of a pulmonary artery. The first factor -vzokonstriktsija, resulting a disbalance and instability Between factors and in the pulmonary Blood circulation. Smooth muscles of vessels of a small circle and Quickly increases the sizes of cages and all it comes to an end Vascular channel. The second factor - balance infringement Curtailing-anticurtailing system which comes to an end the plural Intravascular thromboses also leads to increase PVR. The third factor - parity reduction to by the reduced manufacture nitrogen that brings the contribution in dysfunction. Thromboses Can be secondary in relation to changes , but Increase abilities, dysfunctions and Infringements at the LOG are accelerated by development of complications. It is necessary to remember that The laboratory estimation of a condition of the patient usually includes full the general The blood analysis, time, partial time, Hepatic tests and developed collagen and vascular Illnesses.

At Defeat Pleurae Pains Usually Do Not Carry

At defeat pleurae Pains usually do not carry an acuity and appear more poured. ( Illustration sm) In typical cases at occurrence pains in a thorax at the patient it is marked frequent Superficial breath, restriction of mobility of a bottom edge of a lung on To the defeat party. Quite often at an inflammation of leaves of a pleura it is possible To listen localised or poured (in departments) to noise Pleura friction. The last speaks that in departments Lungs respiratory excursion the greatest. Usually noise of a friction of a pleura Rough, as though scraping, it is listened throughout all Respiratory cycle, and its greatest sounding is shown in the end of a breath - The exhalation beginning. PLEURISY. The pleura inflammation is a consequence Many pulmonary and out of pulmonary diseases, including a pneumonia, Tuberculosis, heart attack of a lung, new growth. Pleural pains at Absence any and radiological signs Pleura defeats can be observed at the so-called epidemic (illness of Boriholma), at other inflammatory Diseases of a pleura of a virus origin, at patients with the system Diseases (in particular, at system red ).

From Calculations Follows That For Days The Person

From calculations Follows that for days the person inhales not less than 100 a dust consisting from Bacteria, the rests of insects, dry excrements of the person, animals etc. If the nature has not given to the person of the protective mechanism ( a road clearance) At such receipt of a dust in an organism, a life it would be impossible, and The weight of a body would increase daily on 100 - 150 gramme. A structure and systems of protection of the bronho-pulmonary device in to system It has developed and improved as multilevel system of protection from Many factors of an environment: mechanical clearing (nasal courses, Sine, Valdeerovo a ring , mucous tracheas and bronchial tubes). Waldeyer'a () a ring (illustration sm) - system Lymphatic glands and formations on an entrance aperture drinks (= a pharynx), Which protects and protects from penetration of external infections. Special attention, at survey of patients, especially with a pathology of bronchial tubes, I consider necessary to turn on degree of narrowing of a pharynx (illustration sm) and Nose bosoms.

- The Tests Noted With (++) It Is

- the Tests noted with (++) it is possible to jump over additional Test, if abnormality is not suspected. Reduced or asymmetric diaphragmatic excursion can specify a paralysis or emphysema. Has affected that "peak metre of a stream to an asthma, As the thermometer to a fever. "The peak sizes (measurements) of a stream Are used to measure gravity of attacks of an asthma and a trace Illness through any time. Ideally new readings are compared to a stream The patient "personal is better." It is less than reading than 80 % of "best" Can specify requirement for additional therapy. It is less than reading than 50 % can specify an emergency situation. Increased fremitus specifies a liquid in Lung. Reduced fremitus specifies sound (normal) transfer, Complicated by chronic interfering pulmonary illness (COPD), Liquid out of a lung (pleural outpouring), air out of a lung (pneumothorax), etc. #Whispered Pectoriloquy the rights there with borborygmi in The list of doctor Rat of favourite medical terms (terms).

Dream And Awakening Stages Are Traced () And

Dream and awakening stages are traced () and (EOG), that To define movement of eyes. For an estimation of a tone of muscles record is provided (EMG). Record EOG and EMG facilitate definition REM Stages of a dream which is connected with the reduced tone of muscles and the increased risk of occurrence of pathological attacks . Respiratory efforts of patients and other indicators are registered with Use of devices of type of the computer. Including in the complete set for devices for record enter during a dream of changes The sizes of a stomach and movements of a chest wall. These devices include Templates of pressure, the device of measurement of an impedance, single strips for Records EMG and air cylinders with the inductive for a breath estimation. Obtained during a dream of the patient the data on To distribution of stages of a dream, frequency of awakening, and can To be described in standard criteria (sm terms and specifications). The central and obstructive types can be differentiated on The basis of objective registration .

Initiatives On Training Of The Patient And Monitoring

Initiatives on training of the patient and monitoring Accompanying diseases, including vaccination from a flu and a pneumonia. Choice of possible surgical treatment Surgical procedures and type manipulations can be executed strictly selected patients with Serious stages COPD to improve functions of lungs and to reduce . Operational interventions on reduction of volume of the respiratory Lung surfaces (LVRS) to reduce giper - ventilation, Can help to improve respiratory function of muscles, elasticity of a lung and Indicators of norm of a stream of exhaled air. It is besides shown Improvement QoL and other indicators of life-support. Results Researches of National community of the USA on the Emphysema have shown that Survival of patients with an emphysema prevailing in the top shares of lungs, Increases, and survival rate more low after LVRS at primary localisation of an emphysema in the bottom shares even in comparison with optimum conservative treatment. Transplantation of a lung among specially selected patients with very late stages COPD can improve functional abilities of body and QoL Patients though the prize on survival terms is for the present doubtful.

) Chronic Productive Cough Typical Frequent Aggravations Of A

) Chronic productive cough Typical Frequent aggravations of a bronchitis Progressing short wind Presence of risk factors Variability of symptoms Can vary in different days Usually peak of infringements within night and the period of early morning Gravity of signs progresses slowly Deterioration is is more often connected and more brightly shown at early stages of illness, against physical activity and during the rest periods. The general accompanying conditions , and skin signs Bronchial illness of a gullet of Artrozo - arthritises Diabetes The case record and lives Family history on an asthma and fevers Noisy breath, rattle, cough, difficulties of breath and a thorax Illnesses of respiratory organs in the childhood, including a bronchitis History of a tobacco smoking and Secondary inhalation of a tobacco smoke, influence of professional factors / , environmental contaminations or a smoke from house devices and Kitchens Restriction of Streams of air at breath In the beginning astable and reversible indicators, become in due course less reversible with process synchronisation It is not enough (to 15 %) reversible, more often constant and progressing Anatomic changes Only air lines of bronchial tubes Air lines of bronchial tubes and lungs Given FEV1 © 80 % with the maximum variations PEF (™ 15 %) Increase PEF ™ 15 % after reception FEV1/FVC <0.

At Auscultation By A Stethoscope Can To Appear

At auscultation by a stethoscope can To appear easing of sounds of breath over this area, in the same place can To change a timbre a sound. (Pleurisy) Pneumonia (Pneumonia) Bacterial and virus infection of a lung Is called as a pneumonia, at which site inflammation The liquid exit in a pleural cavity in limits can cause pleurae Shares. Thus the pneumonia is represented typical signs of an infection: a fever; ; cough; a short wind and unilateral pains at breath height. (or ) a thorax SUPPLEMENT the diagnosis, Though the typical image of a pneumonia sometimes lags behind the clinical Results for one or two days! In addition can be used Blood tests to estimate weight of disease and its forecast. a pulmonary artery The clot of blood which is moving ahead to a lung for The fatal result can have the patient. Therefore one of the most serious Diagnoses which should be considered always by the doctor at pains in Breasts - a pulmonary artery (). Classical idea is had about displays pulmonary , pleural pains thus + fainting (syncope), character of a short wind (+ anxiety), cough with (coughing up blood =hemoptysis) bloody sputum.

Syndrome Of Alveolar Hypoventilation At Persons With Obstructive

Syndrome of alveolar hypoventilation at persons with Obstructive diseases of lungs (COPD) usually does not develop, if The forced volume for 1 (=FEV1.0) not less than 1 litre (or not less 35 % from due). The breath centres Densely and strongly regulate conditions of ventilation of lungs. Alveolar Ventilation (V) is under the constant control of the respiratory centres, Which are located in lateral departments of the top part of a spinal cord and parts of a trunk of a brain. The control of ventilation of lungs has Metabolic and nejro - components. Metabolic The component of fabrics receives chemical and nervous stimulus from the chest Walls and a lung depending on level 2 and 2. At a metabolism quickly there is an accumulation Considerable quantity of coal acid (carbonaceous = 2) in Body fabrics. The metabolism of fats and carbohydrates conducts to formation most Considerable quantity 2, which at connection with water of fabrics Forms coal acid (H2CO3). Lungs a changeable share 2 Through ventilation and consequently constant decrease pH () Fabrics does not occur.

