Figure 18.1: Conditions that can produce dyspnea. ARDS: Acute respiratory distress syndrome.


Figure 18.2: Types of dyspnea.


Figure 18.3: The proposed neural mechanism of air hunger.


Figure 18.4: Balance of pulmonary stretch receptors and chemoreceptor firing.


Figure 18.5: Central regions associated with air hunger.


Figure 18.6: The cycle of anxiety causing an increase in the drive to breathe and air hunger, which in turn causes more anxiety. Psychological disorders can produce air hunger if they involve anxiety.


Figure 17.1: Brainstem respiratory network.


Figure 17.2: Lung volume and pulmonary stretch receptor firing. The top tracing represents lung volume with two full inflations followed by a sustained inflation. In response to the increases in lung volume, pulmonary stretch receptors depolarize, producing action potentials, which are shown in the lower trace as upward spikes. The increase in action potentials with increased lung volume is seen as more densely clustered spikes. Note how the sustained inflation causes an initial high frequency of action potentials that gradually falls as the receptor adapts to the high lung volume.


Figure 17.3: Chemoreflex circuit.


Figure 17.4: Peripheral chemoreceptors.


Figure 17.5: Hypoxic ventilatory response. BTPS: body temperature and pressure, saturated.


Figure 17.6: Hypercapnic ventilatory response.


Figure 17.7: Hypoxic ventilatory responses with varying degrees of hypercapnia.


Figure 17.8: Hypercapnic ventilatory responses with varying degrees of hypoxia.


Figure 16.1: Basic structure of hemoglobin.


Figure 16.2: Hemoglobin saturation curve.


Figure 16.3: The hemoglobin saturation at the lung (A), at the tissue (B), and at very metabolically active tissue (C).


Figure 16.4: Effect of temperature on the saturation curve.


Figure 16.5: Effect of PCO2 on the saturation curve.


Figure 16.6: Effect of pH on the saturation curve.


Figure 16.7: Oxygen carriage.


Figure 16.8: Compartment of blood oxygen content.


Figure 16.9: Formation of bicarbonate at the tissue.


Figure 16.10: Reformation of CO2 at the lungs.


Figure 16.11: CO2 dissociation curve.


Figure 15.1: Schematic of a pulmonary shunt (anatomical or physiological) showing flow (Q) through the pulmonary capillaries (QC), flow through the shunt (QS), and total flow (QT) returning to the left heart.


Figure 15.2: Oxygen concentrations used to calculate the size of a pulmonary shunt.


Figure 15.3: Elements of the shunt equation and where they exist physiologically.


Figure 14.1: The alveolar gas equation.


Figure 14.2: Alveolar and arterial oxygen tensions in the normal state lead to a normal alveolar–arterial PO2 difference.


Figure 14.3: Alveolar and arterial oxygen tensions during hypoventilation result in a normal alveolar–arterial PO2 difference.


Figure 14.4: Diffusion abnormalities lead to an increased alveolar–arterial PO2 difference.


Figure 14.5: Perfusion abnormalities lead to an increased alveolar–arterial PO2 difference.


Figure 13.2: Partial pressures when V/Q = 1.


Figure 13.3: Partial pressures when V/Q = 0.


Figure 13.4: Partial pressures when V/Q is infinite.


Figure 13.5: Ventilation–perfusion line.


Figure 13.6: Ventilation, perfusion, and V/Q distributions.


Figure 13.7: V/Q and alveolar gas distribution.


Figure 13.8: Consequences of V/Q nonuniformity on arterial PO2.


Figure 13.9: Correcting V/Q mismatches.


Figure 13.10: Response of pulmonary vasculature to hypoxia.


Figure 10.1: Pulmonary metabolism of arachidonic acid. Blockade of cyclooxygenase by aspirin means more arachidonic acid is available for the production of leukotrienes, which can cause bronchoconstriction.


Figure 9.1: The pulmonary circulation. A latex cast of the pulmonary circulation shows the complete and vast penetration of the lung structure by the vasculature.


Figure 9.3: Schematic of the pulmonary and systemic circulations – compare capillary densities and pressures.


Figure 9.4: Pulmonary vascular resistance decreases as pressure increases.


Figure 9.5: Pulmonary vessels can be categorized as alveolar or extra-alveolar.


Figure 9.6: The relationship between lung volume and pulmonary vascular resistance.


Figure 9.7: Perfusion distribution up the lung.


Figure 8.1: Diffusion and perfusion limitations.


Figure 8.2: Transfer of gases from alveolus to capillary.


Figure 7.1: Oxygen tensions around the alveolus.


Figure 7.2: Carbon dioxide tensions around the alveolus.


Figure 6.1: Intrapleural and airway pressures during normal/passive expiration.


Figure 6.2: Intrapleural and airway pressures during forced expiration.


Figure 6.3: Typical and normal flow-volume loop. FVC: forved vital capacity.


Figure 6.4: Normal (maroon) and obstructive disease (gray) flow-volume loops.


Figure 6.5: Normal (maroon) and restrictive (gray) flow-volume loops.


Figure 5.1: Laminar flow.


Figure 5.2: Turbulent flow.


Figure 5.3: Transitional flow.


Figure 5.4: Airway resistance down the bronchial tree.


Figure 5.5: Radial traction decreases airway resistance as lung volume increases.


Figure 5.6: Airway resistance and lung volume.


Figure 4.1: The fiber networks of the lung.


Figure 4.2: The action of radial traction.


Figure 4.3: Interaction of lung volume, compliance, and distribution of ventilation.


Figure 3.1: Lung volumes detected by spirometry.


Figure 3.2: Changes in breathing tidal volume and respiratory rate with increasing levels of exercise.


Figure 3.3: Lung compliance curve.


Figure 3.4: Opposing forces of alveolar pressure and surface tension.


