Respiratory Diseases and the Fire Service - IAFF

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Chapter 1-1 Anatomy By Dr. Carrie Dorsey, MD, MPH The main function of the lungs is to provide oxygen to the body and remove the carbon dioxide that is formed during metabolism. It is important to have an understanding of the normal structure and function of the lungs prior to discussing the diseases and injuries that can occur in the lungs. LUNG COMPONENTS The lungs are made up from a series of components all working together to support the respiratory effort. Bronchial Tree The lungs can be thought of as branching trees. The main airways into the lungs are the right and left main stem bronchi which branch off of the trachea. Each of these branch to form the bronchi which lead into the main lobes of the lungs. The right lung has three lobes and the left has two lobes. The airways continue to divide separating the lung into smaller and smaller units. The airways terminate at the air sacks known as alveoli. This is the primary site of gas exchange with the blood. As the airways divide they can be grouped into several distinct categories based on structure. The bronchi are the larger airways and are distinguished by the presence of cartilage in the wall and glands just below the mucosal surface. As the branches become smaller they no longer contain cartilage or glands. These are the bronchioles. The bronchioles continue to branch at last forming the terminal bronchioles. Distal to the terminal bronchiole is the respiratory unit of the lung or acinus, the site of gas exchange. It is composed of alveoli and the respiratory bronchioles. The airway walls of the respiratory unit are very thin, the width of a single cell, to facilitate the transfer of gases. The airways to the level of the terminal bronchiole are surrounded by a layer of smooth muscle that is able to control the diameter of the airways by contracting and relaxing. The smooth muscle cells are controlled by the autonomic nervous system and also by chemical signals released from near by cells. Alveoli The alveoli and respiratory bronchioles warrant further discussion given the essential role they play in supplying the body with oxygen. As discussed above the walls of the alveoli are thin and designed to allow for efficient transfer of gas with the blood. In addition they are an important site of defense against infection. Chapter 1-1 • Anatomy 11
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60 Chapter 2-3 • Tuberculosis: A
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72 Drug and Duration Isoniazid (INH
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80 Chapter 2-4 • Asthma to such a
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82 Chapter 2-4 • Asthma CLINICAL
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84 Chapter 2-4 • Asthma who has p
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86 Chapter 2-4 • Asthma Long-Term
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88 Chapter 2-4 • Asthma Table 2-4
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90 Chapter 2-4 • Asthma Treatment
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92 Chapter 2-4 • Asthma 21. Natha
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94 Chapter 2-5 • Chronic Obstruct
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100 Chapter 2-5 • Chronic Obstruc
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108 Chapter 2-6 • Sarcoidosis or
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110 Chapter 2-6 • Sarcoidosis Fig
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112 Chapter 2-6 • Sarcoidosis Oth
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114 Chapter 2-6 • Sarcoidosis pri
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116 Chapter 2-6 • Sarcoidosis WTC
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118 Chapter 2-6 • Sarcoidosis 18.
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120 Chapter 2-7 • Pulmonary Fibro
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132 Chapter 2-8 • Pulmonary Vascu
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146 Chapter 2-9 • Fire Fighter Lu
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166 Chapter 2-10 • Asbestos-Relat
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178 Chapter 2-11 • Sleep Apnea Sy
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192 Chapter 2-12 • Cough ACUTE CO
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196 Chapter 2-12 • Cough Gastroes
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198 Chapter 2-12 • Cough WORLD TR
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materials may produce smoke that is
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204 The effects of frequent smoke e
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the most intense exposure to air po
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seizures, coma and death64 . Additi
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highly water-soluble and, thus, wil
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Diagnostic Testing Initial pulmonar
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symptoms in an inhalation lung inju
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17. Musk AW, Peters JM, Wegman DW.
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42. Herbert R, Moline J, Skloot G,
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71. Kales S, Christiani D. Acute ch
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222 Chapter 3-2 • Inhalation Lung
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224 Procedure for Determining Appro
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groups have been identified to be a
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238 fever accompanied by mouth sore
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240 and Aspergillus species which a
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242 renal failure. Encephalitis and
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244 progress to severe, fulminant i
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246 may be present. A systemic dise
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248 one percent are primary pneumon
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250 gentamicin is recommended. In a
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252 9. Kilbourne E. Influenza. 1st
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254 44. Marik PE, Bowles SA. Medica
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256 74. Advisory Committee on Immun
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258 Chapter 3-5 • World Trade Cen
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262 Pulmonary function declines or
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268 (FDNY, NY/NJ consortium coordin
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278 Chapter 4-1 • Pulmonary Funct
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280 Spirometry results can usually
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282 of these conditions on spiromet
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284 Figure 4-1.4: Helium dilution t
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286 calculate a single-breath estim
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288 Chapter 4-1 • Pulmonary Funct
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Class 1, 0%-9%: No Impairment of th
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294 Chapter 4-2 • Imaging Modalit
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314 Chapter 4-3 • The Solitary Pu
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While most people are aware that sm
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332 Modified Fagerström Test for S
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334 nicotine gum, inhalers, or nico
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336 Common Reasons Fire Fighters Ex
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338 and while anyone can temporaril
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340 heart and lungs, increasing the
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342 your doctor, healthcare profess
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344 protection from tobacco craving
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346 cessation. The entire program i
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. drive, the neural control of brea
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350 Figure 4-5.2: The balance betwe
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352 TREATMENT OF RESPIRATORY FAILUR
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354 • Less discomfort Mechanical
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356 WEANING OR REMOVING A PATIENT F
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358 7. Esteban A, Frutos F, Tobin M
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International Association of Fire F
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