In This Connection, Use Of Criteria GOLD Is

In this connection, Use of criteria GOLD is necessary for considering only in Complex with the clinical data. Estimation of convertibility of an obstructive syndrome When on it is confirmed or revealed Obstructive syndrome, it is necessary to spend and estimate the answer of the patient on Inhalation . ATS recommends for threshold increase The answer at least on 12 % (or 0.2 L) 10-15 minutes prior to record FVC or FEV1 to execute inhalations of a therapeutic dose . New standards GOLD recommend obligatory use 4 Inhalations (100 mcg everyone, i.e. =400 mcg a full dose) albuterol'a, Submitted through a spray. When there are signs and restrictions for Uses of preparations of this kind, apply lower doses or Use other receptions. The answer to inhalations Means (ipratropium bromide) can be estimated in 30 minutes after 4th inhalations (40 mcg everyone, i.e. = 160 mcg a full dose). Negative The answer to inhalations does not eliminate clinical advantages of application , and an affirmative reply on it is frequent Can correlate with the answer to therapy by steroids.

Further Estimate A Condition Of Humidity Mucous. If

Further estimate a condition of humidity mucous. If adheres on the mucous (sticks), it The dryness certificate in connection with a lack of production of a saliva (=xerostomia). Absence of a saliva under language, behind cheeks or between gums And a cheek is one of key signs of dehydration of an organism. After check of degree of humidity mucous a mouth, check up carefully Possible signs on damages. The approximate list of possible damages on mouth mucous membranes The description of damages The possible reasons and comments Painless ulcer Ploskokletochnyj cancer Plural painful small round Aftoznyj stomatitis (consider: Processes, stress, system , deficiency of vitamin B12, Inflammatory diseases of a thick gut or syndrome of Behcheta) Ulcers with rough borders System red , , virus illness Unilateral painful vials Herpes zoster Absent-minded painful vials and spots Herpes simplex Painful ulcers on throat walls Virus Coxsackie (= herpangina) , , , flat deprive? Red ? ? White stains Measles, viruses Coxsackie A-16, ECHO 9? White stains with (=leukoplakia) Usually caused by chronic irritation - it is typical For a tobacco smoking, often causes suspicion on Pigmentation, adjacent with a foreteeth the smoker White touch on a red basis ? Irregular line on on mucous cheeks The lines of Elba caused by an insignificant trauma of an oral cavity Lacy white stains on an internal surface of cheeks (Sign Wickham') Flat deprive? Dark stain, adjacent with the sealed up tooth Pigmentation from a tooth amalgam Pigmentation with Malignant ? Small red stains with central - a white point (a sign of Koplika) Measles? Check of salivary channels (tubules of Stensena) on mucous cheeks.

An Excessive Congestion Of A Liquid In A

An excessive congestion of a liquid in a cavity Pleurae can be caused also , observed at or a cirrhosis that speaks decrease in the vascular pressure. There is one more reason leading To formation pleural at pleural leaves, - It is obstruction of lymphatic ways of outflow. In this case the investigated The liquid can be characterised both as , and as . As on lymphatic vessels the drainage of fiber is carried out from Pleural cavity, its concentration at obstruction of the lymphatic Ways often it appears rather high, in spite of the fact that Permeability of pleural leaves is not broken. (Illustration sm) Rules in clips (look in illustrations) and the basic indicators of diseases under the analysis of a pleural liquid. More in detail sm - - (lung cancer, pneumonia, tuberculosis) (asbestosis) (sarcoidosis). americanheart.org. www.acc.org. In the following chapter we will consider some important problems of rehabilitation of patients with - a pulmonary pathology. 6. The conclusion and prospects What is a basis for restoration and rehabilitation at diseases of lungs (PR)? Pulmonary rehabilitation and restoration Overall objective of restoration of pulmonary functions Consists in lifting the patient to fullest medical, Emotional, social and professional (technically possible) The status.

Very Important Information On A Condition Of The

Very important information on a condition of the patient Can be received at inspection of an oral cavity and formula record Teeth. At all times was considered that a dental health Most precisely reflects a financial position of the person and a condition Some life-support systems of the person. For example consider that on The condition of the top and bottom cutters can judge quality of work of kidneys And systems, and also about a hearing aid condition The patient. Pathological processes in a liver and to system Are reflected in a condition of canines. Molars reflect quality of functions Stomach, lungs and a spleen. And on a wisdom dental health judge about Heart and intestines functions. Believe that skilled and inquisitive The stomatologist at early stages of illness can already suspect at the patient Intestines polyposes, , and variety of the congenital Diseases and syndromes. For example, a yellow touch on a teeth often Testifies to hyperfunction of adrenal glands (. , etc.). The grayish shade of a teeth often testifies to the functional And organic infringements of a liver and ways, and, sometimes, about Pancreas dysfunctions.

Gipomelanoz Ito (an Achromatic Incontience Pigment) - The

Gipomelanoz Ito (an achromatic incontience Pigment) - the congenital disease characterised The gipopigmentiro-bathrooms stains of the freakish form forming accurately The delimited drawings, strips and plaques on all surface of a body, Which remain during the childhood and disappear at mature age. To hypopigmentation do not precede an inflammation, Defeat, characteristic Bloha- Sultsbergera for a syndrome. (the got pigmentary defect) Arises at any age and it is characterised various under the form and To the size stains with a clear boundary, Localised on a face skin (round eyes and in the field of a mouth), in area Sexual , brushes and feet, elbow and knee joints, top Half of thorax. Skin elements can spontaneously disappear, There can be new stains, or is constant Progresses. 2.8.0 Palpatsija, , and other kinds of inspection of patients. There is a special system of the conditional Designations for a graphic representation of the data received at and easy (Ginara the scheme = (A.Guinard); sin.

Therefore Revealing And An Estimation And With Metastasises

Therefore revealing and an estimation and with Metastasises it is very important for patients with cancer formations. Cervical also are involved in development at . As Treatment for and metastasises of malignant tumours Are various, the exact differential diagnosis between two conditions very much It is important. also it is extended in the World as well as Acquired Immune Deficiency Syndrom (AIDS). Therefore, the exact diagnosis also can render in this case Essential advantage ultrasonic scanning (ultrasonic). Images in an estimation cervical Because of its high sensitivity (98 %) and specificity (95 %) in Combination with fine cytology (FNAC) become all More popular. With use Doppler it is possible to receive the additional information on the cervical also . (PHOTO 5.1) (2-9). The following group at - , , axillary, elbow, and The popliteal. it is necessary to spend symmetrically and cautiously. Special Attention and step at survey, and I recommend to give To research of chest glands at men and women.

Not Seldom And The History Of A Life

Not seldom and the history of a life of the patient is connected with presence of one Or two smokers in a family. These constant wreckers of health Associates provide constant negative influence on members Families. The hereditary factors promoting displays - Pulmonary pathology recently are intensively studied. It is for example shown that an obstructive syndrome It is connected with provoking factors and components, where the cascade of the negative For an organism of events finally conducts to damage of fabrics. Various kinds of an inflammation of a respiratory path at patients with COPD Is the major provoking factor against genetic Damages. Influence of several thus affects Provoking factors and markers, including C-jet fiber, an alpha The factor tumours, interlejkiny - (IL)-8, IL-6 and hemoattraktivnyj-1 Fiber. Levels of many of these markers in whey Blood correlate with indicators of expressiveness COPD at patients, including Respiratory tests (FEV1), level , carried to a weight index Bodies, tolerance to physical activity, etc.

(Is More Detailed Than Illustration Sm) For Modern

(Is more detailed than illustration sm) For modern understanding of a syndrome of the respiratory Insufficiency should remember interaction mechanisms Dissolved in blood and cages of fabrics of oxygen and with Other electrolits. The maintenance of electrolits and in blood whey at Various syndromes and conditions it is subject to considerable fluctuations. Decreasing pressure of oxygen (Rs 2) in small dependence from The reasons conducts to fast changes in buffer in cages Organism. For example maintenance reduction on 1 mEq leads To change of balance of bicarbonates and power failure (and maintenances) Oxygen in blood from 1 to 1,3 mm Hg. Reduction in blood whey Bicarbonates causes changes balance and in Intercellular space. Through any time, nephritic mechanisms Level kislotno-alkaline balance, allocating or holding Bicarbonates. At chronic (2) plasma bicarbonates Decreases approximately from 0.4 to 0.5 mEq on L for everyone 1 mm Hg a column, That conducts to reduction in arterial blood PO2.

