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Hello. Good evening, everybody. Who's there at the moment? I can actually see what the attendees like. If there are people out there, please keep just like one of the two. One of the tube. It's I've published just a double check to make sure that actually, I've not done something wrong has sent out the wrong link. Um, I go through the opening slides, the time being anyway, so hello, and welcome to our respiratory anatomy session. Week two of our anatomy, Siris, this is gonna presented by Dr Tim forced. Do you, Dr Working in the chest? I want to say it's also presented by calling the Caterpillar, but I think Colin isn't part of this. The tin might be able to correct me later about that fact. Um, as each week on their share that making the most obviously take notes. If you fancy taking notes, it's a really good way to help lock things into your head on learn, ask questions. You know, I think Tim, I think Tim's got a lot of interaction planned in this session, so you might not. You might not need to have too many questions, but please do ask them If you have any policy, can email me if you don't want to put them in the chat on, then if you enjoy any bets, please do contact us. We're happy to try and help support. You guys do things that you enjoy wise. Any queries? Email me. Follow us on social media as on, uh, keep an eye out for all. What's month serious? This month. We have case discussion on Here are the other netting sessions we have coming up this week. Oversee it is Tim with respiratory. We then have Doctor Hope next week with and Urinary. And with that, Tim, do you want to share your slides and all, uh, let yours take over? Uh, I'm not saying your slots, Tim. Starting to wonder if the you know. Oh, try now, But I was slide just for this. Uh huh. Uh huh. I can hear you. Oh, okay. Sorry. Yeah, I didn't have my headphones on, right. It's not saying you don't share your slides and then I can put your life. Ah, yeah, sure. Um, on shadows in Ah, it is great. If you share screen, I should have it appear in the bottom. Is content, and then I can let yours take over open share tray, I think will be the thing here. I sure you want to share. Uh um, So if I share that they got you're in charge now, okay? And I'll leave it to you, actually finding the chats. Any other questions, please put them in the chat. Otherwise I give you Doctor Tim Foster. Okay, let me turn my camera and so everyone can see any. All right, Slightly. If I updated, then you're camera. Appear. There we go. Now they can see, uh, brilliant s Oh, I can't see anybody else. So who else do we have in the meeting? Was having a few attendees dripping through, but it doesn't like to update the attendees regularly, so I can actually see when individuals join, But every now and then it randomly shoots up. Okay. In which case Hello, everybody. My name's doctor Timothy Forster. I have seen a doctor for a year and a half now. I graduated hilariously on April Fool's day of 2020. I promise it wasn't a joke on, but I'm going to be teaching about respiratory. I have to try. Make it a bit more interactive. I have a bunch of questions. Aysel the non. Um I've if you can I put into the chat a link to a, uh, question, uh, about a question on storing system called coot. If you could log in, put your pin in on day. Once we got a few people going through that, we can start doing some of the questions and get everything a bit. Ah, I've been a bit more fun. A bit more engaging, Uh, well recognized. We didn't recognize that. Game one for yourself again. 13782013. I know it's changed. I do apologize. It's Ah, 137 82 01. Your eyes changed, but there we go. That's their A one. Just 1378201. All right, so if I just clicked there does that Ah, showed up my screen. It's changed because it yet like the same thing, was my jet. It's brains. Sorry. Working with tec. You think I'd be better time right? S so ideally, it does watch Really worked best for many. If I if people you can turn the web cams on you don't have to turn on your microphone. Please don't turn on your microphone. There is just so I can see what I'm talking to. It allows me to kind of judge the level of the game I'm going to fast if I'm going to. Unfortunately, I think we can share participant Webcams through this set up so that you can have mine on the you'll be able to see me. Okay. Know that. But if if anybody does uh huh, that if anybody does feel I'm going to fast feel like I'm pitching too high, you don't understand anything. If you can pop your question into the chat, Freddie here will be able to pick it up on let me know. I'm therefore I can I can re explain where I can slow down. Or we could re go over whatever it is. Um, if Freddie just lets me know when I come to the end of a slide, and then we can re go through anything unless there's anything else Absolutely brilliant eso for the aims of injective we're going to be talking primarily about and that me to begin with. So we start with the upper airway in the lower airway Onda. Well, then combined that a little bit with the mechanism of ventilation, Richard, The movement of air I/O of the lungs on Relate that to the fusion of how we think of blood supply to the lungs have been back from for oxygenation on. Then go a little bit deeper. Go into a bit more of the actual medical side of things on talk about pathologies, which is diseases. We won't go too deep into it, but we'll have it to a level which is hopefully engaging for everyone involved. Sorry, this is the upper airway. Um, we're talking about the or Oh, Richard, your mouth and nose. Oh, which is your nose? So aro firings on nasopharynx are the connections which I don't know if you can see my mouse, but essentially behind the nasal cavity to difference and behind the oral cavity to the fountains and that connection in between I called the are other nights or firings. Uh, the primary roles of these points is wanted having an outside access, but also they will have lots of cilia, which are cells in order to trap any germs that might tend to to try and keep them out of the body as much as possible. Part of it can also be with the humidification off, which is going in so you don't dry out your mucus membranes. Ah, as you go into the body because it dried something that's meant to be wet and when it turns dry, tends to get inflamed and cracked and more prone to infection. The firings is the connection off all of the oral and nose Oh, carotid into the neck. And it's just above the bifurcation of this tube, which then forms the larynx on the esophagus. So by fication been splitting into on. Do you have the esophagus, which goes behind, um, batted Your gullet is your food pipe is what you swallow for Onda your trachea or Larry larynx. Ventricular is where your air goes through. The larynx has a special function in that is your voice box, which is formed with the turkey or cartilage, which you can see very well on someone like May on D. Generally, men will have a more prominent ah, tricky or cartilage in and woman I'm not sure what the evolutionary advantage was for that, I'm afraid, um Andi in here will be the voice box which controls how I'm doing this presentation to you below that you have to clear. Ah, which then leads down to the lungs. Now, I did have a question. We have four people currently in the ah, on Kohut. If there's anybody more to join, I'll give you another 10 seconds. I was I'm going to start it. I'm not sure if you'll let you draw in after that. Um, so five or 321. All right. In which case we would start it up on. But if you'll look at whatever you're using with the that your laptop, your phone, Um, we have the first question coming up now. You have 30 seconds. Uh, the question is, what structure blocks food from entering the lungs. All right, calm down, guys. Uh, very quick s. Oh, yeah. Um, so most of you got it right there. And the answer is the epiglottis, the epiglottis. If we look on our diagram on the if you go back, one page is what's it's above the larynx. So it's on the diagram on the right. So when you swallow this, uh, or activates the muscle, which pulls the epiglottis down and covers over your airway on. Therefore, this prevents you from inhaling food. Uh, on Dover matter into your lungs, which can cause something we call an aspiration. We can also, which men can lead to an aspiration. Pneumonia, Pneumonia. Being an infection of the lower airways on D is very, very bad. This kind of presentation tends to happen in people who've had a stroke or people who are particularly frail and their nerves are starting to give way. Such a people who have advanced dementia on people with other neurological issues as well, which prevents that muscle from being activated. Eso very well done. Unfortunate a person who wrote Who put the tongue? It's a very good guess. It is an absolutely very good guess, but unfortunately, the tongue Eisen in the right place to block it off that it's