My notes to myself from P-school. Mostly airway anatomy. There are some empty slides from things I haven't quite hashed out yet.

1. Pulmonary!
It’s German for a Whale’s Vagina

2. Very Important!
• Because not everybody is David Blaine

3. 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

4. Nozzle
These bleeds
need an ER, stat
Shove NPA here
These break when
punched in the face

5. Mouth
OPA will hold this
Put Miller blade here
Off of this
(so you can breath)
Put Mac blade here
Shove endotracheal tube here

6. These are your lungs on plastic
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
Hit this (the carina), and they’ll cough

7. Partial Pressures and Janx
Blood
Alveolar lumen (effectively atmosphere)
Simple Squamous Epithelium of Lung
Simple Squamous Epithelium of Lung
Actually, not atmosphere. That shit gets
quite humidified.

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

9. 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)

10. VQ Mismatch
Perfusion Problems
Ventilation Problems
Pulmonary Embolism
Airway Obstruction
If the oxygen carrying capacity of blood is not stymied, this model works

11. 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.

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

13. Pathogens
• Viral
• Bacterial
• Fungal

14. 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.

15. -itis = inflammation
 Sinusitis
 Pharyngitis
 Laryngitis
 Epiglottitis
 Larnygotracheobronchitis (croup)
 Tracheitis
 Bronchitis
 Bronchiolitis (RSV)
Given the stimulus, everything can be inflamed!

16. 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.

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

18. 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!

19. Rhonchi
• Like rales, but more bubbly than crackly.

20. 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

21. Pleural Rub
• From pleurisy/pleuritis
• Infection of the pleural lining

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

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

24. 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.

25. Everything
Laryngitis
Bronchiolitis
Sinusitis
Pediatric Epiglottitis
Adult Epiglottitis
Laryngotracheobronchitis (croup)
Bacterial Tracheitis
Streptococcal pharyngitis
Peritonsillar Abcess
Pneumonia
Tuberculosis
Hantavirus
SARS
RSV
Pertussis
Diphtheria
Costochondritis
Bronchopulmonary Dysplasia
Pleurisy
Emphysema
Chronic Bronchitis
Asthma
Anaphylaxis
Pulmonary Embolism
CHF Exacerbation
ARDS
Cystic Fibrosis
Non-cardiac Pulmonary Edema
Simple Pneumothorax
Tension
Pneumothorax
Flail Chest
Pneumomediastinum