Not Aggressive Superfluous Ventilation With Some Increase Of

Not aggressive superfluous ventilation with Some increase of pressure of oxygen or air (is more detailed than sm NIPPV), Though it is not considered as a standard method of treatment for patients with Chronic , it can be useful to some patients with the serious Chronic . NIPPV Operated through a mask, it is useful to prevention of the sharp respiratory Insufficiency approximately at 56-77 % of patients at an aggravation of current COPD. Besides, use NIPPV allows to reduce duration of stay of patients in chambers of intensive treatment and death rate in hospitalisation. Reduction of influence of risk factors Prevention of influence of risk factors persistently It is recommended for all patients with all stages COPD. The termination Tobacco smoking - the most effective at cost and results means Reductions of negative influence COPD for terms of a life of patients. It is necessary To remember that gradual decrease in function FEV1 is normal Process of ageing of an organism. However, this speed of decrease it is strong It is accelerated at patients with syndrome COPD which smoke.

The Final Alveolar Dead Space Is Invariable, But

The final alveolar dead space is invariable, but The parity of volumes VD/VT is increased because of the reduced volumes of a breath and Exhalation. One of the most frequent reasons of deformation of a thorax - , at which. There is a reduction of vital capacity Lungs and reserve volume of an exhalation, while residual volume It is reduced moderately. Feature of this type of hypoventilation is that, What is the patients is usually long (to last stages of illness) Are compensated or , even in cases with serious Defects of a backbone. muscular infringements Patients with muscular infringements and Disorders usually have the reduced vital capacity of lungs and Decrease in volumes of the reserve exhalation, connected with secondary weakness Respiratory muscles and diaphragm. Residual volume of lungs, as Rule, it is not changed. Reduction of volumes of a lung and work interface Thorax muscles can lead secondary and To reduction of elasticity of a pulmonary fabric. Besides, VD/VT the relation Often happens increased because of the reduced volumes of a breath and an exhalation The syndrome and hypoventilation leads to increase.

NO Additional Researches Of A Condition Of The

NO Additional researches of a condition of the patient More in detail sm Irwin RS et al. Am Rev Resp Dis 1990; 141:640. The algorithm does not apply for completeness of an estimation of a syndrome, and is only a variant of short interrogation of patients Short duration of disease in a combination with Fever assumes the virus or bacterial nature of cough. Slime running off on a back wall drinks - the usual reason chronic Cough. Character change , its colour or volume separated at The smoker with "cough of the smoker" demands additional studying (not less than 4-5 analyses) on presence of atypical cages. Professionally adverse factors in the anamnesis are characteristic for Professional asthma or defeats of lungs. Instructions On a repeated pneumonia are suspicious on , especially in Combination to episodes plentiful , especially purulent character. Change of periodicity of chronic cough, its wearisome character At smoking of cigarettes, allows to suspect a lung cancer. Complications Cough: 1) the Faint as a result of progressing reduction venous Inflow; 2) rupture with formation ; 3) Edge crisis can occur at the healthy subject in the rest.

More In Detail Sm - Respiratory System On

More in detail sm - Respiratory system On weight lungs and bronchial tubes make about 3,5 % from Body lump. They contain 16 % of fiber. Average time to a life floor Cages of lungs about 90 days. For comparison: a skin - 7 % from a lump Bodies 25 % of fiber from weight of body, and also contain 40 days time to a life floor Cages. For a complete recovery of a mucous membrane of bronchial tubes after Inflammations, damages it is necessary not less than 14 days, and for Segment restoration - more than 6 weeks. The important section of an estimation of a condition ways is definition of changes in additional bosoms of a nose (sinus paranasales; . Nearby nasal bosoms) - Cavities in bones of an obverse and brain skull, the mucous Cover and which are informed with a cavity of a nose and are resonators Voices of the person, and at infection or allergy hit are The tanks supporting an inflammation in bronchial tubes. To additional bosoms of a nose carry (), frontal, (basic) bosoms, and Also a trellised labyrinth.

Additional Testing - Tests Marked With (++) May

Additional Testing - Tests marked with (++) may be skipped unless an abnormality is suspected. Decreased or asymmetric diaphragmatic excursion may indicate paralysis or emphysema. It has been said that "a peak flow metre is to asthma as a thermometer is to fever. "Peak flow measurements are used to gauge severity of asthma attacks and track the disease over time. Ideally new readings are compared to the patient's current "personal best. "Readings less than 80 % of"best"may indicate a need for additional therapy. Readings less than 50 % may indicate an emergency situation. Increased fremitus indicates fluid in the lung. Decreased fremitus indicates sound transmission obstructed by chronic obstructive pulmonary disease (COPD), fluid outside the lung (pleural effusion), air outside the lung (pneumothorax), etc. #Whispered pectoriloquy is right up there with borborygmi on Dr. Rathe's list of favorite medical terms. The trachea will deviate to one party in cases (affairs) of intensity pneumothorax.

I Will Remind That There Are Following Additional

I will remind that there are following additional features, with presence OSAHS: 1. A neck circle: the neck circle than 43 cm at men and 37 cm at women is almost always connected with the increased risk of presence OSAHS. 2. Degree of narrowing of an entrance aperture in Respiratory ways (Mallampati): This estimation of degree of reduction entrance Apertures in respiratory ways many years, that are used To identify patients on a danger and necessity scale Difficulties at . Classification (illustration sm) Provides gradation from 1 4 on the basis of the anatomic Features of an input in an air line when the patient opens a mouth Or puts out language. 3. It is estimated as narrowing of lateral walls Input in an air path which is important independent The foreteller of presence OSAHS at men, but not at women. 4. Fatness. 5. A male. 6. Age. 7. A chronic tonsillitis about a hypertrophy, especially at children and young adults. 8. The alcohol use. 9. Kraniofatsialnye deformations (especially at not corpulent and children).

Thus, For Example, A Syndrome Chronic Obstruction Of

Thus, for example, a syndrome Chronic obstruction of lungs (= illness, = COPD), described in 21st The textbook on to researches of patients (the edition with 1957 on 1998 ), it is defined by means of 40 various signs. But recommended For use in practice receptions and symptoms for diagnosing COPD are very seldom accompanied by instructions of their accuracy, sensitivity Or specificity. Besides, one of these qualitative researches Signs and the symptoms, based on two groups of doctors of universities, Has shown that excessive hobby only criteria COPD results in 12 % in the erroneous diagnosis. It is thus revealed that only 4 parametres (1 - Pulmonary the anamnesis, 2 - a low arrangement of a palatal uvula, 3 - A tobacco smoking with the experience at 40 summer patients and 4 - age in more than 44 years) were as much as possible specific and important in diagnosing COPD. Total (99 %) patients with all 4-mja signs had Positive results, unlike 12 % of patients which had no Any of these signs.

However, Syndromes Of Chronic Cough And Superfluous Production

However, syndromes of chronic cough and superfluous production Saliva at any patient should be considered as obvious infringements States of health. And doctors should define principal causes The revealed deviations. The general principles of treatment COPD After diagnosis COPD is established, in The planned purposes of treatment should be included means of the help for Simplification of signs making heavier a condition, removal of restrictions, Illnesses promoting deterioration, improvements on increase Tolerances to physical activity of patients, prevention and treatment Complications, etc. Successful strategy for treatment and clinical Managements of patients with COPD should include measures for an estimation and the control Illnesses, reduction of influences of risk factors, the plan of treatment for achievement Steady phase of illness and tactics for management COPD at aggravations Illnesses. There is a set of aspects of the individual Treatments COPD which is possible only conditionally and approximately to standardise For all patients.