still part of the larynx leading forward into the oral pharyngeal space. So once it's past, there is unable to block anything very well done. Ah, for you. Look at the slides again. Uh, we even go into the lower airway. So we've gone through the mouth down the neck. Now we're at. If you want to feel upon yourselves, you have a little notch right in the middle of your chest in the middle of your sternum. Uh, physical. The angle of Louis. This is actually where you're trickier by Fick aids into your into your to bronchitis. So that's a little higher than most people think of this. Most people think it's a bit more down here on. So this is where the turkey it becomes hypophonic I the bronch I you have a left on the right and then further divides into the bronchioles. We've been further divides into the terminal sacs are alveolus axe on. Then at the end of these alveolus, actually then get the alveolar like the purpose off the check your bronch. I bronchioles are to support the lung structure on the lower effective air entry into. But the vast majority off the lung tissue will be from alveolitis, the connective tissue connecting all so alveolar, which are the endpoint. This is where oxygenation happened. So you breathe all of your air into the alveolar lie where it then meets the blood supply for a very, very fit membrane. So the name of the cells where we give for alveolar. What They're made thumb up off called squamous epithelial cells. So the very, very thin on this allows for better diffusion off oxygen across the membrane into the blood on D. So all they will be in that little cell and a little bit of fibrous tissue holding it all together, called the basement membrane on that allows us to pass the oxygen into the into the blood on their four, get transported away and around to the rest of the body, and that does for most, most of the lower airway. But part of it is also getting it all to work. So if we then go to the next question Oh. Ah, well done. Royal Rabbit to you were the first to answer. Uh, no, actually, we do this. So what part of the lungs has the best ventilation? So it's easier for the lungs to ventilate, meaning mawr air can get there easier. Ah, for those who are a little bit unsure, um, we often find that when people saw a one sedentary and looking all like that, it's ah, it's a bit harder to actually open a certain part of your rib cage. So give it a go. Get a question. You got three seconds left. Okay, so yeah, it's a what? Frilly in. Um, So hopefully you know what? The lungs are the lungs of what we used as part of our respiratory organs. Um, so, technically speaking, we should be calling the ventilator. The organs. Um, we can go into that later. I'm sure. Uh, so yes, The reason why. And I'm I promise you, I'm not killing. Why the upper airway The upper lobes of the lungs are better ventilated is because there's less tissue waiting it down. So with gravity, all of the tissue will essentially increase in mass is we get along. So the bottom of the lungs is like being at the bottom of a pile of people, and therefore, it's a lot heavier on a lot harder to move. But if you're right at the top of the pile sitting pretty king of the castle or queen of the castle Ah, and you've got a lot of ability to move a lot of room to move there for. It's a lot easier in this context for the lungs to expand on. Breathe. So we find with patients if they're laid up in hospital lying flat in a terrible body, positional curled over and awful, they actually aren't ventilating the bottom of the lungs very well on Daz. A result of it, it puts them at a much higher risk of developing an infection because they're not ventilating it down there for the mucus, which are lungs naturally produced, uh, isn't cleared a swell on because it's not ventilated, just kind of all stagnates. And anything that stagnates in the body tends to form an infection Unfortunately, so well done to the one person who got that right of wise. Hard question. Very well done. Thank you for it. For having it go. Well done. Majestic baby, You have taken the lead. So I thought just mentioned little bit more between the writing left lung. Eso The left lung is a little bit smaller than the right lung. The left lung has two lobes on the lingula, which is actually part of the superior, uh, lobe or the upper lobe. Uh, which overlaps the heart slightly on the fisher is just what connects these two lobes together on part of them being separated. Eye allows them to expand and be a bit more flexible. The right lung is made of free lobes. It's a bit bigger on their four. Has to fish is the oblique and horizontal fisher of leak separates out the upper lobe from the middle lobe on the horizontal separates the middle low from the lower lobe. Often interesting note. The, uh the main bronchitis, which is Ah, the May 1st, Splitting off from the takia Ah, is, uh, slightly mawr, uh, more vertical. So we'll branch off like that. The one on the right is a little bit more like this. Therefore, if you inhale something and it goes down into a long so you you accidentally inhaler grape or you've had an aspiration pneumonia. If you do a chest X ray, you're much more likely to notice an infection in the right lower lobe. As this is calm or clear path down into that long. So just a tiny little variants of masturbating. It does change how a lot of pressure and present good question here to him quickly in cue to why we get stitches when running. Why do we get stitches there when running? Okay, um so, interestingly, that's not actually to do with the lungs itself is to do with the muscles on Gwen. You're exercising. You are particularly using your respiratory apparatus. Eso. You have a lot of muscles there, which I believe I'll go into maybe in the next couple slides, if not our circle back on D, because you have so much muscle and it's so active. If you're not getting enough blood supply to that area. Ah, you enter something called an aerobic. Respiration rich, broken down just means without oxygen at respiration. When this happens. Well, the last thing we wanted our bodies not have any energy whatsoever. So we have mechanisms to, uh, compensate for that. And what happens is that you break down the sugar and carbohydrates you need for the energy, but you make a byproduct called lactic acid. Um, which then builds up in your tissues and as a result, changes a bit of the biochemistry because it's it's a phytic on. But we have, ah, we have a balance about how acidic we want our bodies to be on. So because that's our building up in the area, it changes the bitter, the chemistry and can irritate some of the nerves. And that's what causes a stitch. Uh, because you've got that buildup of lactic acid in that area. Therefore, when you breathe deeply when you stopped exercising, therefore you've reduced the amount of Ah, the demand for the oxygen. Ah, you convention solve work down your body content has a bit of time to break down that lactic acid. Andre, return everything back to normal. The dance to the question. Just go. Yes. For the time being, I have not seen a reply. But thank God it truly question three. Yeah, so we're going to question or Hello. Sorry. Ah, we'll get on the question three s. So let me just write this up so majestic Be Let's see if you can hold you leave So I might have mentioned it. Uh, why is the left lung smaller? Brilliant. Uh, Reverend Green, I do appreciate your answers. Ah, eso yes, the heartache. Substance pain. That is literally the reason There's nothing particularly special toe on. And, uh, that is why it is, uh, small. It's, uh, pure Purely Ah, spatial awareness Onda. Well, don't majestic be your roaring in top free, Correct answers in a row all of them. So ventilation. We're both going to put this all together. So if we just had a lot of that, we'd have no way of actually filling it. So what we need to do is about is to create a negative pressure. So in a sense off, when you open your hand like that, you can make a little bit of fun noise us. Ensure. When I'm doing this, I'm expanding a space, therefore creating a negative pressure, which then pushes air into that space, which is exactly what we do with our lungs. So when we breathe in reactivate are diaphragm, which is a big muscle, which under sits our lungs that will contract and therefore come down. It flattens out, which then creates a potential space. Create a negative pressure Grady Int, which then automatically draws long in drawers long in drawers. Aaron Tower lung Ah and brings it down. We have other methods of also bring it in. So we have the external into costal muscles, which sounds fund, but intercostal just means between the ribs on. So we have external intercostal muscles which are on the outside of our ribs, which when we bring in order to breathe in, lift up the rib cage. Hence why? When someone has a deep breath, you know said the rib cage goes up and out on part that it's related to the rib anatomy, which we don't need