pulmonary janx
DESCRIPTION
My notes to myself from P-school. Mostly airway anatomy. There are some empty slides from things I haven't quite hashed out yet.TRANSCRIPT
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Pulmonary!
It’s German for a Whale’s Vagina
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Very Important!
• Because not everybody is David Blaine
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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
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Nozzle
Shove NPA here
These break when punched in the face
These bleeds need an ER, stat
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Mouth
Put Mac blade here
Put Miller blade here
Shove endotracheal tube here
OPA will hold this
Off of this(so you can breath)
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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
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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.
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Alveolar Epithelium in comparison to ECMO: do we do it better?
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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)
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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
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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.
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Infectious Etiologies
The Culprits:• Streptococcus• Staphylococcus• Haemophilus Influenzae• Respiratory Syncytial Virus (RSV)• Bordetella pertussis (Whooping Cough)• Corynebacterium diphtheriae• Influenza A-C
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Pathogens
• Viral• Bacterial• Fungal
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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.
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-itis = inflammation
SinusitisPharyngitis LaryngitisEpiglottitis Larnygotracheobronchitis (croup)TracheitisBronchitisBronchiolitis (RSV)
Given the stimulus, everything can be inflamed!
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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.
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Adventitious Sounds
• Rales = poppy crackles.• Ronchi = bubbly bong sounds.• Wheezes = continuous musical sounds.• Rub = dunno. Never heard it.
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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!
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Rhonchi
• Like rales, but more bubbly than crackly.
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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
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Pleural Rub
• From pleurisy/pleuritis• Infection of the pleural lining
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Stridor
• Not a lung sound• Made by narrowing of the larynx• Usually inspiratory• Almost always bad
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Stertor
• Stridor’s lesser known brother• The other upper airway sound• Known to most as snoring
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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.
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EverythingLaryngitisBronchiolitisSinusitisPediatric EpiglottitisAdult EpiglottitisLaryngotracheobronchitis (croup)Bacterial TracheitisStreptococcal pharyngitisPeritonsillar AbcessPneumoniaTuberculosisHantavirusSARSRSVPertussisDiphtheriaCostochondritisBronchopulmonary Dysplasia
PleurisyEmphysemaChronic BronchitisAsthmaAnaphylaxisPulmonary EmbolismCHF ExacerbationARDSCystic FibrosisNon-cardiac Pulmonary EdemaSimple PneumothoraxTensionPneumothoraxFlail ChestPneumomediastinum