Figure 3.5: Summary of lung volumes and compliance. At low volumes alveoli are small and subject to greater surface tension forces that generate an inwardly acting force that requires greater alveolar pressure to achieve inflation. At higher lung volumes surface tension is less effective at generating an inward force, so less pressure is required to cause inflation (the lung is more compliant). At very high lung volumes surface tension poses even less of a problem, but the elastic limits of the lung are being reached, and increases in volume require alveolar pressures to overcome elastic recoil.


Figure 2.1: The diaphragm.


Figure 2.2: Diaphragm positional change.


Figure 2.3: Inspiratory muscles of the rib cage.


Figure 2.4: Expiratory muscles.


Figure 2.5: The pleural membranes and space.


Figure 2.6: The breathing cycle.


Figure 1.2: The mucociliary escalator of the airway. The cilia on the apical surface of the pseudostratified epithelium push a layer of mucus (produced by the goblet cells) toward the mouth, carrying pathogens and particulates out of the airway.


Figure 1.3: Air conditioning. The highly vascularized nasal cavity helps warm and humidify inhaled air before it proceeds toward the lower airways.


Figure 1.4: The bronchial tree. The major airways of the conducting zone (anatomical dead space) are labeled.


Figure 9.1: Severe pleural effusion leading to displacement of the mediastinum and heart to the right. This patient’s condition is critical because of the threat to cardiac output.


Figure 9.2: Appearance of pleural fluid and diagnosis.


Figure 9.3: A tall, thin body morph (right) is more prone to a spontaneous pneumothorax.


Figure 9.4: Rupturing bulla and blebs can lead to spontaneous pneumothorax.


Figure 9.5: Pathophysiology of a pneumothorax


Figure 9.6: CT comparison of an uncomplicated pneumothorax and a tension pneumothorax.


Figure 8.2: Chronic phase of hypersensitivity pneumonitis with established fibrosis.


Figure 8.3: Patchy airspace consolidation associated with Goodpasture’s syndrome.


Figure 8.4: Progression of diffuse fibrosis in chronic SLE.


Figure 8.5: Pleural effusion in a rheumatoid patient.


Figure 8.6: A nodular lesion (arrow) associated with rheumatoid disease.


Figure 8.7: Fine reticular fibrosis in lower lung fields (upper CT image) progressing to honeycombing (lower CT image).


Figure 8.1: Acute phase of hypersensitivity pneumonitis. Note presence of giant cells in the alveolar septum on the center, right-hand side of field of view.


Figure 7.1: Pathophysiology of pulmonary embolism.


Figure 6.1: Potential radiographic findings in lung cancer.


Figure 5.2: Pathophysiological events of ARDS. ROS = reactive oxygen species.


Figure 5.3: Alveolar wall edema and onset of hyaline membrane formation during the exudative phase of ARDS. The debris inside the airspace is the result of the inflammatory response and the beginning of a hyaline membrane made of “cellular debris.”


Figure 5.4: Proliferation of type II cells and infiltration of fibroblasts in the proliferative phase of ARDS. A clear amount of debris in the airspace can be seen and forms a hyaline membrane that will impede gas exchange.


Figure 5.5: Fibrotic stage of ARDS.


Figure 5.7: Diffuse bilateral densities associated with ARDS.


Figure 4.1: Basic mechanism of interstitial lung disease.


Figure 4.2: Changes in pulmonary histology (A, B) and gross anatomy (C) with interstitial lung disease.


Figure 4.3: Pathophysiological consequences of ILD.


Figure 4.4: Classifications of ILD.


Figure 4.5: Smoker’s macrophages occupying an airspace.


Figure 4.7: Diffuse alveolar damage.


Figure 4.8: Extremes of nonspecific interstitial pneumonia.


Figure 4.10: Silicotic nodule in the parenchyma of the lung.


Figure 4.12: The pathophysiology of silicosis.


Figure 4.13: Pathophysiology of asbestosis.


Figure 4.14: Ferruginous bodies associated with asbestosis.


Figure 4.15: Radiographic findings in asbestosis.


Figure 4.16: Example of coal macules in simple CWP showing fibrosis and coal macules.


Figure 4.17: Large perihilar lesion in complicated CWP.


Figure 4.18: Pathophysiology of berylliosis.


Figure 3.1: Pathophysiology of acute bronchitis.


Figure 3.2: Histological and radiographic findings for an RSV infection. The left panel shows syncytial giant cells (circled). The right panel shows an x-ray of a child with RSV where densities folow bronchi and a flattened diaphragm.


Figure 3.3: Neutrophils, bacteria, and exudate occupy airspaces in a typical pneumonia.


Figure 3.4: General pathophysiology of pneumonia.


Figure 2.2: Pathophysiology of the common cold.


Figure 2.3: An x-ray of the upper airway of a child suffering from tracheal croup. The arrow points to a narrowing of the trachea that produces a characteristic “steeple” sign as the constriction looks like the pointed steeple of a church building.


Figure 2.4: Typical signs of “strep throat.”


Figure 2.5: Clinical signs of C. diphtheriae: pseudomembrane exudate (left) and bull neck (right).


Figure 1.1: Forms and prevalence of asthma.


Figure 1.2: Example of a mast cell loaded with secretory granules.


Figure 1.3: Vagal reflex of irritant airway receptors and the onset of asthma.


Figure 1.4: Factors promoting asthma at night.


Figure 1.5: NSAIDS, including aspirin, shift metabolism of arachidonic acid toward bronchoconstrictive leukotrienes.


Figure 1.6: Illustrations of normal (A), mildly asthmatic (B), and severely asthmatic (C) airways.


Figure 1.7: Histological signs of asthma: A = Charcot–Leyden crystals, B = Curshman’s spirals.


Figure 1.8: Components of airway remodeling in persistent asthma. The epithelium in asthma shows mucous hyperplasia and hypersecretion (gray), and significant basement membrane thickening. Smooth muscle volume is also increased in asthma.


Figure 1.9: The progression of an asthma “attack.”