to go into numb. But essentially, when you just up here, you breathe in and all you notice is that's the upper part of the chest. Mostly mostly moved in when you look at the lower part of the chest which you can't see on my webcam. Ah, you notice If you breathe in, your lungs will go outwards like this. Friends well is up. We do know biologically. Ah that women tend to have more of a diaphragmatic breathing pattern. They tend to breathe more of their diaphragm on their four nights, so more of a shift of going down and then also tend to have more of a intto. Costal based once of the rib cage is tend to open up a lot more. This isn't a hard and fast rule. Of course, it goes both ways. We're not fact different in anatomy, but we do tend to notice fat is a, uh, theme. What I have put under there are something called the accessory muscles, so sometimes the intercostal muscles are very, very small. So it's one rib toe. One rib so they're not particularly strong on the diaphragm is very strong, but it is still only one muscle, and sometimes you need a little bit of extra help to breathe deeper and faster. You would have circumstances like this when you are for example, just out of breath. You just run to the shops and your bit out of breath. You need to catch your breath, and you really want to ventilate your long. It's hard it's possible on, but we'll also note of it. Notice this in patients, which are particularly more unwell. So there's various reasons why part of it could be could be because they have a chest infection. Other times, it could be because of getting narrowing after airways due to asthma or anaphylaxis, which is a severe allergic reaction. Or they have something physically blocking their airway, and they're choking on their four are responses to try and open that airway, try and get a fruit eso To do this, we have our abdominal muscles, which is the rectus abdominus so particularly if you're breathing I/O yourself, expand your abdomen and contracted back down. You have the sternal cleidomastoideus, which means sternum, which is here in your chest, Clyde. Oh, uh, God knows a mastoid, which is your, uh which is a bone up in your skull here on. So what happens? It's a buck muscle which connects right there on disease right on the neck. If you breathe in deeply, you might notice that these become a lot more pronounced. They are involved in the rotation of the head, but when acting together, combretum this part of the chest up therefore creating more negative pressure. And you also have your pectoral is your pecs, which your muscles on your chest on duration use ius, which are muscles which insert on your back right up here. Onda. So normally, if I'm resting like this, I can't actually activate my pectoral list or much. A page is what I need to do is plant my hands either on my knees are on in my chair on then I can use these to breathe in so the normal mastered off the Pexis to bring the arms to the chest. They move like this to PCs moves the arms like this. They shrug. And so what? I planned thumb down and don't allow my arms to move. The opposite happens because although all they are is connecting on what they're doing, it's the easiest movement. So my chest is not going to move when my arm could move. So if my arm stays still, uh, allows these muscles to vendor the reverse movement, So it pulls this out towards my arms and therefore allows me to breathe deeper. We got an activating these strong muscles. Well, multiple, the stronger someone like May ah to activate and open up the airways. So that's inspiration. Inspiration. It's just means breathing in. I don't know quite how inspiration became a term for inspiring someone, but if you inspired someone, I don't think you get very far. Sorry. Terrible anatomy. Um, the other aspect of inspiration. It's expiration, which is breathing out so the diaphragm relaxes The internal intercostal muscles contract as well, because of the positions will bring the ribs back in. Say, you find that you are actually able to convulsant terribly, contract some of your ribs when you really want to blow out as far as you can as much as you can. You will contract your abdomen. You'll contract your intercostal muscles on their four. Push out as much air as you can on that brings in the accessory muscles for when you want to do it a little bit extra. But on the most part, expiration can be entirely, uh, passive. Because when we breathe in, we create this negative pressure, which then brings a lot of air in without, really, then brings it above our normal atmospheric pressure. Therefore, if you just relax, all of the air will come out. Uh, well, not all of it, but most of it. We have a residual amount of there in the lungs which hold everything open. I've had just matches the normal atmospheric pressure because if we had to work so hard to open up our airways because if imagine there's no end there, Aaron, they're all of these airways with just constricting completely close. So then we got to open all of them up again, and that requires a lot of force, which we don't want to have. So unless there is another question we could move on to question for? You're good, I believe. Okay, so the next question Look, your devices, please. What membrane surrounds the lungs and allows for Use your ventilation? I didn't mention it. So this is more of a gauge mint of how much you guys know. Um, so do your best. Is no stress. It'll Uh huh. Very good. So we had two people who got it right. So it's something called the pleura s. So you have to pleura, um, which eso What the pleura is is essentially it's a membrane which surrounds the lungs. Event folds back on itself, form a little bit, see on, and is essentially like a little bag which surrounds thie surrounds the lung. And within it, there's little bit of just really fluid which lubricates the lungs with the chest. So when you grieve in, uh, you have this lubricated wall, which then allows for a smoother expansion on because it's not pulling against something directly allows a little bit of the week or room. It actually reduces the amount off force matted required to keep everything open, to talk through the other points. The alveolar lie is what's ventilation is ah, is what the end goal of ventilation is it is to bring aircrew DLV Oh, like to allow oxygen to pass across the membrane into the blood. Andre, the peritoneum is ah, a lubricating membrane which is found in the abdomen. So it's involved with healthy regulation of the gut. Very well done. I wish I could say who? All those questions right on Dwan dose storage. You have taken the top spot. Majestic be. You're gonna have to, uh, uh, get faster on the next one. Okay. Well done. Very well again, I what I just mentioned before that lubricates the space and five reduce the fours days required to expand the lungs. Ah, by the mechanism of having essentially a little bubble in there already ready to expand? Oh, question five. No break for anyone. So, what part of the lungs receive the best profusion? So perfusion is blood supply for those who don't know if the rich part of lungs has the best blood supply, if you need a hint, um, I mentioned that Thiebaud, um of the lungs are denser. Hence, we get better ventilation at the top of the lungs. Yes, Well done. More done. So the bottom of the lungs are denser, there's war tissue there. Therefore, there's more blood fair. And it's a simple as that theaters owns, while the best ventilated are not actually the best perfused. Ah, if you want the best matching, you go to the middle zones because you have a not the best, but not the worst. So you have a moderate level of ventilation on not the best, but not the worst perfusion there for a moderate. Therefore, they actually match very well in the middle lobe middle zones off the lungs. So but very well done. Uh, on one door, ostriches taking the lead. Well done. That effusion is Ah, it is clean. So important that we kept led to our loans that we have entirely one side of our heart dedicated to it. So deoxygenated meaning without oxygen, blood will enter the right atrium of the heart. Theeighties. Um, well, then contract. Bring it down to the right ventricle. The right ventricle is ah much bigger muscle on their four pumps that up to our lungs, this occurs via the pulmonary arteries. Pulmonary in medical speak just means lungs on, but this will then refuse away throughout our lungs. arteries become arterials become capillaries, which are the finished ah, smallest vessels we have. But because they're so small in there, so many of thumb, the surface area is much, much higher, which is also the point of the Alvesco life. Even though they're smaller, there's so much more of thumb. The surface area is so much bigger, therefore, allows a lot more diffusion off oxygen across from the lungs to the blood supply and also allows carbon dioxide, which is a byproduct of our aerobic respiration, too, then gets moved across into our lungs to then breathe it