The Lung – What are 7 functions of the lung?

alveolus-7-functions

Joke (fun) answer :   1)  inhalation  2)  exhalation  3)  O2 exchange  4)  CO2 exchange  5)  phonation (voice)

6) buoyancy (while swimming)  7)  cushion (for the heart).

Real answer :

1)  Gas exchange.

2)  Vascular reservoir :   between right and left heart.

3)  Filter :  embolized material gets caught at the level of the capillary radius.

4)  Homestasis :  heat & fluid transfer.

5)  Defense barrier :  foreign organisms (bacteria) and particles (dust).

6)  Endocrine function :  angiotensinogen gets converted to angiotensin.

7)  Metabolic function :  surfactant synthesis & fibrinolytic systems.

The lung is a top shelf organ that is not given its due respect in the field of medicine.

Tons of research is done on the heart and the brain and the immune system.

However, the lung is simply seen as an oxygenation / ventilation tool and possible considered

as a gateway for foreign objects from entering  the inner milieu of the human body.

Great interest should also be given to the fact that the lung is a vascular reservoir.

When this pulmonary vascular reservoir is overwhelmed is when the pulmonary edema starts.

It is incredibly versatile and it should be followed by the research community as to

the result of the demise of the lung.

 

 

 

 

The Alveolus – understanding the many different visions / versions of the alveolus.

alveolus-many-views

The evolution of the understanding of the lung / alveolus in the last 30 years.

Old textbooks (circa 1970s) mostly offer hand drawings.

Since then, we have an improving understanding that has gone

from a view at the level of the microscope to the electron microscope

to the scanning electron microscope.

What is missing in the literature is giving the clinicians at bedside a

good understanding of the physics and physiology of the lung and the alveolus.

 

I’ll give one example :

One of the major functions of the lung is an endocrine function : that of

converting Angiotensinogen to Angiotensin.

The lung is the primary place where ACE (angiotensinogen converting enzyme is

located.  The kidney is the secondary place where ACE is found.

What happens to this pulmonary feature of conversion via enzymatic process in the

lung when the lung is significantly atelectatic or the lung is in serious crisis during

a pulmonary edematous event?

Angiotensin is the endogenous hormone that keeps vasculature constricted as the

body deems necessary.

Is it that we as a medical society do not know?

Is it that we do not understand this mechanism of action?

Is it that we have never entertained this notion?

 

 

eLibrary – high value pix – alveolus ARDS (normal vs. injured)

hi-value-pix-ards-nl-vs-injured-alveolus-nejm-2000

This picture printed in NEJM 2000 is a great picture to learn from.

I will expand on content at a later date.

Simply GOOGLE search for images with the following “nejm 2000 ards alveolus”.

Pick the image.

Then choose “view image” for a picture of moderate resolution.

 

eLibrary – high value pix – alveolus ARDS (injured vs. repaired)

hi-value-pix-ards-injured-vs-repaired-nejm-2000

This picture printed in NEJM 2000 is a great picture to learn from.

I will expand on content at a later date.

Simply GOOGLE search for images with the following “nejm 2000 ards alveolus”.

Pick the image.

And then choose “View image” for a picture of moderate resolution.

 

QoW – 2016 – Q4 – 001 – The Consummate Respiratory Therapist – Thinking Outside the Box

You are called for a patient who is agitated & having a desaturative event  >  you see the following as you enter the room :

monitor-spo2-69pct

pvroute006

uryll

avsv

chtb

The Intensivist meets you at the patient bedside to discuss the patient.  His SBAR report :

S – Situation :  Patient agitated & demonstrating oxymetric desaturation to 69%.

B – Background :  Cardiogenic shock  > Post-op day #3 ; Hospital day #4.

A – Assessment :  Patient agitated but looks comfortable.

P – Plan :  Increase FiO2 from 35% to 50%.

Do you concur?

QoW – 2016 – Q3 – 003

mri02

The patient was on the following ventilator parameters in the CTICU :  SIMV-VCV,  RR(set)=8,  Vt(set)=700,  FiO2=50%,  PEEP=5.

The patient will be in the MRI suite for the next 75 minutes.

a) what will the settings be on this ventilator ?

b) how do you set patient trigger ?

c) how do you set Vt(set) on this ventilator (the “cheat sheet” was ripped off of the side of this ventilator).

d) if you use the vent with the settings that are currently dialed in, what will the ventilators translate to in standard ventilator parameters.

 

20160915-edwards-hemodyn

eLibrary – FREE

 

20160915-edwards-hemodyn

Build up your eLibrary starting with this gem – great hemodynamic tutorial. Hemodynamics is a huge part of our jobs as respiratory therapists and being proficient is key to being a great practitioner.

Anyone and everyone should get this booklet if you are interested in hemodynamics.

It is free to download.

Google search “edwards hemodynamics pdf” and then select the search item I have identified in the inset.

If you go to the Edwards website’s homepage, there are other good booklets for free.

There is a lot of good stuff out there for free from our vendors.

As I have opportunities, I will post them – I will use the key search words eLibrary or FREE so the references can be found.