Figure 1.10: Typical chest x-ray of an asthmatic patient showing hyperlucent fields and hyperinflation. Notice the flattened diaphragm and the number of ribs that are visible; more than six anterior ribs or ten posterior ribs being visible is indicative of hyperinflation.


Figure 1.11: Pathophysiology of chronic bronchitis.


Figure 1.12: The Reid index compares the width of mucus glands to the width of the submucosal layer of airways.


Figure 1.13: Prolonged irritant exposure can lead to airway remodeling with loss of normal ciliated epithelium.


Figure 1.14: The pathophysiological and clinical events as chronic bronchitis progresses.


Figure 1.15: Histological comparison of normal (left) and emphysematous (right) lung tissue.


Figure 1.16: Characteristic patterns of emphysema.


Figure 1.17: Pathological process of emphysema.


Figure 1.18: The pathophysiological events that lead to the clinical signs of emphysema.


Figure 1.19: The impact of ion currents in normal and CF cells on fluid layer and cilia.


Figure 1.20: Pulmonary consequences of CF.


Figure 1.21: Clinical signs of the pulmonary progression of CF.


Figure 1.22: Typical chest x-ray findings of CF.


Figure 1.24: Pathophysiology of bronchiectasis.


Figure 1.25: Instigating factors for bronchiectasis.


Figure 1.26: Histological and gross changes associated with severe bronchiectasis.


Figure 1.27: Forms of bronchiectasis.


Figure 1.28: Chest x-ray and CT of severe bronchiectasis. In the x-ray there are clear markings in the right lung that follow the path of affected bronchi. The distinctly widened airways on the right of the CT are consistent with severe bronchiectasis.


Figure 1.29: Common locations of the segmental and subsegmental broncho affected by bronchiectasis.


A pressure-time graphic


Static pressure-volume curve during volume-controlled mechanical ventilation. High pressure ('P high') is set below the high inflection point (HIP) and low pressure is set above the low inflection point (LIP). [ 1 ]


Corresponding pressure and flow curves during one cycle of inflationdeflation. Notice the flow curve goes back to zero at the end of inflation, indicating full lung inflation; and also goes back to zero during the release period before inflation starts, indicating complete gas exhalation with no intrinsic PEEP. [ 1 ]


Pressure-time curve for APRV. 'P high' is the high CPAP, 'P low' is the low CPAP, 'T high' is the duration of 'P high,' and 'T low' is the release period or the duration of 'P low.' Spontaneous breathing appears on the top of 'P high.' [ 1 ]


Image illustrating transpulmonary, intrapleural and intra-alveolar pressure


Atelectasis occurs when distending pressure of the alveolus is overcome by  surface tension  of fluid within the alveolus. Repeated atelectasis and re-inflation leads to  atelectotrauma .


Portable electronic system


Left-sided pneumothorax (right side of image) on CT scan of the chest with chest tube in place.


Size of chest tube:  Adult male = 28–32  Fr Pp Adult female = 28 Fr  Child = 18 Fr  Newborn = 12–14 Fr   [ 15 ]


Chest tube drainage holes


Chest tube drainage system diagram, with parts labeled in


Curschmann's spiral


Heimlich valve:  The flutter valve functions by allowing only outwards airflow from the body of the patient.


Lung volumes


The Life Pulse High Frequency Jet Ventilator


Bidirectional Flow During HFJV


Inhaled nitric oxide (iNO) delivery with high-frequency jet ventilation


Sensormedics 3100a Oscillatory ventilator


Details of a patient circuit


Drawing of air movement during high frequency oscillation ventilation


Tidal volume versus power setting


Tidal volume versus frequency in Hertz


Vascular ischemia of the toes with characteristic cyanosis


Latent hypoxia affects the diver on ascent


Oxygen-Haemoglobin dissociation curves


Vascular, bronchial and parenchymal margins of a lobectomy, showing staple line of bronchial margin being removed with scissors.


Respiratory therapist examining a mechanically ventilated patient on an Intensive Care Unit. The more time a patient spends exposed to the forces applied to them by a mechanical ventilator, the higher the risk of suffering a ventilator-associated lung injury.


Robert F. Furchgott, PhD


Bill Clinton meets the 1998 Nobel Prize Winners in the White House. From left to right: Ferid Murad, Medicine; Louis Ignarro, Medicine; Daniel Tsui, Physics; Robert Furchgott, Medicine; Bill Clinton, The President; John Pople, Chemistry; Horst L. Störmer, Physics; Robert Laughlin, Physics


Airway pressure release ventilation graph


Cough medicines usually contain mucoactive agents


Plaque honouring  Robert W. Philip , phthisiologist in Edinburgh


Dr. Ricardo Pineda, University of Pittsburgh. Mouse precision-cut lung slice (PCLS; 300 μm) stained for collagen & fibronectin. Made with a vibratome.


A. Preparation of lung tissue on a sample holder B. Setup to obtain slices. C. Generation of precision-cut lung slices using a vibratome.


Chest radiograph of a 3-year-old who underwent right pulmonary plombage with insertion of three Ping-Pong balls 1 year earlier. [ 13 ]


A clinician auscultating the posterior lung of a patient.


A Neonatal mechanical ventilator. High gas flows are often used in neonatal ventilation which carries the risk of  rheotrauma .


3100 A Oscillator


Image shows early occurrence of tracheal deviation.


Age-standardised   disability-adjusted life year  (DALY) rates from respiratory diseases by country (per 100,000 inhabitants).


Classic steeple sign indicating croup


Pulmonary interstitial emphysema


Deaths from respiratory diseases per million persons in 2012     19–125    126–169    170–196    197–225    226-–75    276–308    309–365    366–440    441–593    594–1,227


Ragweed is a plant and some are allergic to its pollen.


Skin Prick Test


Some older children can be taught to use their prescribed Metered-Dose Inhaler.