out. The capillaries taking the oxygenated blood will then get moved to the pulmonary veins, which in terms of anatomy arteries, anything leaving the heart, veins there, anything entering the heart. So the pulmonary veins. We'll bring all of that lovely oxygenated blood back into the left atrium. The mechanism for this is positive pressure from blood being pushed behind it from the right side of the heart, as well as the actual mechanism off. Ventilation helps move everything along as well, so breathing in and breathing out will motivate the bloods to keep things when it goes into left atrium. left. Other heart goes around the rest of the body as dictated by the arteries. Uh, leaving the heart. The as I mentioned, profusion is best of the bottom of the lungs. There is just more tissue for hence why it's better perfusion on D. We have something called a ventilation profusion Grady int, which is called of each You I don't know why profusion is Q. I do apologize. Um, but the ideal model is where you have perfect ventilation to perfect perfusion. Therefore, as much oxygen it you can get in is being taken away by the blood supply on. We have the blood continuously moving across the lvot lie. Ah, to always have the optimal Grady int off deoxygenated blood. Because the more deoxygenated the blood is, the more oxygen will go to it. So it's kind of like having really salty water on not a tall, salty water compared to very similarly salty water. Because the salt has essentially mawr room to move on. That same thing happens with oxygen. There's Mawr room for the oxygen to move to, therefore it will move into the blood. Better not having a continuous supply of deoxygenated blood on moving that oxygenated blood out the way allows you to oxygenate farm or efficiently than having it go there, fill up, move more. They continuous going, feeling, feeling, feeling, gone, going, going on a pill available in gone that's most better on hands. The point off perfusion, that continuous supply. And so, ideally, we want a match fat as best as possible. Therefore, we're getting the most out of our lungs per square itch off space. So we find one toe. One tends to be more in the middle zones on. Do you get more profusion? Therefore you get if we use 1.1 point zero is optimal. We'll get Lord 0.75 at the bottom on Van. If we're if we're at the top, will get greater than one. So we wanted a daily at one because then you're not wasting any energy. There are other things which cause a VQ mismatch, which is where you're getting an issue with ventilation or an issue with perfusion. So primarily you can have issues with ventilation going down rather than going up eso. If your ventilation is going down, you might have a obstruction. Something is stopping the air from getting to the long as you can imagine, this isn't a very good thing if it's in the upper part of the airway. We call this choking on. But if it's in the lower part, it tends to be as a result of. It can also be an obstruction. It can be an aspiration. It can be a pneumonia, which is an infiltration, a movement off inflammatory cells, which are body produces into the airways, which forms pass prices. Not lovely to think about, but I got a pneumonia is onda. These comprise vent airframe. Getting into those spaces, therefore, reduces the ventilation quota perfusion. You can have a sense in excessive amounts of blood going to somewhere when it's not any air, or you can have no blood go into that area, which can be from a hemorrhage or a clot, or you're just not getting a good amount of output from your heart. But that has more to do with heart disease and not the purpose off a lecture today that as you a little progress and hopefully you will to get into the medical field you want to, you will learn more and more about how all interconnected our bodies are and how one system affects another system affects another system on days. What makes medicine so wonderful? Eventually learned that the kidneys, soul function know they were at heart. Soul function is to pump blood to the kids. Have a question. They called you doctor Timber thing, which I quite like. I don't think I'll get away with calling you that very often. Uh, it's square inch and s unit, which I've gold. Apparently An S I unit Master International Standard Unit. Ah, we wouldn't particularly use the Internet eye unit for measuring lung capacity. You can. It is a potential move, but we wouldn't. We wouldn't, uh, use it as a standard way of explaining how the lungs work. It was more of a method that I used to choke. Teo, show that there if you had a certain volume off lung. Ah, how efficient it is. So if you to take one sample of the lung, uh, from, say, someone who has tons of all the airlines on, then, uh, take a sample from a lung from someone who, for whatever reason, hasn't developed out of your life. Um, that I would tell you about this person would be dead. Ah, you would find that the surface area within that square inch, um, would be so much higher in a regular person's lungs than someone who didn't have our viola, who had, say, one big balloon, uh, as the as their lung instead of multiple. Lots of little tiny balloons all stacked upon each other, all bubbling out. So it's that's folding off space, which therefore increases. Uh, the surface area I have balance is the question. I'm sorry if it confused Teo saying a square inch My mind more simple answer is the anatomy textbooks work in a very long time ago in inches were more normal back then. Oh, yeah, that's also very true. Well, they were in America where they still seem to love inches. Yeah. Yeah, You leave it a metric system. Ah, yeah, that's ah, that's well it you know. So I think I've got some another question coming up now. So if everyone's to return to the tab where they've got this open on D, so it's related to the to mismatching So which of these would cause a ventilation profusion? Mismatch Now have been mean because I have said a couple of things which might right slightly affected. But while I'm talking, it's a major effect. Very, very, very good. So I I did confuse a couple of view when I talked about past of the pneumonia. Generally speaking, the amount that you would put into their wouldn't significantly affect your whole lung ability to match ventilation and profusion on the amount in that area as well. It won't be like a swimming pool. It won't be completely full of past your heavy on. Well, if that was the case, it would be more like there is a coating around, maybe a little puzzle at the bottom of the alveola. So still a lot of air will be able to get into that part of the lungs and therefore ah, the blood supply and thie ventilation won't be significantly affected. But I did mislead you. I do apologize on that. Pulmonary embolism is a very fancy word of saying lung clot. Uh, which is where the artery from the heart. The pulmonary artery, um, gets a clot ray gets ah. Similarly, if you cut your skin, it will clot off so that it doesn't believe anymore back and happened within your vessels. And if it happens in the artery, it can stop any blood flow from getting through that potential space on, therefore, prevents any blood from getting too entire section of the lung. This isn't Ah, a very good condition. Toe have is very painful, and we'll go into it a little bit later. Uh, do I have more questions immediately after this one? I do. So here's a really fun part. Um, make sure you pay attention. Look through. Enjoy it. We'll talk about a couple off a follow geez on. But what I'm going to do is I'm going to do the questions first on. Then we'll talk through each of them, visit part of it. Part of it is just me gauging how much fat, you know. And therefore we can talk a little bit more as we go for about eight months. So everyone prepare yourself. There are, I believe, five questions. So everyone do your absolute best. It doesn't matter if you get it wrong. This is a learning situation, and part of it's me getting you engage in Also me checking on that, you know? Sorry, we haven't paid year old girl history of having a bit wheezy it as a toddler has a cough that's been going on for quite a while on they do notice it particularly worst when it's cold out. Brilliant. Well done, everyone. Brilliant, brilliant, Brilliant. Well done. Eso asthma very, very common in Children. Some people do grow out of it. Some people will have it for their entire lives. It is not a ah benign disease as a lot of people believe. Oh, it's just asthma. Asthma is a leading cause off morbidity and mortality. Meaning ah, morbidity. Meaning they have a reduced quality of life. Onda uh, mortality Meaning well, a reduced quantity of life as well. Ah, COPD is something that stands for chronic obstructive pulmonary disease. Onda that you find in particularly elderly individuals who have done a lot of smoking s don't smoke is at my free public broadcast. Eso yes, asthma, Absolutely. The ones where pneumonia is an infection. Ah, which