In Some Cases Signs Asthmas Can Be Caused,

In some cases signs Asthmas can be caused, inhalation of allergens - substances, Start trigger mechanisms of the immediate immune answer). Trigger mechanisms of the immune answer most often join at Hit in a respiratory path of a dust from pets, pincers, Cockroaches, soil or pollen of plants. Signs and asthma attacks can Also to be caused infections and illnesses of respiratory ways, inhalation Cold air, physical exercises, a tobacco smoke and others atmospheres, an emotional pressure, some kinds Products or allergies on medicines (drug allergies). For example, aspirin and others not steroid resolvents (NSAIDS) cause strengthening of attacks of an asthma in some patients. Under reports National Agencies behind health approximately 20.5 million Americans Now suffer an asthma. Many patients with an asthma have Long individual history of allergies, and it is frequent also a family allergy (allergies), type of a hay fever (an allergic rhinitis) or (eczema). (asthma and allergy - support group) Basic signs signs of an asthma include: * Sudden rattles on an exhalation * Periodicity of episodes of attacks and rattles * There can be an appreciable deterioration of attacks at night or early in the morning * Frequent coincidence of deterioration to colds, physical activities (Shortness of breath) and a heartburn * Not seldom an attack can come to an end spontaneously without treatment * Asthma attacks decrease with application * Cough with or without (Cough) * The short wind amplifying on a cold or at strong smells.

Ways Of Revealing Of Syndromes Of Diseases Of

Ways of revealing of syndromes of diseases of bronho-pulmonary system Complaints and questionnaires of an estimation of quality of a life As a result of a wide experience of use of questionnaires On revealing of symptoms of bronho-pulmonary diseases, it has been noticed that Such frequent symptom as cough can appear at various times (the early In the morning, at liftings from bed), in the beginning day to progress during Day, but seldom happens completely night. Chronic cough, usually Productive, it is often underestimated as a symptom, as It is considered as an expected consequence of smoking. Besides It is noticed that at an estimation of huge quantity of questionnaires on studying Chronic cough, doctors not seldom pass a syndrome at patients or crises of edges in connection with cough. at diseases of bronchial tubes on To the questionnaire data in great volumes departs in the morning, though and later Also separates during the day. This symptom proof enough and, as The minimum, mucous comes to light in overwhelming number of cases at Patients with a bronho-pulmonary pathology.

Presence Of Any Such Sounds Specifies In A

Presence of any such sounds specifies in a pathology more often. I recommend to listen in the beginning to the patient from the usual Depth and silent breath. If breath sounds clearly are not audible, Ask the patient to breathe deeply with an open mouth. Describe sounds Breath and sounds casually revealed thus. Pay attention on Intensity of sounds of breath, also compare their quality from both parties. Estimate length (=) a breath and an exhalation. Listen during a pause between Breath and exhalation and changes of quality of a sound thus. Compare Intensity of sounds of breath between the top and bottom part chest Cages, and also over back and forward fields of lungs in the vertical Position of the patient. Compare intensity of sounds over pulmonary fields, Representing mentally lung shares. Will pay special attention on Presence or absence of casual sounds. Listen to sounds at Breath imitations. lungs, The cores respiratory :1 (duration - is more breath, loudness on a breath - weak, Timbre on an exhalation - low, localisation - over a zone of lungs).

Use Besides Is Recommended Vaccines For Patients Are

Use Besides is recommended Vaccines for patients are more senior 65 years to reduce probability a pneumonia at patients with COPD. Therapy now Admits a key component of treatment for patients with COPD from 1st Stages to IV th. include , 2 - antagonists and , preparations. Last agents increase FEV1 through easing of a tone of the smooth Muscles in slizisto-podslizistom a layer of air lines of bronchial tubes and Create a necessary gleam at constant or worsening signs Obstructions. Though treatment can improve functions Lungs, partially releasing lungs from - hypoventilation, a short wind and Improves state of health of the patient, they cannot suspend or raise Quality of function of lungs and also do not improve the forecast of the patient. For patients with 1st stage COPD are appointed necessarily, only during the periods Displays of aggravations. For these purposes is better approach the short period of action (type albuterol and ipratropium). The Same preparations are more often used for maintenance The relative urgent help and liquidation of dangerous signs.

In A Mouth To Examine And To Describe

In a mouth to examine and To describe a dental health (is more detailed than sm in section 5). It is important to describe The form and skin of auricles, external acoustical pass. To all patients It is necessary to check up quality of hearing for each ear (distance Audibility speeches in metres, at healthy it makes nearby 6 Metres). * Features of a structure of a head and a neck, (on parts Heads come to light stains on a skin, dandruff, a peeling of a skin, etc.), character heads; ** On a neck it is necessary to estimate a condition of a skin, hypodermic Vessels to spend and to describe the sizes and density (Submaxillary, and cervicothoracic). (foto 5.1) Usually begin with definition of the sizes And density lymph nodes (=). find out Presence, the sizes and density (= a consistence) submaxillary and cervical (= ) . Metastasises in necks often enough Meet at cancer diseases of a neck and a head and other bodies. Presence of metastatic knot on one party of a neck reduces 5-year-old term of a survival of the patient on 50 %, and presence Metastatic knot from both parties of a neck reduces term of a survival to 25 % .

Signs Of A Pleurisy The Pleurisy - Accumulation

Signs of a pleurisy the Pleurisy - accumulation Liquids between layers of a pleura which covers a chest wall from within And a surface of lungs. The Sin.-liquid in a breast; a pleural liquid, and Other Organism makes a pleural liquid in small quantities, To grease surfaces of a pleural bag. Allocate two various Type of accumulation of a liquid in a pleural cavity: , usually caused by increase of osmotic pressure in a lung fabric (Congestive heart failure) and which are formed as a result of an inflammation, irritation or a pleura hypostasis. Syndrome . The code number MKB - Hydrothorax (511.8); and leaves of a pleura at The person form among themselves closed space containing in To norm a liquid small amount. Thus exist the steady Balance between a liquid arriving () in the pleural Cavity and absorbed from it. Transpleural transport of a liquid Is a part of the more general law - a liquid exchange between Intra- and extravascular spaces. In usual conditions a liquid It is filtered () by a pleura and it is soaked up on Other sites, leaving pressure in a pleural bag about 30 mm Water column.

-- Besides, It Is Necessary To Consider Signs

-- Besides, it is necessary to consider signs Depressions and-or anxieties which can specify in requirement in Corresponding treatment of these conditions. - other uncertain signs, snore type in Dream time, a thorax or a frequent morning headache. The tobacco smoking history is very important. The history of the smoker concerns the major risk factors for patients with Bronho-pulmonary pathology also should be in details described in the questionnaire. The detailed history of smoking is necessary with calculation of quantity of packs Cigarettes in a year (month, week, in day). So the general recommendations at biographical (as well as at ) inspection of patients with a bronho-pulmonary pathology Include: 1. Careful studying of the anamnesis. Infringements Breath of a pulmonary origin usually in an onset of the illness develop More gradually also it is reserved, than at heart defeat; but night conditions are equally frequent. 2. Interrogations about results the previous inspections usually Give the information confirming defeats of lungs or heart.

At Persons Not Having A Pathology Bronho-pulmonary System

At persons not having a pathology bronho-pulmonary System and a thorax respiratory excursions of a thorax Are symmetric and synchronous. Asymmetric expansion of a thorax Testifies to a pathology. The party on which it is located Pathological process, usually, extends less and lags behind at Breath from the healthy party. Any form of unilateral process in Lung, kostno - a muscular skeleton or a pleura can cause asymmetry Thorax movements. Character of increases, cambers of a skin in area poles indirectly testifies to expressiveness of an emphysema Lungs. intercostal intervals and intensity of muscles. compare sonority of fields of lungs and search Rattles (rashes) also define a parity of time of a breath and an exhalation Always carry out the short scheme of inspection Other systems of an organism. For example, hearts - listen to warm sounds And tones (definition of sonority, rhythm, presence and noise, etc.). Estimate a stomach condition - auscultation of noise of intestines and vessels of a belly cavity; Execute (superficial, deep and topographical); Finitenesses - research and an estimation of pulse a minimum in five typical points; -- Comparison of temperature of the top finitenesses and a trunk (a syndrome of "hot hands").

The Obstruction Of A Nasal Course Comes To

The obstruction of a nasal course comes to light if the patient is not capable To exhale through the right or left nasal course. An estimation of a partition of a nose. The nasal looks round Partition with the lighter, softly pressing a tip of a nose of the patient Thumb of the left hand. Light on a threshold (lobby) of a cavity of a nose The patient goes the right hand of the researcher. Usually, nasal The partition of pink colour in an average part also is not damaged. Usual deviations from norm at research of a partition of a nose include the following: The nasal partition is rejected from an average line; Presence red and mucous, which Assumes a sharp allergic rhinitis or an inflammation; Pale and The flabby mucous assumes a chronic allergy; Red colour and the dryish mucous Assumes frequent use and Means. -- The following step to nose research-transljuministsentsija Nasal partition for search of possible punching. A nose partition Examine on one party, and shine from other nostril.