Metered-Dose Inhaler Mask (Child)


A summary diagram that explains how allergy develops


Tissues affected in  allergic inflammation


Degranulation process in allergy. Second exposure to allergen.  1  – antigen;  2  – IgE antibody;  3  – FcεRI receptor;  4  – preformed mediators (histamine, proteases, chemokines, heparin);  5  –  granules ;  6  –  mast cell ;  7  – newly formed mediators (prostaglandins, leukotrienes, thromboxanes,  PAF ).


An allergy testing machine being operated in a diagnostic immunology lab


Skin testing on arm


Skin testing on back


Patch test


Anti-allergy immunotherapy


Signs and symptoms of anaphylaxis


Urticaria  and flushing on the chest of a person with anaphylaxis


Skin allergy testing  being carried out on the right arm


An old version of an EpiPen brand auto-injector


Skin lesion from anthrax


Anthrax skin lesion on the neck


Anthrax skin lesion on the face


Photomicrograph  of a  Gram stain  of the bacterium  Bacillus anthracis , the cause of the anthrax disease


Inhalational anthrax,  mediastinal  widening


Possible edema and necrosis in a case of injection anthrax.


B. anthracis  Capsule Depolymerase (CapD) degrades the unusual PDGA capsule on the outer surface of the bacterium. The pegylated enzyme has been used in mice to protect against 5 LD50 challenges of lethal Ames spores. [ 67 ]  The human enzyme (white surface) has been overlaid onto the bacterial CapD structure (PDB 3G9K [ 68 ] , blue ribbon). In red is the substrate binding loop of HuGGT which CapD lacks. CapD binds polymers of D-glutamate. Original figure from Hu, Legler, et al. [ 67 ]


Louis Pasteur inoculating sheep against anthrax


Colin Powell  giving a  presentation to the United Nations Security Council , holding a model vial of supposed weaponized anthrax


Salbutamol  metered dose inhaler commonly used to treat asthma attacks


Fluticasone propionate  metered dose inhaler commonly used for long-term control


Rates of asthma in 2017 [ 283 ]


The Gold-dust Book of Cold Damage dated '1st year of the Zhengyuan reign period of the Yuan dynasty' (1341) Wellcome.


Atelectasis.


Atelectasis of the right lower lobe seen on chest X-ray.


Atelectasis of the middle lobe on a sagittal CT reconstruction.


Guinea-Bissau's frontline healthcare workers


Health problems associated with cystic fibrosis


Respiratory infections in CF vary according to age. Green =  Pseudomonas aeruginosa Brown =  Staphylococcus aureus Blue =  Haemophilus influenzae Red =  Burkholderia cepacia  complex


Cystic fibrosis has an autosomal recessive pattern of inheritance.


The CFTR protein is a channel protein that controls the flow of H 2 O and Cl −  ions in and out of cells inside the lungs. When the CFTR protein is working correctly, ions freely flow in and out of the cells. However, when the CFTR protein is malfunctioning, these ions cannot flow out of the cell due to a blocked channel. This causes cystic fibrosis, characterized by the buildup of thick mucus in the lungs.


The location of the  CFTR  gene on chromosome 7


Intracytoplasmic sperm injection can be used to provide fertility for men with cystic fibrosis.


Dorothy Hansine Andersen  first described cystic fibrosis in 1938.


The genes for human HLA are located on chromosome 6.


High resolution computed tomography (HRCT) images of the lower chest in a 16-year-old boy initially diagnosed with DPB ( left ), and 8 weeks later ( right ) after a 6-week course of treatment with erythromycin. The bilateral bronchiectasis and prominent centri-lobular nodules with a "tree-in-bud" pattern shows noticeable improvement.


Molecular structure of Erythromycin A, an antibiotic used to treat DPB


Human embryo—length, 2 mm. Dorsal view, with the amnion laid open. X 30.


Key inducers of the epithelial to mesenchymal transition process.


Epithelial to mesenchymal cell transition – loss of cell adhesion leads to constriction and extrusion of newly mesenchymal cell.


Cancer cells enter the bloodstream after undergoing EMT induced by TGF-β released from platelets. Once in the bloodstream, metastatic cancer cells recruit platelets for use as a physical barrier that helps protect these cells from elimination by immune cells. The metastatic cancer cell can use the attached platelets to adhere to P-selectin expressed by activated endothelial cells lining the blood vessel walls. Following adhesion to the endothelium, the metastatic cancer cell exits the bloodstream at the secondary site to begin formation of a new tumor.


Diagnostic approach to solving the puzzle of hemoptysis.


Hemoptysis


Lesions lips, patient with hemorrhagic hereditary telangiectasia.


Tongue telangiectases as seen in a person with hereditary hemorrhagic telangiectasia


A very large arteriovenous malformation in the left hemisphere (on the right in this image) of the brain.


Hereditary hemorrhagic telangiectasia has an autosomal dominant pattern of inheritance.


A schematic representation of the TGF-β signaling pathway. Endoglin (yellow) is needed for signalling. The ligand (blue) binds to the receptor complex; red indicates a type II receptor protein, which activates a type I receptor protein (turquoise) such as alk-1, which in turn phosphorylates a SMAD-based nuclear transcription factor (green and purple).


A vascular lesion in the digestive tract, being treated with argon plasma coagulation.


CT-scan of vascular malformations in the liver in a patient with hereditary hemorrhagic telangiectasia causing an inhomogeneous perfusion pattern.


The  Netherlands Antilles , where HHT is more common than anywhere in the world, located off the coast of Venezuela.


Fusion glycoprotein trimer, Human parainfluenza virus 3 (HPIV3).


A scanning electron micrograph (SEM) depicting a number of Gram-negative  Bordetella bronchiseptica  bacteria.


Transmission electron micrograph of parainfluenza virus. Two intact particles and free filamentous nucleocapsid.


Lipid-laden alveolar macrophages in a case of  vaping-associated pulmonary injury . Left:  Papanicolaou stain ; right:  Oil Red O  stain. [ 1 ]


Placement of an endotracheal tube to aid breathing


Mediastinum Anatomy


CT scan of a patient with Descending Necrotizing Mediastinitis.