we mentioned before is an infection of the lower risperidone retract, which is in the lungs. A supposed to in the fruit, which is your upper respiratory tract. Uh, new movie, four AKs, New Moment's air four AKs means chest so new move air in the chest. Visits where air gets into the pleural cavity, which we mentioned before, makes it easier to breathe from an air gets in very lot harder to breathe. This can happen to people of all ages. Tends to be. Can be traumatic. Cannot be traumatic, but we'll go into that a bit later. Next 1/1. Prepare yourselves. Oh, who's very good? Well done. One. Drop straight. You're doing wonderfully So 19 year old humanities student, sudden onset chest pain and having difficulty breathing but doesn't appear to have had a trigger. Woke up suddenly. Very difficult. Pain in one side on D. Uh, just worse. If helps, this person might have just been knocked into a wall or something. That might be an element of trauma. Very, very good. Eso The to differential from this to pneumonia is that they don't have a fever. They're not coughing. They're not systemically unwell. I wish I could put the full history, but the question won't let me. So Yes, listen keeps with new mow for after having difficulty breathing, they're short of breath because they can't really expand the lung as well, because the air is compressing it and therefore preventing its expansions have a need. Oxygen. Therefore, they're brief faster. Um, and the difficulty is because they've now got Aaron that space, and it's pushing on the lung. It's a lot harder to breathe on because the air's there is expanding frames, and that makes it painful. I will tell you why then. Being a humanity student is important later, but it is an inside joke from medical from scientists. Science students toe Manage it, uh, who is now in the lip? Well done. One. The roster dwelled on wings Right now you're holding in there majestic. Be everyone you're doing absolutely brilliantly. So 75 year old man's are elderly individual. 20 pack year history means that they've been smoking 20 cigarettes a day every day for a year and therefore have been 20 years off that level. They have shortness of breath there, coughing on. It's been gradually worsening for about a year, so it's a long time course, brilliant, very well done. S o COPD is pregnant. So chronic obstructive pulmonary disease onda what happens in COPD, which will go into a bit more detail later is, you get damage to your lungs and it causes scarring, and it causes everything to get a bit stiffer and a little bit harder to expand on. What we find with these people, because they have this card inflamed uh, dilated was dilated means it's so if that's constricted, that's dilated. So it's, uh, expanded out. It's filled up more space. Ah, you get these Dilated Airways, we've taken more space and aren't as effective on because they're not effective. The body needs to compensate. Therefore, uh, you get shortness of breath, so the breathing quicker, that's what s O. B. Means to apologize. Uh, coughing happens because they're stiff airways. They're not moving as they're meant to. Therefore, they're not clearing the mucus, which we produced in order to protect our airways as well. Therefore, they need to cough in order to get this mucus up, even though it's not an infectious cough release. Not always. People have COPD are unfortunately ah, lot more prone to getting a chest infection on. I have met people who have been in hospital every single month of the year with a chest infection for a least a week. Um, unfortunately, they weren't doing very well. But that's not the typical picture for people with COPD, at least not early. Wrong. Uh, same doing well done. Majestic Bayer on announced streak of three. Catching up to one drawstrings you're in, You're in trouble. So we have now have a 40 year old man with shortness of breath. As so the shortness of breath feverish cough, unwell, feels rotten on down. I had a smoke a little bit of well, as a cute onset, so it's only been going on for a week. All right, so we split it up a little bit. Eso pneumonia is the correct answer. Well done. Eso The reason why I've is it's, um, pneumonia and not COPD is one. We have a younger individual, so it's a bit less likely Younger people can still get COPD, but what's really telling us? But visit we correct answer is that we have, uh, fevers. So there's an infectious process going on here on down the clinical picture indicating it's the lungs, which are the infected part is the having the shortness of breath is having the cough on Diffuse looked into that cough more, you might find it green or particularly Purulence. Where? Where it itches. Essentially a fancy word for saying pass. Uh, which means it's over. Very sore, fixed and white, or even green. Yellow. A brownie color. And you can get chest pain with these cause you're getting inflammation of that part of the lung due to the infection. If you smoke, you're more likely to get infections. So don't smoke. Please don't smoke. COPD is more of a long term long course, a picture. You'd be expecting this over months. Two years, And you wouldn't be getting fevers with, um, vote. As I mentioned before, they're more likely to get chest infections so it can be a bit of a mixed picture. All right, well done. Well done. After ST of hate. Well done. Wonder ostrich. Well done, everyone else that allow you rule. You're very pack to rely on the middle Onda. Final question. What on earth is this? I haven't told you about that yet, So this is a chest radiograph. This is showing someone's lungs. We are seeing that quite overly. There is something big and white, which is not what seen on the left hand side. They should look very similar that little lump on the left hand side is the heart, the spine and middle ribs around on. Yes. So what we're seeing there is something called a pleural effusion. Don't worry. If you didn't know, this is very harsh of May. So I'll bring up the image again on what we're looking at here is anything that's black. Is Aaron this case? So if you look at the left side of the chest, we can see that there is lots of air going around the heart down into the bases, all the way up the lung, right to the top, called the papacies on the right side. You know, side, there's much more reduce space, a lot less air in there, so I don't see this X ray. Oh, your counts. Oh, um, I'm not sure how to get it up, man. Know what, then? Never mind, Then, uh, so if you try to remember it having meniscus, which just means they're the little were level. So if you have a glass of water, if you look at the edge, there is a little bit of a bit Where it sticks to decide on that shows a static water in there, or effusion, which isn't technically water, but it acts like water. Uh, and therefore it's full of fluid rather than full of air. If it's full of air, you would see a very dense black space that it wouldn't be any of the lung markings. And that's the end of the quiz. We'll just quickly see who won. They're in third place. We have one. The finch Absolutely well done. Six have 11. We have wings dry in the next seven level. Will turn on first place, 10 out of 11. Well done to one drawstrings. You are wonder. I don't think you're in ostrich, but very well done, and we'll return to the slides. So that was everything. S So we have asthma. We talked for each one. So asthma is a hyper sensitive airway, meaning that your airways will overreact to normal. Ah ah, distressing inflammatory particles in the air. So everything in the air Concordes a little bit of reaction. Dust in the air, cold air, any kind of level of bug or grit or anything, which about it is like including pollen. Uh, on. So what happens is that visual gets into the lower airway is, unfortunately unavoidable. You breathe in and it's going to get there on. Got happens with people with asthma. Asthma. Is that the drunk I, Which is the lower airways? Less so with the turkey and the tree? It doesn't really contract. So the bronchitis, the bronchioles, which is a smaller divisions, uh, do react. And what happens is that they produce a lot more mucus on. They constrict because what they are being told is that I've got something which is going to harm the body coming into my space. And I don't want that getting to the alveoli where it can then get into my blood. So what, it does it restrict the air flow off that getting in to into your lungs and then into your bloodstream? Unfortunately, with people with asthma, you get on over reaction where it's sensing that harmless things Um ah, getting in on. Unfortunately, it's recognizing voters frets and hyper vigilant on it is constricting on their four, causing you to have some difficulty breathing. Ah Onda can be very uncomfortable. It can also be life threatening. So please asthma is a as another public safety broadcast. Asthma is serious. Please do you take it seriously? If you are asthmatic, please take your inhalers. Are they