Remember, That Only After Special The Patient It

Remember, That only after special the patient it is possible to start to To this kind of research. Revealing of roundish formations, consolidations in Chest glands demands additional questions to the patient ( "Oncological" questionnaires) and inspections (). Approximately to define the sizes of a thyroid gland Its uniform / non-uniform density. More exact characteristic The sizes and a condition and thyroid gland function it is possible to establish with The help ultrasonic or scannings and computer Tomographies. At neck inspection necessarily it is necessary to estimate a condition Pulsations of vessels - of carotids and veins see in more in detail Section 4 or http://www.pennhealth.com/ Condition of other sites of a skin - (to examine all sites of a body to estimate Colour, humidity, skin tourist's mountains, rash presence, , pigmentary Stains, hems (=), thickenings on a skin, etc.) and the visible mucous (Colour, humidity, etc.); - growth, weight of a body, proportionality Constitution, constitution type; - gait, a bearing and a pose in sedentary Position.

Each Layer Also Contains A Connecting Fabric With

Each layer also Contains a connecting fabric with e fibres, which Support to fibres. (PHOTO 6c) Skin changes are connected with genetics of the person, Environment factors, cosmetics, food structure, and others Factors. With the years an external layer of a skin () even If the quantity of layers of cages remains invariable. Number of cages , Containing a pigment, (=melanocytes) decreases, but for preservation Pigment increase in size. A skin, thus, Becomes more thin, pale and concerning transparent. Big the stains named age stains (synonyms - Hepatic stains or ) (see foto 6-1) appear, usually, on Back part of brushes of hands and other places opened to the sun. Changes in Connecting fabric of a skin reduce its elasticity (= solar , , etc.). Blood vessels become more Fragile that, in turn, conducts to raised fragility, , under a skin, etc. Sebaceous glands with the years Make smaller quantity of fatty components. The hypodermic fatty Layer which provides isolation and protection, . It Increases risk of damage of a skin and reduces ability to support Stable body temperature.

Egophony Ask, That The Patient Spoke "ee" Continuously.

Egophony Ask, that the patient spoke "ee" continuously. ++ Listen some symmetric areas on each lung. You should hear the muffled sound "ee". If you hear "yes" a sound, it is mentioned as "E->" or egophony. Notes For more information refer to A Guide to Physical Examination and History Taking, Sixth Edition by Barbara Bates, published by Lippincott in 1995. A prolonged expiratory phase (E> I) indicates airway narrowing, as in asthma. AP diameter increases somewhat with age, however, a round or "barrel" chest is often a sign of advanced emphysema. Notes For quantities of the information Address (concern) the Supervising principle (guide) to Physical To examination and History Capture, the Sixth Edition Barbara Bates published Lippincott in 1995. Long expiratory the stage (E> I) specifies narrowing of an air line, as in an asthma. Increases in diameter of AGENCY AP a little with Age, however, around or a breast (chest) of "barrel" - it is frequent Sign (signature) advanced emphysema. The trachea will deviate to one side in cases of tension pneumothorax.

The Dairy-matte Shade Of A Teeth Quite Often

The Dairy-matte shade of a teeth quite often It is connected with thyroid gland hyperfunction. It is known also that is yellow - Teeth gets brown colour at smokers and persons breaking rules Hygiene of an oral cavity. Zak (V.N.Zak's) sign, - puffiness in the field of a corner between nebno-jazychnoj and nebno-pharyngeal handles at a chronic tonsillitis. Sheja.-are palpated from both parties of a neck (foto 5.1), a consistence and the sizes of a thyroid gland (foto 5d1). (PHOTO 5d) (foto ). Pemberton'a A symptom - Patients with history of a multicentral craw have a short wind, With a hoarseness in a voice and episodes which it is progressive Worsened last months. The patient usually complains on in Throat also tests an asthma lying on a back. Fizikalnoe inspection Shows moderated , persons and increased a thyroid gland with the lowered bottom poles. When The patient lifts both hands above his head, strengthening is marked persons, strengthening mucous and venous drawing Scalp. Behind. To estimate a backbone and muscles.

Chronic Obstructive Diseases Of Lungs Tracheitis, Among All

Chronic obstructive diseases of lungs Tracheitis, Among all respiratory diseases an inflammation and lymphatic Valdeerova Pharyngeal ring meets more than in 10-15 % of cases. Thus to 50 % of patients with these diseases receive strong antibiotics and Anti-inflammatory preparations. One of the reasons of an inflammation drinks, throats and The top part of a trachea the group of bacteria with prevalence is a streptococcus of type And. In practice use a little The express train of tests by definition of features of microflora at diseases , drinks and tracheas. The most simple such tests are Rapid Tests for Streptococci [= Latex agglutination (LA) antigen tests] Overview of streptococcal throat infection; What is a rapid strep test?; Why is identification of streptococcal infection important?; What is the traditional test for strep throat?; Why is the rapid test better?; How is a rapid strep test done?; What are the limitations of the rapid strep test? Or Solid-phase enzymes test (ELESA).

Instructions On An Exact Site And Various Forms

Instructions on an exact site and Various forms of a dropsy allowed to differentiate character of noise. For example, such difficult diagnosis for those times as "a dropsy Pericardium "the doctor whom it is distinct could put confidently, only Heard sounds of presence of water directly in a pericardium cavity. In 1761, Leonard Auenbrugger - the doctor from Venice, has published a management on the technician and auscultations. Features revealed at a sound, Received at blows of a wall of a thorax and-or a stomach were Are characteristic for various pathological processes and fabrics. The known pioneer of clinical use and - The French doctor Jean-Nicolas Corvisart has written fine articles on at heart troubles. The special, unusual diagnostic Technics Jean-Nicolas Corvisart was bright and outstanding diagnostic Step of that time. In 1816, Rene Laennec (http://www.answers.com/topic/ren-laennec ), When still was student Corvisart'a and knew works of Bejla on , has invented a stethoscope which has made research chest Cage and a stomach of the patient much more convenient the doctor and the patient.

The Proof Limited Rattles Assume Presence Barriers In

The proof limited rattles assume presence Barriers in bronchial tubes of any aetiology of type of a tumour, a foreign matter or Mucous formation. Thus partial mucous blockade usually Disappear after any cough. (LISTEN - to the reference Internet on Sound files in illustrations) Rattles on a breath assume presence is more often The big barrier to an air stream. So loud, heard on distance Rattles on a breath name . (Listen to sounds under the reference stridor). Sick of a bronchial asthma often as have Sonorous rattles on a breath unlike patients with an obstructive syndrome (=COPD). High-pitch tone rattles are called as whistling or sonorous (listen under the reference sibilant). Low tone rattles are called as largely bubbly and sonorous (listen under the reference sonorous). a symptom (.Seitz), sin.-Zejttsa Changeable noise-auskultativnyj a phenomenon: change Damp rattle in the breath beginning bronchial or breath in The breath end; it is observed at presence in a lung of the cavity containing Air and liquid.

- Red, Weak Or Flexible And Wrinkled Ears

- Red, weak or flexible and wrinkled ears Speak about possible . This disease is characterised The sudden beginning unilateral or bilateral pains of auricles, Their hypostases and zone redness. -- At superficial infections of a skin, type , the skin of ears can be as is involved, but hypodermic The infections of a skin similar to a cellulitis, on ears do not meet (a sign ). - The anatomic defects of an ear caused by a trauma (Ears of fighters) are often presented as the thick, elastic painless Ugliness. - The diagonal fold of an auricle often offers the increased coronary risk. -- Presence of long hair in an ear bowl offers normal function at men (a sign of Hamiltona). -- Sometimes on auricles come to light Gouty , especially at persons who lived in a frigid climate (The low temperature of air reduces solubility of uric acid). -- Unique painless small knot on a lobe Ear can specify in defect the valve, as congenital Pathologies (=Darwinian tubercle). - The movements of an auricle coinciding with Pulse, offer defect of the three-folding valve of heart (not Constant sign Paul Dudley').