Apgar score for newborn infants


Wheat harvested has dust blown in the air.


Breathing air with high oxygen pressure can lead to several adverse effects.


The curves show typical decrement in lung vital capacity when breathing oxygen. Lambertsen concluded in 1987 that 0.5 bar (50 kPa) could be tolerated indefinitely.


The lipid peroxidation mechanism shows a single radical initiating a chain reaction which converts unsaturated lipids to lipid peroxides.


The label on the diving cylinder shows that it contains oxygen-rich gas (36%) and is boldly marked with a maximum operating depth of 28 metres (92 ft)


The retina (red) is detached at the top of the eye.


The silicone band ( scleral buckle , blue) is placed around the eye. This brings the wall of the eye into contact with the detached retina, allowing the retina to re-attach.


Retinopathy of prematurity (ROP) in 1997 was more common in middle income countries where neonatal intensive care services were increasing; but greater awareness of the problem, leading to preventive measures, had not yet occurred. [ 37 ]


Paul Bert, a French physiologist, first described oxygen toxicity in 1878.


Robert W. Hamilton Jr , lead researcher on tolerable repetitive exposure limits at NOAA.


Stress Index of an ARDS patient with different values of PEEP


Piccadilly Circus  during the  Great Smog of London , 1952


Table and title page of John Graunt's (1620–1674)  Natural and political observations ... upon ... mortality  (1662) which notes mortality attributed to air pollution in London [ 16 ]


Disability-adjusted life year  for birth asphyxia and birth trauma per 100,000 inhabitants in 2002


Sagittal CT image showing "tree in bud" appearance of mucous impaction in distal small airways related to primary ciliary dyskinesia


CT image showing dilated and thickened medium-sized airways (bronchiectasis) in a patient with Kartagener syndrome


Oblique sagittal CT image showing lower lobe cylindrical bronchiectasis in the same patient


CT image showing  situs inversus . The liver is normally on the right side of the body and the spleen on the left, they are switched in this patient with situs inversus.


Axial CT image showing dextrocardia with the IVC and morphologic right ventricle on the left and the left ventricle on the right


Axial CT image showing chronic sinusitis in an individual with Kartagener syndrome


An immature  little blue heron  with psittacosis


It is common to see RAD incorrectly used as a synonym for asthma.


First page of the 2010 ICD


Pulse oximetry is a simple, quick, painless test.


Causes of respiratory failure


Clubbing


Arterial blood gas analyzer


Mechanical ventilator


Indoor Swimming Pool


Respiratory system  anatomy


Deaths from respiratory infections per million persons in 2012     24-120    121-151    152-200    201-244    245-346    347-445    446-675    676-866    867-1,209    1,210-2,090


CT scan of a saber-sheath trachea in a patient with COPD


Certified respirators, without exhalation valves, are the recommended form of source control.


In hospitals, proper source control protocols are essential.


Droplet spread without source control: up to ~8 meters (26 ft) for sneezes and coughs, up to ~2 meters (6.6 ft) for talking. Aerosol spread is much further than this. [ 2 ]


Masks with exhalation valves are not very effective for source control. However, some respirators  with  exhalation valves performed as well as a surgical mask in source control. Respirators  without  exhalation valves should be preferred. [ 10 ]


1997 proposed  OSHA   administrative  rule:  No Admittance Without Wearing a Type N95 or More Protective Respirator [ 29 ]


Similar to  NIOSH 's  Hierarchy of Hazard Controls , multiple controls are used for source control of  TB [ 30 ]


NIOSH guidelines for TB, with focus on  respirators  under the old  30 CFR 11 , replaced in  1995  (On  Wikisource )


HICPAC  2007 Guideline for Isolation Precautions . A more general guideline for hospital  PPE  procedures. (PDF, 225 pages)


A chest x-ray showing pulmonary edema with bilateral pleural effusions.


An illustration of an individual receiving intravenous blood transfusion.


A person receiving supplemental oxygen via nasal cannula.


A  schematic of a typical e-cigarette with a cartridge containing nicotine dissolved in propylene glycol


Bronchoalveolar lavage sample from a patient with acute lung injury associated with vaping, showing alveolar macrophages laden with vacuoles (A) and extensive lipid deposits (B) [ 59 ]


Micrograph  of  diffuse alveolar damage , the histologic correlate of ARDS.  H&E stain .


A chest x-ray of  transfusion-related acute lung injury  (left) which led to ARDS.  Right is the same patient with  resolved injury 72 hours after ventilator support. Note the clearance of bilateral diffuse infiltrates.


Micrograph  showing  hemosiderin -laden alveolar macrophages, as seen in a  pulmonary hemorrhage .  H&E stain .


Histopathology of smoker's macrophages with anthracotic stippling, indicating the presence of both  respiratory bronchiolitis  and  anthracosis .


Micrograph of carbon-laden macrophages in the lung,  H&E  stain


Micrograph of an alveolar macrophage in the  lung tissue  showing the nucleus and other organelles including the  Golgi body  and  mitochondria .


Bench top analyzer ABL800 FLEX -  Radiometer Medical


Modern, blood gas analyzer. This device is capable of reporting pH,  pCO 2 , pO 2 , SatO 2 , Na + , K + , Cl − , Ca 2+ , Hemoglobin (total and derivatives: O 2 Hb, MetHb, COHb, HHb, CNHb, SHb ), Hematocrit, Total bilirubin, Glucose, Lactate and Urea. (Cobas b 221 -  Roche Diagnostics ).


Detail of measurement chamber of a modern blood gas analyzer showing the measurement electrodes. (Cobas b 121 - Roche Diagnostics)


Oxygen-haemoglobin dissociation curve


Christian Bohr, who was credited with the discovery of the effect in 1904.


The original dissociation curves from Bohr's experiments in the first description of the Bohr effect, showing a decrease in oxygen affinity as the partial pressure of carbon dioxide increases. This is also one of the first examples of  cooperative binding . X-axis: oxygen partial pressure in  mmHg , Y-axis %  oxy-hemoglobin . The curves were obtained using whole  dog   blood , with the exception of the dashed curve, for which  horse   blood  was used.