very important? Uh, a key aspect of Oh, off asthma is that is reversible. So if you have a inhaler So the blue inhalers, you might see people take them, they'll shake them. They'll take a deep breath in while taking one will relieve it are reasonably well. There are conditions where the airways have inflamed themselves so much they have overreacted so much that they aren't fact responsive to sell Beautiful in that form. For these people, they might have multiple puffs and it doesn't get better. This is called an asthma attack a moderate to severe asthma attack and therefore could need to come in the hospital for further treatment emergency treatment in order to get their lungs working again. Because, as you can imagine, if you're not getting oxygen in your not a very good state. So for these people, we would put on something called a nebulizer on. But what that means is that we get some liquid salbutamol, which is the medication we have in that inhaler. Okay on Do we run a room it through it, which essentially forms it into a cloud, which makes it a lot easier to breathe it right down deep into our lungs. Therefore, gets Mork lows to the point where our lungs are saying, no, no, no, we're contracting Onda. So beautiful is saying, calm down, relax a bit on that may get some air through from the human alternative treatments are giving steroids, which, uh, bring down the level of inflammation on their arm or medications. We can give on top of that as well, which we don't need to go into unless you're particularly interested. But we'll have time in the end, and we can always come back and go into a bit more detail. Another key point of asthma is that the hypersensitivity can be stereotypical, meaning they might have things which always triggered them off. For a lot of these tend to fall into similar categories for people, But some people are particularly sent sensitive to cold weather. Um, some people are particularly sensitive to exercise, which isn't it is not an excuse tonight. Besides, you just have to find ones which you can manage, uh, on but other ones can be. Pollution would be a big one, a swell. So we do find that we get a lot of people who are as Matic in London due to a local absolution. Uh, so, uh, climate change, please support a low, Um, on. So it tends to have these specific triggers. I noticed it more when I'm doing this, Uh, or when this happens, Um, so I've used on an acronym there, so P e f r is peak expert experience. Tree flow rate. What that means is, had your maximum pushing out this off. Um, how fast is that? They're going. So if you were to take a big deep breath in and then push it out, push it out as much again. Hard as you can. Contract your abdomen. Contract your chest, push it out. How much is that going? Uh, so there it is, a judge on Dwight appropriate. So you can't just say 800 is a normal figure, which is actually a pretty, very good It goes to the weight in the age of the person on then it is also person specific. So even that their best someone might not reach what their age appropriate level is. But you discover that over time Onda. What this is telling us when it is reduced is that your body has having difficulty pushing out the air. Ah, which is inside. Which means that there is construction off those airways, which means that the air is essentially getting trapped in there, which isn't good or is getting trapped. Or it's more like blowing for us for ah, for a straw. So normally, breathe for Iowa. Easy briefers, throat Much, much harder. I hope anyone with headphones on that wasn't too loud. I do apologize on. So receivers die earn a lot variation. Another fancy term. It means morning and night, we noticed was specifically with asthma that in the mornings and in the nights, for whatever reason, which I'm sure some fancy doctors know about 40 after gotten, I do apologize. Um, we do know that it tends to be worse on, but so you get them to measure the peak experience Tree frog. Let a peak experience tree flow rate for several days for several weeks, and you start to notice. Very predictably, they have this pattern every single day, where it's worse instead of just continuous anything lumpy kind of onda. So depending on the age with younger individuals. Say, from the age of 5 to 10, Um, we tend to diagnose from just clinically. They're having this cough for having wheeziness, which is when you breathe out, you get a found. Ah, he's awfully long experience three friends face, so they take longer for them to breathe out because their airways constricted on. That forms the weeds on getting shortness of breath, difficulty breathing on so we'll combine it with some peak exploratory flow rates. Onda usually will just start him on medication. However, if there's a bit of clinical uncertainty, we're not really sure we might send it to people to have spirometry where they breathe into a tube so they'll have a mouthpiece. They breathe into the tube, and they'll only breathe into this tube I/O. It measures the ventilation off their chest. How much is going in? How much is coming out? How quickly it's going in, how quickly is going out, how much they can get in, how much they can get out on how quickly they can do it? A swell which is similar to the beach experience? Three Floor eight. But it measures it much more accurately. And you get something called the four States spiritually volume, which we can go into more detail if people want later. If there's time on, do what they can also do. A spirometry is rather me that you give something that irritates the airways. Uh, which, um, we give a certain amounts which for a normal person or normal person, puts us in someone without asthma. Ah, woods not cause a reaction on. Then we give it increasingly until it causes the reaction that we give them an asthma attack. But ideally, just a mild one on day. Then we've got a measure for how sensitive airways are on Ben. We give themselves beautiful, which I mentioned is the medication we give to relax the airways, uh, which, uh then reverses that so is here it is hypersensitive, and it is reversible, with salbutamol therefore showing that we have an asthma like picture. The obstruction, which I've written on the side with control. Some of you figuring out is related to that constriction of the airways. So it's a physical obstruction. It is, but not in the same sense off. I've choking on some food. Know that kind of obstruction Which way? So I've put a lot of acronyms at the bottom. I promise I will explain So a Sabah s A B a is a short acting beater. Agonist visit salbutamol. There are beater adrenoceptor adrenal means I adrenaline which if you notice if you're in a fight or flight mode you will start breathing quicker and easier. You want to ventilate your lungs if you're running from a tiger, Therefore you open up your airways allow the air to get I/O. Um so what this does is it is a short acting minute last for a small, longer period. Short period of time between onset really quickly on agonist means it activates it activates the beater. Adrenosterone receptor is a septal, um and therefore activates the adrenaline receptor which increases the air flow to the lungs. This is what so beautiful is cortico steroids. And sure, many of you have heard of steroids. Steroids are hormones which are produced in the body because off the structure they competitor eight cells very, very quickly and affect the body very, very quickly. Um, course ago is just a spectrum on the steroid, uh ah activity because steroids do act in a variety of different ways, so max more in the kidneys while others active or in the tissues on go. What we want is one that reduces inflammation cause steroids are very, very good at reducing inflammation. These could be inhaled, in which case the acts just on the lungs, which is brilliant because we want to bring down the inflammation in the lungs. But when that's not enough, we can also give it as a tablet, and we can also give it through. A vein on this one has a more systemic effects. It's tonic meanings throughout the body. Onda. What's brilliant doctor is it that they reduce the inflammation, which is what is causing the constriction in the area on causing the irritation, causing the symptoms on causing the pathology that is disease on. So we want to bring all of that inflammation down. Bring it to a nice relax take. No one likes to have something inflamed. Montella. Cast is a specific drug which also act within the lungs. It's only useful for certain people. It's a tablet, and it's very useful. On labs are long acting beta agonist, so similar to sell beautiful but act on a long term. Therefore, we used to prevent asthma attacks. Um, could there last throughout the day be something called Salmeterol if you want her to have an example of the medication for records? If people don't know a type, of course of steroids, typically reduce something called prednisolone. If you know that medication any questions before I move on