Then Examine Visible Nasal Structures And Pay Attention

Then examine visible nasal structures and pay attention to any changes mucous, cartilages and nose bones. Prominent aspect of an estimation of functions of a nose-paranazalnye Bosoms (sine) - the cavities filled with air and areas in bones Skulls which serve as resonators for pronouncing of sounds and Manufactures of protective slime with which the nasal cavity is greased. The frontal bosom is extremely individual on To the sizes also is in the bottom part a frontal bone. Verhnecheljustnye bosoms are for lateral to walls of a nasal hollow in Body of the top jaw. Trellised bosoms - between eyes and a nose, and a bosom in a body of the basic bone of a skull. Further check passableness of each nasal Course. Standing directly ahead of the patient also close one nostril The patient with a forefinger of the right hand. Ask the patient to breathe In usual rate through the right nostril. Repeatedly, closing the right nostril Forefinger of the left hand ask the patient to breathe through the left Nostril.

At Anamnesis Gathering, Concerning Unpleasant Or Conflict Situations,

At anamnesis gathering, concerning unpleasant or Conflict situations, follows: 1) more to listen; 2) to remain The quiet; 3) to calm the patient; 4) to be sincere; 5) to give To time sick enough; 6) to help council. Does not follow: 1) to be irritated; 2) To evade from situation discussion; 3) to be familiar; 4) too Many to speak; 5) to condemn participants of the conflict; 6) to be the patron. It is very important to make representation about Family tree of the patient to reveal and document possible congenital and Genetic defects and deviations. The best means at this kind Family tree drawing up is considered researches. After gathering of the anamnesis the doctor is obliged to allocate dangerous (for a condition of the patient and associates), significant (=) and little significant (= specific) for a concrete case symptoms and syndromes. Important after inquiry to construct the project of a ladder of value of symptoms and Syndromes (as the decreasing importance) for each concrete Case.

At Revealing Of Pulmonary Sounds Of This Kind

At revealing of pulmonary sounds of this kind Try to put the patient in kolenno-elbow position (position) and Again try to listen to sounds in the same zones over Lungs. Disappearance of sounds over lung zones Confirms stagnant (the warm nature such and rattles). At survey of a skin and mucous membranes of patients not seldom reveal signs The short remark on this common symptom: -purpurno a bluish shade Separate areas of a skin, mucous, lips and a special kind of nails. (Sm Illustrations). A clinical estimation of level and the nature (hypoxemia), As it is known, is very unreliable for following reasons: *, influencing display of this symptom it is a lot of, from a natural pigment of a skin before room illumination. * doctors Diagnose as the indicator when it it is real Is absent (that is blood of the patient has a normal saturation Oxygen). * seldom doctors do not reveal which is present. Auxiliary signs and Symptoms (for example, a tachycardia, , infringements Orientations of the patient) uncertain enough and any value in Reliable revealing do not bear.

Symptom Of Dushkova-Kisjakova - Stupid A Sound In

Symptom of Dushkova-Kisjakova - stupid a sound in the field of extensive and thick pleural imposings (Unions). At a raising of hands upwards clears up (but NOT at patients with a pleurisy!). Symptom of Shkody - over level at a pleurisy at patients with an emphysema of lungs. Korani-de Kampa a symptom (F. Koranyi, 1829-1913; O.de la Camp, 1871-1925) - Sound in the field of V-VI chest vertebras at increase Back . The symptom of Rudzitisa - at pronouncing by the patient of a melodious sound "And" over a zone a lung is listened wide "At". Syndrome of Aersa: 1) fingers in a kind Drum-type sticks (= Mari-Bamberga); 2) cyanotic ; 3) the expressed emphysema; 4) secondary ; 5) "the pulmonary Heart "; 6) a sclerosis of a pulmonary artery. (f3-6) Bekker's syndrome - skin of the top part of a thorax and a neck, the skin atrophy is sometimes expressed. Syndromes of consolidation of a pulmonary fabric: a symptom of Birmera - Shortening a sound at process in lungs in Vertical position it is defined more low, than in the horizontal; a symptom of Gerhardta - Change a sound at change of position of the patient, in lungs Which there are oval cavities or the cavities containing a liquid.

Usual Complaints And Algorithm Allocation Of The Basic

Usual complaints and algorithm Allocation of the basic syndrome and the questionnaire according to quality of a life Patients I result in last edition and the elementary variants of questionnaires for an estimation of some kinds of pains and diseases: Eye discomfort and redness; Vision problems; Nasal congestion; Sore throat; Headaches; Difficulty swallowing; Abdominal pain; Nausea or vomiting; Constipation; Blood in stool; Diarrhea; Shortness of breath; Dizziness; Chest pain; Heart palpitations; Wheezing Shoulder pain; Neck pain; Low back pain; Pelvic pain: female; Pelvic pain: male; Urinary problems; Foot pain or ankle pain; Foot swelling or leg swelling; Hip pain; Knee pain Headaches; Difficulty swallowing; Nasal congestion; Abdominal pain; Blood in stool; Chest pain; Constipation; Cough; Diarrhea; Eye discomfort and redness; Foot pain or ankle pain; Foot swelling or leg swelling; Heart palpitations; Neck pain; Shortness of breath; Sore throat; Urinary problems; Shoulder pain; Low back pain; Hip pain; Knee pain; Pelvic pain: female; Nausea or vomiting; Pelvic pain: male; Wheezing; Numbness or tingling in hands; Vision problems 2.

Accumulation, Superfluous Manufacture And Allocation Occurs At: Excessive

Accumulation, superfluous manufacture and allocation occurs at: Excessive manufacture in connection with change of the air environment; Changed physical properties ; Change of quality mucous bronchial tubes; Imperfect carrying out of calculations of quantity . Unproductive cough is usually connected with Irritation of respiratory ways also can be mechanical, chemical, Temperature, inflammatory and other nature. Complications at cough arise and Can be connected with persistent cough, the paroxysms stimulating Vomiting; and dizzinesses; an exhaustion; crises of edges; Anguishes of muscles and sheaves; crises of vertebras; the head Pain; spleen ruptures; expansion of veins of a gullet; The phenomena of stress, etc. Diagnostic features of revealing of sharp and chronic cough Sharp or chronic The sharp: virus or ljaringo-traheo-bronchial and at inhalation of allergen or irritating substance. The chronic: a chronic bronchitis (cough With within 3 months in a year not less than 2th years), , a tuberculosis, , an asthma, etc.

In 2006 Year In San Francisco Some Rules

In 2006 year in San Francisco some rules and definitions of definition of a condition (= a syndrome) are confirmed. http://www.emedu.org/simlibrary/UploadFolder/syncope.doc Exact identification of a condition syncope at patients is defined as 7 days repeating in a current a serious clinical case proved (sudden weakness). Sensitivity and specificity of rules of revealing under the report San Franciscos for a primary case have made 89 % (the confidential Interval of 95 %) and 97 %. Criteria of risk of sudden death in the presence of a syndrome under standards San Francisco Syncope Rule are Thus named and shown. The rule convincingly worked on all patients and was good sudden death. The risk of death on the first year after research settled down in a range From 1 % for patients without risk factors to 27 % for patients with three or Considerable quantity of risk factors. One of syndrome variants - Dizzinesses, are the general clinical syndrome which includes Also it is a lot of conditions of a various range on an aetiology.

The Form And Topografo-anatomic Mutual Relations With Adjacent

The form and topografo-anatomic Mutual relations with adjacent formations depend on their degree . Vyvodnye apertures bosoms are located in Medial part of a forward wall, is closer to its upper edge, and Open in a nose cavity at level of the back end of the top nasal Course. Trellised labyrinth (laburinthus ethmoidalis) Set of bosoms (cells) of the trellised bone informed among themselves and With a nose cavity. Allocate forward, average and back cells. Lobbies Cells open in average, back - in top, averages - in The top or average nasal course. Cells settle down in 3-4 numbers, Their quantity fluctuates from 5 to 15. Methods of research of bosoms of a nose. In diagnostics of diseases of bosoms of a nose use external examination, Allowing to reveal in the field of projections of bosoms, thresholds of an oral cavity and Hard palate a swelling, soft fabrics, , a fistula. With the help and estimate a consistence of fabrics in the field of a projection of bosoms, reveal their morbidity. Gives the chance to examine nasal courses and nasal bowls, to define Mucous membrane condition, character separated from bosoms.