The magnitude of the Bohr effect is given by

 Δ
 log

 (

 P

 50

 )

 Δ

 pH

 {\textstyle {\scriptstyle \Delta \log(P_{50}) \over \Delta {\text{pH}}}}

 , which is the slope on this graph. A steeper slope means a stronger Bohr effect.


Haemoglobin changes conformation from a high-affinity R state (oxygenated) to a low-affinity T state (deoxygenated) to improve oxygen uptake and delivery.


Though they are one of the largest animals on the planet, humpback whales have a Bohr effect magnitude similar to that of a guinea pig.


Illustration depicting bronchoconstriction (Asthma)


A heme unit of human carboxyhaemoglobin, showing the  carbonyl ligand  at the apical position,  trans  to the histidine residue. [ 1 ]


Respiratory centre and its groups of neurons


Climbing  Mount Rainier , 14,411 feet (4,392 m) above sea level.


Pressure as a function of the height above the sea level


The summit of  Mount Everest  is in the death zone, as are the summits of all  eight-thousanders .


The summit of  K2 , the  second highest mountain on Earth , is in the death zone.


Athletes training at high altitude in  St. Moritz ,  Switzerland  (elevation 1,856 m or 6,089 ft).


Diagram showing expiration


Oxygen-Haemoglobin dissociation curves


Staged image showing how victims may black out quietly underwater, often going unnoticed.


Latent hypoxia hits on ascent


Max Perutz  won the  Nobel Prize for chemistry  for his work determining the molecular structure of hemoglobin and  myoglobin [ 15 ]


Protein alignment of human hemoglobin proteins, alpha, beta, and delta subunits respectively. The alignments were created using  UniProt 's alignment tool available online.


Heme  b group


A schematic visual model of oxygen-binding process, showing all four  monomers  and  hemes , and  protein chains  only as diagrammatic coils, to facilitate visualization into the molecule.  Oxygen  is not shown in this model, but, for each of the  iron  atoms, it binds to the iron (red sphere) in the flat  heme . For example, in the upper-left of the four hemes shown, oxygen binds at the left of the iron atom shown in the upper-left of diagram. This causes the iron atom to move backward into the heme that holds it (the iron moves upward as it binds oxygen, in this illustration), tugging the  histidine  residue (modeled as a red pentagon on the right of the iron) closer, as it does. This, in turn, pulls on the protein chain holding the  histidine .


The sigmoidal shape of hemoglobin's oxygen-dissociation curve results from cooperative binding of  oxygen  to hemoglobin.


Gene expression of hemoglobin before and after birth. Also identifies the types of cells and organs in which the gene expression (data on  Wood W.G. , (1976).  Br. Med. Bull. 32, 282. )


A hemoglobin concentration measurement being administered before a blood donation at the  American Red Cross  Boston Blood Donation Center.


The giant tube worm  Riftia pachyptila  showing red hemoglobin-containing plumes


Heart of Steel (Hemoglobin)  (2005) by  Julian Voss-Andreae . The images show the 5-foot (1.5 m) tall sculpture right after installation, after 10 days, and after several months of exposure to the elements.


Global distribution of red blood cell abnormalities


Himalayas, on the southern rim of the Tibetan Plateau


A Sherpa family


Quechua woman with llamas


Aymara ceremony


Diagram showing inhalation


Scheme of changes in lung volumes in restricted and obstructed lung in comparison with healthy lung.


The structure of  cytochrome b5 reductase , the enzyme that converts methemoglobin to hemoglobin. [ 1 ]


An  Alpine chough  in flight at 3,900 m (12,800 ft)


Naked carp in  Lake Qinghai  at 3,205 m (10,515 ft)


The  Himalayan pika  lives at altitudes up to 4,200 m (13,800 ft) [ 28 ]


The deer mouse


Domestic yak at  Yamdrok Lake


A  Sherpa  family


Rüppell's vulture  can fly up to 11.2 km (7.0 mi) above sea level


Male cinnamon teal


Cushion plant  Donatia novae-zelandiae , Tasmania


Structure of oxyhemoglobin


Hemoglobin saturation curve


Fetal hemoglobin saturation curve


Illustration of the pressure-time waveform during an inspiratory hold. During the inspiratory hold, the decay in pressure towards the true plateau pressure is due to pendelluft, as well as the relaxation of elastic chest wall / lung tissue.


A  Lindbergh  perfusion pump, c. 1935, an early device for simulating natural perfusion


AMPA receptor


3D rendering  of a  high resolution computed tomography  of the  thorax . The anterior thoracic wall, the airways and the pulmonary vessels anterior to the  root of the lung  have been digitally removed in order to visualize the different levels of the pulmonary circulation.


Image showing main pulmonary artery coursing ventrally to the  aortic root  and  trachea . The right pulmonary artery passes dorsally to the  ascending aorta , while the left pulmonary artery passes ventrally to the  descending aorta .


The opening page of one of Ibn al-Nafis's medical works


Alveoli  are the spherical outcroppings of the  respiratory bronchioles .


Survanta , surrounded by devices for its application.


Respiratory pressure meter


Cigarettes are known to cause many lung diseases including emphysema, chronic bronchitis, and lung cancer.


Smoking-related deaths in firsthand and secondhand smokers in the US between 2005 and 2009 (no data available for secondhand smokers with COPD deaths [ 7 ] )


Histopathology of a smoker's macrophage. The brown staining is likely due to the granular autofluorescence bodies from tar.


Diagram of iron homeostasis. A: The role of hepcidin; B:The effects of environmental factors; C: Genetic variation in iron homeostasis. Exposure to cigarette contents leads to abnormal ferritin metabolism and increased TFR1 activity.


A patient's lung diagnosed with lung cancer


The survival rate when smoking cessation was initiated at age 25–34. Ex-smokers have significant improvement in survival and become nearly as healthy as non-smokers.