to COPD, none displayed at the moment. That's fine. If you think of any, I'm more than happy to try and answer them later. So COPD chronic obstructive pulmonary disease, This is, as I mentioned before, is characterized by scars and rigid meaning Stiff Airways, which causes an effective level of obstruction. So the obstruction here is not actually that they're constricted. Even though this can happen, it is more that they can't move. They can't normally our lungs a very bouncy in a sense, almost spongy and therefore have a lot of ability to expand the contract. And this movement is very, very important because that allows the air to move around. And what we get with COPD is because they're so rigid. The air doesn't move around, so you get something called dead space which is non functional. Air is a riches in your lungs, but it's not their toe oxygenate. The blood is just They're filling space and not really doing anything, and you get a lot more of it in COPD. On their four is called an Obstruction, the mainstay of COPD. That is not particularly reversible, so the airways are just rigid and inflamed and fibrous onda awful on do. Therefore, it's giving the salbutamol. It might have a little bit of an effect. It might open them up a little bit and make it a bit easier to breathe on before we do still give thumb. Um, but it's not going to be as effective with asthma on D uh on acute exacerbation off COPD tends to be far less reactive to just how beautiful and it tends to be caused by an infection. Therefore, they'll probably need to come into hospital to have some antibiotics, have some steroids and bring the inflammation down. In contrast to asthma, there's not a predictable variation, a step from that long term. It is a progressive disease. It will continue to get worse for instead of getting better. Unfortunately, with COPD, once you're diagnosed. It's only really going to go one way, which is unfortunate on our medicine isn't very yet, but what we can do is slow the curve. So instead of going down really quickly, we can get it very slow over time to a point where they can still live a Xylol and is happier. Life is possible. Ah, the management of sorry. The diagnosis of this is a combination of clinical history. Taking an examination, you talk to the patient, you find out about the history I've been having, Ah, shortness of breath and this chronic cough, and it's been going on for years. I've been smoking a pack a day since I was a two year old on, but I, uh, just generally feeling a lot more tired a lot more short of breath than I usually am on now, The typical history you then do a chest X ray, you might do a CT, which is sounds awful. Computerized tomography is ah, scan where you take lots of lots of x rays and you go for a doughnut essentially, and to take lots of lots of X rays around you. I guess a detailed imaging off the lungs on D. Part of this is making sure that the patient doesn't have a tumor, which we'd like to avoid. Where it'll possible on? We'd like to treat if we can if we find them. Um, Andi shows the state off the airways. It shows if how rigid they are, how fibrous they are Onda how essentially damaged they are, uh, in the first time since we would still just do a chest X ray, just in case it is something else on. There are signs on the test tapes, Ray to show. Ah, uh, founded by the COPD versus other chronic lung disease is which also includes pulmonary fibrosis. But serve it is by far the more common one. That's why I'm telling you about the management. We give salbutamol. We give steroids and we give a long acting beta agonists all together. We give them really strong therapy right from the get go, because this, um, we'll get, uh, the COPD under control. This is different. How? It was very recently, only within about past 5 to 10 years where we used to do a step up therapy. Now, with realizing maybe we should give people therapy Ah, harder therapy from a lot younger. A lot earlier and nervous is it was a question here for you. 10 inches. If people stop smoking, how can it continue to get worse? It's a very, very good question. Um, so they stopped smoking on That is already very good. So if we have the curve coming down, stopping smoking immediately ah, so stops fat deterioration. So it would in this in. And if people didn't change on didn't unfortunately deteriorate through life, it would stop it. And it would, um, just continue on the two reasons Essentially, why it will continue to get worse is one. There is already a large lasting level of damage there which promotes an inflammatory state of the lungs reached us. Unfortunately, because of the chronic inflammation there has been there because of the scarring on the rigidity of the lungs will continue to, uh, become inflamed and stay inflamed. It will continue to get worse because of the inflammation, causing more scarring and forms of a vicious cycle, uh, on and and then also from having the increased risk of infections as well, which come from that which causes more scarring and more damage on then. The second reason is because as we age, everything in our body unfortunately does deteriorate. Our hearts get weaker, our lungs get weaker. I got scared. Weaker on their four is already bean, so significantly damaged that it will damage be damaged more significantly compared to someone who hasn't smoked too. Hasn't developed COPD, and that's why the to rewrites I could. I had one third point in time, which is. Smokers tend to accumulate, so if you smoke, the likely is those close to you will also smoke and it just tends to happen that way. So although you may give up smoking a lot of the time, you'll be Maurits posed to secondhand smoke than, say, the average person on the street. So in that sense, so you can you can continue to get a tear grating lung quality because although you're not smoking, you're still exposed to the smoke in the same way. Unfortunately, passive smoking. If if it was done to the same level of smoke that interest lungs off a smoker, the smoke that is from outside from the end of the cigarette is unfortunately a lot more damaging. It has not gotten the filter, which is found that the start of a cigarette Unfortunately, passive smoking is also very, very bad for people. A swell, um so that COPD are there any more questions? Oh, so I didn't go into that point. Um, so with these to the states with COPD on other interstitial lung disease is interstitial means within the tissue. Um, but the because the body the lungs aren't as effective is actually oxygenating. Um they start to run at a lower point, but because it's happens very, very slowly instead of very quickly, the body actually adapts to this, and it learns how to cope with less oxygen on. Therefore, if you were to take a finger probe and you're to measure someone's oxygen saturation, which is how much oxygen is in their blood, for which right to the people like you and may, uh would be greater than 96% and for someone who's particularly old but hasn't smoked would be greater than 94%. With people with COPD, we might see it get down to 88% or 88 to 92 as a reference range, and I have met patients with COPD, who have gone down lower than 88% on day 10 to actually run about 84%. So they got very, very damaged lungs and have had so for a very long time. Eso they can be a little bit remarkable on that. But for some people, that is normal on, but we don't even need to supplement them with oxygen. Ah, though there are criteria for that. Some people do have COPD on day do have these low saturations but do require toe have a continuous extra supply of oxygen, which they then have at home. But it is very, very important that these people don't smoke and don't have any open flames in the house because oxygen is very explosive on it really don't need her to cause anybody that level of harm. The next point, which we mentioned earlier, is pneumonia we talked about. It's an acute onset lower airway infection. You can have chronic pneumonia's. You can have chronic infections, but typically speaking, we're talking about carry, Uh, short time periods were talking a number of days number of weeks, but you can get long term infections, which last four weeks and months the most common infection. Actually, ah in the world is a type of pneumonia. It is tuberculosis. Very, very common not in the UK, but particularly in more equatorial countries as well as lower unfortunately, poor countries. Um, and tuberculosis is a lung infection, and it will be in the system for about six months. Eso It's very, very awful. Disease on is. Unfortunately, one of the most common disease is on the entire planet. Is one of the biggest killers on the entire planet on involves It is very, very hard to treat. Not Ah, the diagnosis. You'll have a cough. You'll be short of breath. You'll be feverish. You'll feel terrible, systemically unwell on Do you might have some pain, some chest pain around it. Uh, it's not comfortable. It's not nice. You