01 Pulmonary Anatomy

Lobes

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• RLL pneumonia

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• left: sharp angle

• vomit and then pneumonia: usually right sided

• supine: superior portion of right inferior lobe or posterior portion of right upper lobe

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• right PA: anterior to right bronchus

• left PA: superior to left bronchus

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• caval foramen: IVC

• esophageal hiatus: esophagus

• aortic hiatus

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• dyspnea: can't contract diaphragm to breath

• other side move down, push affected side up

Respiration

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• quiet: diaphragm sole muscle

• accessory muscles: in hospital, see pts contract neck/abd when breathing = respiratory distress

Respiratory tract

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• URI: does not involve lower respiratory tract (sinusitis, pharyngitis, etc.)

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• barrier to infection

Alveoli

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• clara: not in alveoli, in terminal bronchioles

Surfactant

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• surfactant: alveoli stay open when exhale

• Laplace law

• if pressure in sphere below distending pressure, alveoli collapse

• low sphere: small radius, distending pressure high, takes more pressure to keep small sphere open, also more likely to collapse

• when inhale, alveoli gets large; when exhale, gets smaller

• result: when alveoli need the air to keep open, air leaves, distending pressure gets high

• surfactant shrinks surface tension as radius falls during exhalation

• when exhale, surfactant molecules gets closer, concentration higher, reduce surface tension

• falling radius and surface tension offsets one another

NRDS

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• NRDS if not mature

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• hyaline: glass like, what alveoli looks like

• give O2: all goes to healthy alveoli, sick ones collapsed (shunting)

• high glucose from mother stimulate baby's pancreas to make insulin

• all related to O2

• bronchopulmonary dysplasia: hyperplasia and fibrosis of airways (exposing premature lung to high O2 concentration, O2 toxicity)