Two dogs  sniffing each other


Doing spirometry


A modern USB PC-based spirometer.


Device for spirometry. The patient places his or her lips around the blue mouthpiece. The teeth go between the nubs and the shield, and the lips go over the shield. A nose clip guarantees that breath will flow only through the mouth.


Screen for spirometry readouts at right. The chamber can also be used for body  plethysmography .


Normal values for peak expiratory flow (PEF), shown on EU scale. [ 21 ]


Diagram of anatomy of pulmonary alveolar structure


Diagram of anatomy of lung structure


An animated diagram that shows the change in thoracic volume during ventilation, and the exchange of oxygen and carbon dioxide between the pulmonary alveolus and capillaries during perfusion.


Diagram of the lungs showing regional variations in V/Q ratio


Diagram of alveolar dead space in alveoli and pulmonary capillary


Diagram of pulmonary shunt in alveoli and pulmonary capillary


Output of a spirometer


VO 2  max measurement using instruments on a metabolic cart during a graded treadmill exercise test


Gas exchange of VO 2  and VCO 2  during max test. Begin for 3 minutes at 60 watts and add 35 watts every 3 mins until exhaustion.


Graph of the breathing resistance of an open-circuit demand regulator. The area of the graph (green) is proportional to the net mechanical work of breathing for a single breathing cycle


Endobronchial valve


A man undergoing whole body plethysmography.


A modern body plethysmograph using ultrasound


A simple float spirometer being used in a high school science demonstration


Adult with air entrainment (Venturi) mask


In 1919 several hundred Philadelphia school children form a living TB double cross, the logo at the time of the National Tuberculosis Association.


An American Lung Association booth at a local 5k race in  Kansas City


The first German tuberculosis sanatorium, founded by Dr Hermann Brehmer in Görbersdorf (today Poland), about 1870


Postcard of Heidehaus, Otto Ziegler’s sanatorium, about 1907


Mass screening of apprentices in a steelwork in Mannheim, 1939


Hemopericardium , wherein the  pericardium  becomes filled with  blood , is one cause of cardiac tamponade.


Electrocardiograph: the portion of normal  sinus rhythm  during which commotio cordis is a risk if a severe chest impact occurs within the narrow  vulnerability window


Defibrillator training kit


Axial lower chest CT scan showing bowel herniation due to left diaphragmatic rupture


Left posterior diaphragmatic rupture undergoing surgery


Ambroise Paré


Diaphragmatic rupture in a dog


Diagrams depicting the paradoxical motion observed during respiration with a flail segment


A  chest radiograph  of a flail chest associated with right sided  pulmonary contusion  and  subcutaneous emphysema


Gross pathology of hemopericardium, with clotted blood surrounding the heart (in this case appearing yellow due to epicardial fat).


Autopsy specimen showing large clotted hemothorax filling the entire pleural cavity.


Pleural fluid sample from a hemothorax taken by thoracentesis


A tube thoracostomy unit


Hemothorax mid-VATS showing diaphragmatic injury caused by a costal exostosis


Hemothorax mid-thoracotomy showing bleeding from tears in the pulmonary ligament and no other obvious injuries.


Hemothorax in an animal caused by  anti-coagulant  poisoning


Large, right lower lobe pneumatocele is shown, compromising ventilation in a premature infant with  RDS  and superimposed  RSV  pneumonitis.


A schematic drawing of a bulla and a bleb, two lung abnormalities that may rupture and lead to pneumothorax


CT scan  of the chest showing a pneumothorax on the person's left side (right side on the image). A  chest tube  is in place (small black mark on the right side of the image), the air-filled  pleural cavity  (black) and  ribs  (white) can be seen. The  heart  can be seen in the center.


CT with the identification of underlying lung lesion: an apical bulla on the right side


A chest tube placed on the right for a pneumothorax


Video-assisted thoracoscopic surgery  (VATS) wedge resection


The  alveoli


Motor vehicle collisions  are the most common cause of pulmonary contusion.


Normally,  oxygen  and  carbon dioxide  diffuse across the capillary and alveolar membranes and the interstitial space (top). Fluid impairs this diffusion, resulting in less oxygenated blood (bottom).


A chest X-ray showing right sided (seen on the left of the picture) pulmonary contusion associated with rib fractures and  subcutaneous emphysema


A chest  CT scan  revealing pulmonary contusions,  pneumothorax , and  pseudocysts


An  ultrasound image  showing early pulmonary contusion, at this moment not visible on radiography. Lung swelling is seen as vertical white lines, the "B-lines". [ 48 ]


Mechanical ventilation  may be required if pulmonary contusion causes inadequate oxygenation.


This CT scan, taken 22 days after pulmonary contusion with major chest trauma, shows that the contusion has completely resolved. [ 64 ]


A chest  X-ray  showing acute respiratory distress syndrome


Severe pulmonary contusion with pneumothorax and hemothorax following severe chest trauma [ 68 ]


Giovanni Battista Morgagni , credited with having first described lung trauma without chest wall trauma


A CT scan of a pneumothorax, a chest injury that may accompany pulmonary laceration


A chest X-ray of a right sided pulmonary contusion associated with  flail chest  and  subcutaneous emphysema .  Contusion may mask pulmonary laceration on chest X-ray.


Anatomy of the rib cage


The "hooking maneuver" being performed on a model skeleton


Illustration showing sternal fracture between ribs 3 and 4


CT scan showing a  comminuted  sternal fracture. [ 12 ]


Pneumothoraces  of both lungs (large arrows),  pneumomediastinum  (small arrow) and  subcutaneous emphysema  in a patient with complete disruption of the right bronchus. Air leak was continual despite suction. [ 1 ]


Diagram of the larynx, trachea and bronchi


A patient with traumatic complete disruption of the right bronchus. Computed tomography scan following emergency chest tube drainage. Axial 1.25 mm thick sections with a lung window. (a) Persistent bilateral pneumothorax, pneumomediastinum and extensive subcutaneous emphysema. (b) Multiple lucencies around the right bronchial tree (curved arrow) precluding the correct recognition of the bronchial rupture. (c) The Macklin effect around the right lower  pulmonary vein  (white arrow). (d) Coronal view demonstrating multiple areas of  alveolar  consolidation in the right upper and lower lobes: intraparenchymal lucencies resulting from lung lacerations are visible on the right side (thick arrows).


