Pulmonary!

It’s German for a Whale’s Vagina

Very Important!

• Because not everybody is David Blaine

Pathway of an O2 atom (assuming you’re not mouth breather)

• External naris -> nasal cavity -> nasopharynx -> pharynx -> vocal cords -> larynx -> trachea -> mainstem bronchi (either right or left)-> lobar bronchi (to each lobe) -> segmental bronchi (to each segement) -> bronchioles -> terminal bronchioles -> alveola

Nozzle

Shove NPA here

These break when punched in the face

These bleeds need an ER, stat

Mouth

Put Mac blade here

Put Miller blade here

Shove endotracheal tube here

OPA will hold this

Off of this(so you can breath)

These are your lungs on plastic

Hit this (the carina), and they’ll cough

Trachea

Left mainstem bronchus. Because it turns sharply, it’s much harder to accidentally get a tube down there.

Right mainstem bronchus. You’ll put a tube here if your overshoot the carina

Partial Pressures and JanxAlveolar lumen (effectively atmosphere)Bloo

d

Simple Squam

ous Epithelium of Lung

Simple Squam

ous Epithelium of Lung

Actually, not atmosphere. That shit gets quite humidified.

Alveolar Epithelium in comparison to ECMO: do we do it better?

Getting V to that Q

• A couple things you can alter• Rate (normal 12-20)• Depth (tidal volume .5 L, vital capacity 6.5L)• Perfusion (mileau O2 and CO2)

VQ MismatchA

irway

Obstru

ction

Pulm

onary

Em

bolis

m

Ventilation ProblemsPerfusion Problems

If the oxygen carrying capacity of blood is not stymied, this model works

Richard, in a box

• How long would it take, given a tidal volume of 500mL and a VO2 max of 50 mL/kG/min at rest, for a 69 kG fellow to equilibrate with his atmosphere?

• His atmosphere is 886L (average casket size) – 69 Liters (presumptive human volume) = 817 liters of STP air.

Infectious Etiologies

The Culprits:• Streptococcus• Staphylococcus• Haemophilus Influenzae• Respiratory Syncytial Virus (RSV)• Bordetella pertussis (Whooping Cough)• Corynebacterium diphtheriae• Influenza A-C

Pathogens

• Viral• Bacterial• Fungal

Trauma can do some shit, too

• Big concern is pneumothoraces. Broken ribs and flail segments can hurt like a bitch, but there’s not a damn thing we can do about them

• Latent problems like ARDS and pulmonary contusion can fuck with your ABCs too, but that will by PMH instead of HPI.

-itis = inflammation

SinusitisPharyngitis LaryngitisEpiglottitis Larnygotracheobronchitis (croup)TracheitisBronchitisBronchiolitis (RSV)

Given the stimulus, everything can be inflamed!

COPD – Marlboros and mining

• After lots of cigarettes, CO2 made a home in your lungs

• Arteries dilated and veins constricted, causing pulmonary hypertension

• Your atrium stretched and stretched until it fibbed and then failed.

Adventitious Sounds

• Rales = poppy crackles.• Ronchi = bubbly bong sounds.• Wheezes = continuous musical sounds.• Rub = dunno. Never heard it.

Rales

• Water in the alveoli (read: pulmonary edema)• Force the water over the alveolar membrane

into the blood to fix it• CPAP• You shall not pass!

Rhonchi

• Like rales, but more bubbly than crackly.

Wheezes

• Albuterol for wheezes, except cardiac wheezes.

• If it doesn’t fix it in toddlers/infants, it’s bronchiolitis (RSV).

• Not made by vocal cords! Occurs lower, you can hear it in the lungs

Pleural Rub

• From pleurisy/pleuritis• Infection of the pleural lining

Stridor

• Not a lung sound• Made by narrowing of the larynx• Usually inspiratory• Almost always bad

Stertor

• Stridor’s lesser known brother• The other upper airway sound• Known to most as snoring

Tension Pneumothorax

• This one’s an interesting balance of pneumatic pressures

• It’s lethal because when your mediastinum shifts, it tends to kink those all-important low-pressure great vessels known as the vena cavae

• And if you can’t get blood to the right atrium, you’re going to have a hard time getting it to the lungs and the left ventricle, where your really want it.

EverythingLaryngitisBronchiolitisSinusitisPediatric EpiglottitisAdult EpiglottitisLaryngotracheobronchitis (croup)Bacterial TracheitisStreptococcal pharyngitisPeritonsillar AbcessPneumoniaTuberculosisHantavirusSARSRSVPertussisDiphtheriaCostochondritisBronchopulmonary Dysplasia

PleurisyEmphysemaChronic BronchitisAsthmaAnaphylaxisPulmonary EmbolismCHF ExacerbationARDSCystic FibrosisNon-cardiac Pulmonary EdemaSimple PneumothoraxTensionPneumothoraxFlail ChestPneumomediastinum