Bronchoscopic Anatomy

Reviewed and revised 21/2/13

OVERVIEW

Dave Pilcher’s 4 rules for finding where you are:

  • the trachea is D shaped, the flat wall is posterior
  • the RML bronchus is anterior
  • the apical (aka superior) segmental bronchi of the lower lobes are posterior
  • if in doubt, go back to the carina

VIDEO

ENDOTRACHEAL TUBE

  • via adaptor
  • clear plastic with markings on ETT
  • Murphy’s eye

TRACHEA

  • mucous membranes
  • anterior and lateral walls: cartilaginous ‘U’ shaped rings connected by connective tissue
  • posterior wall: muscle (trachealis, par membranaceus)
  • length: 10-15c in adults (cricoid -> bifurcation)
  • diameter: 19-22mm

CARINA

  • cartilaginous ring that runs anterior-posteriorly between to main bronchi
  • lumen narrows slightly as it progresses towards the carina

RIGHT MAIN BRONCHUS

  • more vertical orientation than left
  • bronchus intermedius directly ahead
  • 1-2cm in is the RIGHT UPPER LOBE BRONCHUS @ 0300

RIGHT UPPER LOBE BRONCHUS

  • trifurcation: APICAL, ANTERIOR AND POSTERIOR SEGMENTS
  • this is the only place that has 3 orifices
  • 1/250 people have their RIGHT UPPER LOBE BRONCHUS coming directory off CARINA

RIGHT BRONCHUS INTERMEDIUS

  • come back into RIGHT MAIN BRONCHUS
  • identify the RIGHT MIDDLE and LOWER LOBE BRONCHI

RIGHT MIDDLE BRONCHUS

  • seen at 1200
  • D shape
  • MEDIAL and LATERAL SEGMENTS

RIGHT LOWER LOBE

  • APICAL SEGMENT @ 0600
  • four basal segments (MEDIAL, LATERAL, ANTERIOR and POSTERIOR)

-> withdraw back into trachea

LEFT MAIN BRONCHUS

  • lies more horizontal than RIGHT MAIN BRONCHUS
  • it is longer and divides into LEFT UPPER and LEFT LOWER LOBE BRONCHI

LEFT UPPER LOBE BRONCHUS

  • divides into SUPERIOR and LINGULAR DIVISION @ 0900
  • SUPERIOR: gives rise to APICOPOSTERIOR and ANTERIOR segments
  • LINGULA: gives rise to the SUPERIOR and INFERIOR segments

LEFT LOWER LOBE BRONCHUS

  • APICAL SEGMENT @ 0600
  • 3 BASAL SEGMENTS (LATERAL, ANTERIOR and POSTERIOR)

References and Links

LITFL

Social Media and Web Resources


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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