Internal Medicine

P1: SBT

0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8

176 Asthma Atelectasis

■Most patients can achieve good control with no limitation of function

■Asthmatics appear to lose lung function throughout life at a rate

slightly faster than normals

■Chronic undertreatment may lead to nonreversible (fixed) airflow

obstruction (remodelling)

Atelectasis.........................................

THOMAS SHAUGHNESSY, MD

history & physical

Risk Factors

■Hypoventilation: impaired consciousness, obesity, supine posi-

tion, general anesthesia, postop splinting after thoracic and upper

abdominal surgery

■Hypersecretion: impaired secretion clearance, cystic fibrosis, bron-

chitis

■Cardiac: pulmonary edema

■Pulmonary: pneumonia, restrictive lung disease

Signs & Symptoms

■Tachypnea, shallow tidal volumes, hypoxia unresponsive to supple-

mental oxygen, consolidation on CXR, impaired cough and secretion

clearance

tests

■Atelectesis often diagnosis of exclusion based on history, exam, and

radiography

Basic Studies

■Auscultation and percussion: decreased breath sounds and tones

over affected area

■SpO2 <90% on supplemental oxygen

■CXR:

➣Blunting of costophrenic angle, heart borders

➣Consolidation with circumscribed edges esp at fissures

➣Shifting of cardiac silhouette toward affected side

Advanced Studies

■CT: well-circumscribed consolidation