feel awful. And so typically we were diagnosed people. Clinically, it's like you've got a chest infection. Let's give you some antibiotics and get you better. Some people, if they don't respond to antibiotics, or they present a little bit weirdly and it's, ah, a bit of a mixed bag or that's just something you don't particularly like. You mind to get a chest X Ray, if you're if you're GP. If you go in the hospital, you're getting a chest X ray. Everyone gets a chest X ray. Uh, not always. Uh, get the chest X ray too. Just look, if there is a actual physical pneumonia, which means that there is puss in the lung versus just a lower respiratory tract infection which doesn't have passed in the lung if we're being very, very iniquity, we was say that And pneumonia is only diagnosed with a chest X ray or other radiological findings because it you need to prove that there there is puss on a consolidation in the chest to prove that there is one there. Otherwise, it is just a lower risperidone retract infection. But we call everything in the Mona anyway, Uh ah, or a chest infection treating with antibiotics. Unfortunately, we are getting more resistant bacteria, uh, as we have used antibiotics, then used and abused from unfortunately on, they are getting resistant to the antibiotics we have. So we are finding ourselves having to use stronger antibiotics, which, unfortunately come with more side effects. Ah, for crystal, we're still a long way off from having completely a resistance uh, bacteria on. I should also point out we can also get viral pneumonias, which I'm sure you'll know after this past year. Next one is the new before it's I've mentioned this before. It's a rand. The pleural cavity, the blower cavity, the pleural membrane and pleural space is what used to help age with the event elation mechanism. It could be spontaneous. Meaning it just happened. You get a pop in your lung enters entity. Ah, floor space on D. I just get some advocate, you breathe it in, and then it breaks into, uh, that part, uh, or it could be traumatic. Mean you've had a injury. Onda say you fallen off a ladder and you think your chest and you've broken a rib. The rib, Then punch is your pleural space for remembering. And as a result of that to you, uh, get Aaron, there could have caused damage to it and therefore airconditioning the, uh, one of the reasons why I really I said it was humanities in and this is a joke. I'm obviously not stereotyping humanity students is that if you smoke marijuana, a weed or whatever you want to call it cannabis Ah, it puts you at a much higher likelihood of having a spontaneous pneumothorax. Um, so it's just a joke. Obviously, humanity students are no more likely just be taking it. But it's Ah, it's a stereotype. We had one out of university, Um, and so, yes, if you smoke weed, you're much more likely to have a new before X, which isn't fun, so I never reason not to smoke weed. The management varies depending on severity, so you can have very, very small new before the risk case. You're more likely to cause thumb harm by doing anything. They're naturally helping them, in which case the management is conservative, meaning we watch and we wait and we observe and we make sure that it doesn't get worse. And if it does, then we can ask a NATO up the treatment plan aspiration. So this is actually used differently. So there is that Earlier than aspiration is where something enters your lungs. When it's not meant to like food. We also use it to mean putting a needle into something in drawing it out Onda. So in this case, we get a culture, a sound machine. We'd put it on to the back. We find a safe space between the ribs and bear in mind between the ribs. We do have nerves and blood vessels. Uh, so our it risk of damage if we don't use a safe technique and we get the older sound we find where that air bubble is on, we put needle in on, pull out the air on, then get Then pull out the needle and put a pad on so we don't accidentally make the new before X worse. The next stage on top of that is putting in a chest drain, which is where we put in a ah, well, a drain. We put in a tube into the lungs to continuously keep that air out and prevent it from accumulating. We, uh, put it through some fluid or into a bag fluid so that we don't therefore introduce Aaron to the chest. We prevent it from, uh, making the new before it's worse. I'm there for allowing it to bubblefruit some fluid there. Focal keeps the pressures in a way that we don't introduce more hair into the chest on. Then we have something called emergency decompression. So there's little noon before X rays is like a little millimeter bubble and might be a little bit painful, but it will be okay and fine, too. A full blown. Your lung is crushed and your two Kia your bigger airway, has moved all the way across. So it's central nice. And here it's right in the middle on. Therefore, if it's moved over to one side, you've got all of this pressure all in the side of your chest, moving everything to the other side of the chest. Now I can imagine Well, um, sure, you can imagine that the lung is not going to like that very much on lorazepam thing else in the chest. So in those circumstances, they are at a very, very high risk off going into cardiac arrest, meaning their heart. It stopped beating on very going to need CPR, which is way do compressions on their chest. You ventilate for them, and you try to bring them back to life. This is called attention, Loomer. Four acs ended in absolute medical emergency on go in these circumstances, we don't want too fast around with the ultrasound machine and finding a needle on finding everything else. What we want to do is get a cannula, which is what we used to give, uh, blood give fluids and medications for a vein. Essentially, it is a hollow needle on. We just put it into the chest. We put it into a spot around about here, right on the upper point of the chest. In between the second and the third rib, which we palpate. We know that it it's Aaron. There could would do a little bit of a tap and it will come back and be very loud. Percussive. Um, which, if it was not airplane was fluid on. We did that. It would be very dull because it be a lot of be very dense. So if he tapped something very dense is not going to be as loud as if he capped something that's full of air. Kind of like a drum. If you feel the drum full of liquid, it wouldn't sounds good about full of air. Very loud, very noisy. And so we talked there. We know it's there. Good on. Then we put the cannula in on. Do you hear a very audible Heston as we decompress that ah, bubble of advice compressing our lung and then compressing the rest of off four AKs area or chest area on. But we might put a couple of thumb in there in order. Just emergency. Decompress on, then, While that is happening, get the chest draining on. We call up for the intensive treatment unit and harder to, uh, make sure we support. Um, probably because envies people we might need to take over the ventilation, which is called intubation. So they have the tube down the fruits. You might see them in on medical dramas or during surgery where we take over ventilation for these people because they will be very unwell. So how my doing for time, Freddie? It's bang on eight. So five over a little bit. Yeah, I don't have a particular time, in which case we won't go into the clinical case, but I can answer any questions that have come up. I do apologize for over running on taking up your evenings. If there are any questions, though, I'm happy to do my best to answer them. If not, go as I have shared the feedback link in the chat, pleased you fill it out. If anyone who wants the surgical attendance or wants to give any particular feedback. Um, I'll also email that round for anyone whose note got the chance to see it. Otherwise, I'll give you guys 90 seconds to ask any questions. You got any massive? Thank you to the wonderful doctor. 10 for a very important for a good session. Um, I'll give you another minute or so. Just aren't any queries. If if anyone comes up with any bit later on, feel free to email me, well, I can pass them along. Um, in regards to feedback. Um, I I do appreciate any feedback. It doesn't have to just be positive. I do appreciate negative feedback. It's an important part of a learning process for all of us on dydo want to get better a teaching. So if there are areas you think I can improve, please be nice. But please also be truthful on D. Let me know if there was any where where you felt I could improve on be better. It's very important to me. I will appreciate it. Um but ah ah, yeah. Be kind. I'm human. So I was putting the chance. Thank you. It was really good. Oh, thank you for two things. Juicy had sexual kind of couple of feet backs. Yeah. Okay. Uh, so I'll leave it there, so thank you. Everyone. See you all next week and a master. Thank you to 10. Thank you, everyone. Thank you, everyone. It's been a lab slip. Pleasure.