The Chest Pain Can Be Initial, Primary The

The chest pain can be initial, primary The complaint and, often, demands detailed research not only chest Cages, but also all organism. Features with a chest pain syndrome can include researches of patients: Measurement of arterial pressure (BP), frequency Pulse (PR), frequency of breath (RR), a body temperature and blood oxygenation Oxygen (O2) At research of a head and a neck allocate Pulsation of arteries and head veins Stretchings of veins of a neck or their swelling, Listen to carotids and bulbs of carotids on presence of noise Thorax walls ( and ) intercostal intervals and intensity of muscles compare sonority of fields of lungs and search for rattles (rashes) and define a parity of time of a breath and an exhalation Heart - listen warm to sounds and tones ( Definition of sonority, rhythm, presence and noise, etc.). A stomach - auscultation of noise of intestines and vessels of a belly cavity; - superficial, deep and topographical; Finitenesses - research and an estimation of pulse a minimum in five typical points; Comparison of temperature of the top finitenesses and a trunk (a syndrome of "hot hands").

Symptoms Can Be Absent In Rest And Appear

Symptoms Can be absent in rest and appear only at the physical To loading. 3. Research of a condition of functions of external breath (). Defeats Lungs seldom cause breath frustration. If indicators of tests on Obstruction presence (1, 1/) or () are not lowered (<80 % from due), diseases of lungs can be doubtful. 4 estimation of function hearts. Emission fraction ( ) Left at diseases of lungs in rest and-or during time Loadings as a rule it is lowered. At ultrasonic heart scanning should be Are calculated pressure in a cavity right and the estimation is spent Conditions the device. Especially these researches are important at Accompanying pulmonary hypertension. Additional references under schemes of interrogation of patients - Nasal congestion; Chest pain; Cough; Difficulty swallowing; Shortness of breath. Cough and its versions Cough (-786.2) concerns the most frequent signs of disease of lungs. Cough is natural reflex reaction of a human body On any drinks, tracheas, bronchial tubes and, especially - Trachea site on a branching of the main bronchial tubes.

2-adrenergicheskih Receptors Antagonists And Stimulate , Influencing On

2-adrenergicheskih receptors antagonists and stimulate , influencing on 2-adrenergicheskie receptors, Located in smooth muscles mucous air lines. Excitation of these receptors increases production of the cyclic (AMP) which in turn forbid Bronchospasm. Recommendations about inhalation forms of preparations 2 -adrenergicheskih receptors are cautious, because Forms of preparations have slower beginning of action and, as a rule, Are connected with the big range of action (and complications!). Short Actions beta2-adrenergicheskie antagonists (=SABAs), type terbutalin'a And albuterol'a, it is often used as necessity to reduce Signs COPD because they operate faster and reach a maximum Effect soon after appointment also provide Effective approximately at 4-6 o'clock. Application terbutalin'a In high doses also have shown that is possible seriously To improve ventilation of lungs even at patients with late stages and Serious forms COPD. It is shown what to improve state of health at Patients with a short wind it is possible and with irreversible forms COPD.

For It Is Considered A Symptom Of Unny-Dare,

for It is considered a symptom of Unny-Dare, when at a friction stains or or after a touch to them of a warm subject soon There is a reddening and element swelling - it gets a kind. in a progressing stage can Periodically to disappear and appear again that as a result conducts to more To dark colouring of elements of a rash, up to brown colour of stains, and To increase in their number - from individual to hundreds. Disease regress Begins at the age of 6-7 years or by the period of puberty and It is characterised gradual and sometimes even by the permission Elements. Spontaneous occurs approximately at 50 % of patients in age, at 25 % the partial permission comes in the mature Age. System signs of liberation at (Incidental "inflow", a tachycardia, breath infringements, a headache, Intestinal , the diarrhoeia, a hypotension) are almost constant. Robert D Sweet'a the syndrome has been described as sharp Feverish 40 years ago. A classical picture Sweet a syndrome: usually at women without problems with health appear The raised, reddish, steady and painful damages of a skin.

This Symptom Proof Enough And, As The Minimum,

This symptom proof enough and, as The minimum, mucous comes to light in overwhelming number of cases at Patients with a bronho-pulmonary pathology. Colour change and it Volume always assumes strengthening of infectious process in bronchial tubes. The analysis of a progressing short wind (dyspnoea) by means of questionnaires has shown that through any time a short wind Becomes a constant with joining , and quantitative Definition of level of a short wind now usually spend with Use Modified Medical Research Council scale (see Illustrations). It is important to remember that at filling of the questionnaire of type SF-36 any of following conditions should be noted: - History of a possible asthma, an allergy, an infection and Illnesses of respiratory ways in the childhood or any other illnesses Respiratory ways of type of a tuberculosis, etc. - Family history of obstructive diseases of easy or other illnesses of respiratory system. - Any hospitalisation or long treatment of diseases of lungs.

The Semiotics - Arithmetics Of Medicine Also Includes:

The semiotics - arithmetics of medicine also includes: 1. A cognizance and-or revealing of symptoms and syndromes. 2. An estimation of quality, quantity and the importance of symptoms and signs. 3. Distribution (arrangement) of signs as their specificity. 4. A finding and communications of symptoms and signs. Thus it is necessary to remember that under one term, Symptom, syndrome different doctors mean sometimes the various Interpretation. Such terms are considered as typical examples: the Hypotalamichesky syndrome, the Arterial hypertensia, Allergic reaction and Other Unequivocal interpretation and understanding of symptoms, syndromes, accuracy in Choice of terms is a semiotics basis. In the more general space Human knowledge enters into section of Akribologija. It is necessary to notice that most Perfect system of communications between people now Music which contains only 7 notes, and volume of the information is considered, Transferred in this system, it is extremely great. It is a vivid example The transfer of the major information of the general property which are not containing Graphic and digital component.

Is Available Also The Characteristic Non-uniform Maintenance Of

Is available also the characteristic non-uniform maintenance of leukocytes in various parts Lung fabrics, including , and T-limfotsity (especially CD8 +). Obvious instability (type is marked which constantly destroys in norm a connecting fabric in Lungs) and (type alpha1-antitripsin). It is considered that proteazno/antiproteaznaja instability can cause process deterioration Inflammations of a lung also it is often connected with Genetic factors of the patient and environment. Thus processes (= pressure) as think, is important Component of speed of development COPD. More in detail illustration sm. Other important factor of development of an early emphysema Lungs - deficiency 1 (AAT) is important genetic Marker of development COPD. AaT-antiproteazy which show the protective Effect on a lung fabric, forbidding action which is constant In norm destroys a superfluous connecting fabric of a lung. Approximately 3 % of all patients with COPD have This factor. Initial displays at patients COPD with AAT-deficiency Occur on earlier periods of a life, than at patients without AAT - Deficiency.

As It Is Known, Age Of A Cage

As it is known, age of a cage and The certain fabric can define if to learn age of chromosomes - The genetic material which is in its kernel. And age of chromosomes It is possible to learn if to measure dynamics maintenances in them 14. It should be precisely same what was maintenance 14 in air at a birth of the given cage as chromosomes is the passport of the cage which have been given out to it on all life. Measuring concentration 14 In chromosomes, the group of scientists of the USA and Sweden has shown that some Parts of our body are much younger than others. So, for example, muscles The 30-year-old person have appeared twice more youngly him. In the same Experiments it has been established that nervous cages of a brain The same age, as the person have. Therefore it is possible to name a brain The computer, which components never or very seldom Are updated. The carbon maintenance in enamel of a teeth (0,4 %) more than in Other fabrics of our organism. Therefore, studying percent 14 In tooth enamel it is possible with a split-hair accuracy (Ђ1,6 years) to define date Births of the person.

The Uvula Assumes Infection Presence, A Syndrome Sleepy

The uvula assumes infection presence, a syndrome sleepy or illness Heavy chains (scale). The uvula redness is marked at virus and Bacterial infection. Classification of pathological changes of the palatal Sm uvula in illustrations. -- Nose research Estimation of a condition of a nose Nose research can give a lot of the valuable Information concerning the general status of health of the patient, including Identification of certain system illnesses. Besides, this estimation Will provide the doctor with the additional information on a condition respiratory Systems where the nose serves as body of warming, humidifying and the filter Inhaled air. Besides the nose carries out such major functions As definition of smells and development of antibodies. Outwardly a nose To investigate not difficult. Mucous a nose and internal structures of bosoms Can be observed with use of the special lighter (penlight) and nasal reflectors (speculum). -- By preparation of the patient for nose research it is necessary to explain All procedure to the patient in simple and clear to it terms.

Skin Changes At Motley Are Identical That At

Skin changes at motley are identical That at late skin , differentiate them on the various Reactions to treatment. Hyperpigmentation of a healthy skin is observed at Chronic nephritic insufficiency, primary a cirrhosis. At chronic deficiency of a food (, a syndrome, a syndrome , etc.) appear stains on a trunk skin. At a zone Pigmentation it is limited to the sites of a skin subject to influence Light or ; deficiency of vitamin 12 is accompanied Premature hair and , especially well Expressed round small joints of brushes. can be Treatment consequence , , , Aminazine, etc. Giperpigmentirovannye skin elements. Freckles (=), - the small pigmentary stains located at level of a skin on The person from both parties of a nose, on shoulders. Stains of larger size of colour Coffee with milk can be display and Recklinghausen at which are found out skin and Peripheral nervous system, a hypertensia, the premature sexual Maturing. Or the syndrome of "leopard" represents Autosomno-prepotent condition with distribution Dark brown stains in a combination with deafness, Growth backlog, heart diseases, anomalies of genitals.

Symmetry And Mutual Is Estimated Arrangement A Thorax.

Symmetry and mutual is estimated Arrangement a thorax. Smoothness of movements the chest Cages, presence or zones of the changed sensitivity, etc. (tactile fremitus ++ 05) () a thorax It is necessary to remember that for effective Thorax various technicians are applied. In the corresponding Managements four various ways are described to a measure. (Bates' Guide to Physical Examination and History Taking) Back part of a thorax (illustration sm) it is spent usually from top chest Cages (illustration sm), passing areas of an arrangement of shovels. Perkutornye sounds compare in symmetric areas and to the general The standard (stupid, box, normal). Further on Axillary (or axillary) lines find a zone a sound at equal breath of the patient also mark this point On the right and at the left. Then ask the patient to inhale deeply and To detain an exhalation for some seconds. define size Displacement of the dulled sound downwards also put the second mark. Further Ask the patient to exhale and hold the breath as much as possible on an exhalation.

Use The Biggest Reflector Which Will Be To

Use the biggest reflector which will be To correspond acoustical pass of the patient. Survey of the external Acoustical pass allows to reveal changes of a skin of the acoustical Pass and membranes. Research of the external acoustical channel In the beginning the condition of the right ear - is usually estimated Softly having pulled downwards and back for a lobe of an ear the left hand to straighten External acoustical pass and to examine it. Further at direct visualisation It is necessary to put . Originally pay attention to a condition of a skin of the external acoustical channel and check the following: * Whether there is no redness of a skin of the channel with white, Similar that assumes presence of an external otitis. * Red painful follicular formation that assumes a furuncle. * Brown adjournment assume an exit and drying of plasma of blood. * Blood presence in external acoustical pass (Channel) assumes a local trauma more often. It is necessary to remember that Falling or a serious head injury blood presence in the external acoustical Pass, can be a sign of crisis of the basis of a skull or parietal Bones.

Thus Doctors, Patients And Organizers Rehabilitations Should Put

Thus doctors, patients and organizers Rehabilitations should put the realistic purposes and understand that at Different patients these purposes are various. Treatment and an outcome of a condition of patients With COPD strongly depend on gravity of illness, the general installations and Motivation (status) of the patient which should be measured and estimated on To basis of special questionnaires of quality of a life (QoL), and not just Exclusively on degree of restriction of streams of air at measurement PFT. Additional general recommendations about treatment of patients c COPD 1 - IV stages In addition to the step-by-step scheme of treatment of patients with COPD to the approach there is a set of the general recommendations presented in recommendations GOLD 2006 which can be applied in treatment strategy. So it is offered and recommend, that all patients with COPD Have received an annual inoculation from a flu. Use of a vaccine of a flu Has shown that it reduces gravity of complications for patients with COPD On 50 and more %.

It Is Solved Were To Call Those Varangians,

It is solved were to call those Varangians, That lived in territory of Northern Germany and Northern Poland and Named itself . Thus, first "Russian" Rjurik with a team Has appeared on our earths in 859-862 years, rules of 14-15 years and veins in The site of ancient settlement - Novgorod yet was not. bequeathed Board on these earths to the relative Oleg, having left it on Hands of son Igor. Oleg as a result of the conflict to radical tribes Has begun movement on the south and has won at first Smolensk, then Kiev. In Conditions of political vacuum tribes began to be pulled together to a place Crossings of trading ways where there was Novgorod. Thus, "Russian" are a self-name of one of tribes. Precisely As there was a word "people" - so named itself . By the way, on a native language means "the present people". Physical mixture () different groups of mankind (both racial, and ethnic) Has begun in an extreme antiquity, proceeds and today. Uncountable migrations and ethnoracial mixtures occurred during an epoch The first great division of labour (III-II thousand BC), when tribes separated from the agricultural.

J. Of Respiratory And Critical Care Medicine) Assert

J. of Respiratory and Critical Care Medicine) assert that always It is necessary to start with the data of the World Organization of Public health services (WHO), When the help is represented as "aspiration to prevent And-or to reduce to (release) sufferings of patients from the early Identification (definition), estimation and treatment of a syndrome of a pain and Other types physical, psychological, emotional and spiritual Disasters, "" it is ideal, all patients using medical Or preventive procedures should receive and the help. Elements and intensity of this help should be strictly It is individualised and include interests of the patient and members of his family" The basic clinical recommendations in offers ATS (2007) following: * the help should be accessible To patients and it should be based on all stages of illness on Individual requirements, preferences of the patient and its family (The obligatory recommendation!). *, participating in diagnostics and treatment Patients with the chronic or started illnesses bronho-pulmonary Systems should be trained and capable to practical maintenance Totality of the skills recommended on the basis of requirements Competence on the palliative help.

Use Various Radioactive Elements Gives The Chance To

Use Various radioactive elements gives the chance to allocate the wide Range of pathologies with very high permission of a total picture in 2 And 3 projections. imaging techniques Still the big diagnostic possibilities opens MRI, allowing To reveal vascular both metabolic and other defects in fabrics. In Last years more and more wide application are found by practice , allowing to reconstruct the diagnosis, especially in area Gastroenterologies, cardiology, pulmonology and a number of other general Conditions. endoscopy Many of these researches extremely expensive and, that the exact diagnosis has been as much as possible balanced in the relation The price \quality for effective decision-making on treatment, are necessary Special standards, researches and algorithms. Aspiration to guess the diagnosis before inspection (no Time, reactants, equipment and .) - the most frequent reason of errors Directed by the diagnosis and, accordingly, in schemes of treatment of patients. (1) For example, the local doctor within a year meets probability of 95 % In total with 16 diseases: 350-400 times are a flu or (), 40-50 Time - an arterial hypertensia, 20-30 times - or a neurasthenia, 5-10 Time - , 3-5 times - a stroke and .

Dlmed.net.ru/standart.pdf Section 1. Broad-brush Observations To Classification Of Illnesses

dlmed.net.ru/standart.pdf Section 1. Broad-brush observations to classification of illnesses and signs 1.1 Terms the diagnosis and syndromes 1.2 Rather and . 1.2.0 Semiotics. Kinds of signs, them Sensitivity, specificity, diagnostic value and them The predictive importance. 1.2.1 Key rules of a choice of methods of research and an estimation of results. 1.3 Features of activity of the general practitioner. 1.4 Symptoms and the syndromes included in - 10 (the separate program). Section 2. A scheme breadboard model researches of patients. 2.0. Feature of psychology of patients (examples of questionnaires of interrogation). 2.1. Finding-out of the official data and definition of a leading syndrome. 2.2. Complaints of the patient their sorting and measurement of a syndrome of a pain. 2.3. History of development of the basic disease. 2.4. Interrogation on separate systems, (<questionnaires> an index of quality of a life). 2.5. The preliminary forecast of a condition. 2.6. The general rules of gathering of the anamnesis and dialogue with the patient.

Each 5 Years There Is An Updated Variant

Each 5 years there is an updated variant of edition In cost nearby 200$. In this connection I try to fill up mine Electronic editions new references and illustrations. www.proqolid.org/public/SIP.html Section 2 the Breadboard model of the description of the scheme of primary inspection of patients 2.0 Features of psychology of patients Experts on confirm: anything So does not change feature of character and the person of the person, as Chronic illnesses. Illnesses of kidneys always cause the general Organism intoxication. It conducts behind itself slackness, decrease in attention, Weariness, desire that all have left alone. The nephritic patient it is difficult To concentrate, force itself to work. The feverish are shown Mood swings, tearfulness. Aggravation of urolithic illness or chronic Pyelonephritises creates one more very discomfortable condition, about which And not to all relatives you will tell, - frequent desires in a toilet. It creates The general nervousness and even . Happens that the person at all Dares to leave the house, without having run some times "in a small way".