An  endotracheal tube  may be used to bypass a disruption in the airway.


A left main bronchus laceration, resulting in pneumothorax. Air is evacuated from the chest cavity with a  chest tube .


Bronchial  stenosis  (arrow) two weeks after surgery for a tracheobronchial laceration [ 1 ]


An example EKG for pulseless electrical activity. In this rhythm, cardiac activity will be seen on electrocardiogram, but a pulse will not be felt on provider's exam.


An EKG showing asystole, or "flat-lining."


Echocardiogram is a study in which an ultrasound is used to exam the function of the heart. In Traumatic cardiac arrest, an echocardiogram may show ineffective motion of the heart and may provide clues that point to a specific cause of the arrest.


La Miseria  by  Cristóbal Rojas  (1886). Rojas had tuberculosis when he painted this. Here he depicts the social aspect of the disease, and its relation with Living conditions at the close of the 19th century.


Hippocrates.


Henry IV of France touching numerous sickly individuals during the ceremony of the "royal touch". The original caption reads:  Des mirabili strumas sanandi vi solis Galliae regibus christianissimis divinitus concessa liber unus .


The  Russian  writer  Anton Chekhov , who died of tuberculosis in 1904


Robert Koch , a  Prussian  physician, discovered the cause of tuberculosis.


1950 Census Enumeration District Map of Aibonito, Puerto Rico, United States, indicating a "Tuberculosis Sanatorium" to be a special (Census) enumeration area


A map of deaths from tuberculosis in  Washington, D.C.  in 1900–1901.


A chart showing the rate of tuberculosis in  inspected  livestock in a 1938 publication of the  United States Department of Agriculture .


Tuberculosis mortality in the USA from 1861 to 2014.


Specialist Nurse at 18-bed 'Fresh Air School' for children with TB. Royal Victoria Hospital, Montreal. 1939.


Gray (right) prior to his March 1927 world record attempt.


Hamlisch, at age 29, holding two of the three Oscars he won in 1974. With him are  Donald O'Connor ,  Debbie Reynolds , and  Cher .


Hamlisch conducting


Hamlisch at the piano, 2006


Heche at the  Primetime Emmy Awards  in 1997


Heche in June 2007


Heche with  Ellen DeGeneres  in September 1997


Heche with  James Tupper  in November 2014


Crypt of Anne Heche at Hollywood Forever Cemetery


Rivers with Jim Connell and  Jake Holmes  in "Jim, Jake & Joan", early 1960s


Rivers in 1987


Rivers poses for a photograph at  The Pierre  hotel in New York City in 2001


Rivers in 2010


Rivers performing in her show at the 2008  Edinburgh Festival Fringe


Rivers with her daughter Melissa during  New York Fashion Week  2012


Rivers in 1967


Grave of John Christopher Stevens in Grass Valley, California


Statue of Payne Stewart at  Waterville  Golf Links, Ireland


1910 journey to Tenerife, Schrötter in back row, far right.


Hermann von Schrötter. 5. August 1922. Portrait gezeichnet von Hans von Schrötter (Familienbesitz). © B. Mader.


Schrötter's diagram of a pressurized cabin for gas balloons


Respiratory therapist in an intensive care unit


A respiratory therapist gives an immunization to a patient


A respiratory therapist teaches students about the dangers of smoking.


Anesthesia vaporizer


CABG surgery with CPB


A respiratory therapist takes a blood sample from a 3-day-old in preparation for transfer to an Extracorporeal Membrane Oxygenation unit


A  pediatric  patient prepared for a  polysomnogram  by a respiratory therapist.


A premature infant on  ECMO , a form of heart/lung machine, is being transferred between hospitals


An acid-base diagram for human plasma, showing the effects on the plasma pH when  P CO 2  in mmHg or Standard Base Excess (SBE) occur in excess or are deficient in the plasma [ 23 ]


An intrapulmonary percussive ventilator machine


Many of today's current analytical nebulizers, as of 2017


A teflon PFA concentric nebulizer.


A Meinhard glass concentric nebulizer.


Dr. Virginia Apgar  co-authored a 1953 study that was critical of the device.


A Both cabinet respirator being used to treat a patient at the 110th Australian Military Hospital in 1943


A Both respirator on display at the National Museum of Australia


Demand valve exhalation


Demand valve inhalation


pressure-regulated volume control


Epinephrine vial 1 mg (Adrenalin).


Chemical formula of nitric oxide (NO) together with its molecular size (115  pm ).


Three-dimensional model of NO.


An experimental setup used to measure the fraction of exhaled nitric oxide (FeNO) in human breath samples. The subject blows into the tube (1) after a mouthpiece (2) has been connected to it. The wires on the side are part of the system that measures parameters like breath velocity, while the exhaled gas is taken to a FeNO analyzer (3).


The NIOX VERO® FeNO testing device.


Flonase brand nasal spray


Heat and Moisture Exchanger


HME, HMEF, and bacterial viral filters


Heliox  diving cylinder color coding : Illustration of cylinder shoulder painted in brown and white quarters


Illustration of cylinder shoulder painted in brown (lower) and white (upper) bands


Multiplace hyperbaric chambers, showing control panel, monitoring facilities, and different chamber sizes in Spanish facilities


A recompression chamber for a single diving casualty


An example of mild portable hyperbaric chamber. This 40-inch-diameter (1,000 mm) chamber is one of the larger chambers available for home.


Monitoring the decompression chamber during a simulated medical emergency


Typical deck decompression chamber used on site for surface decompression and emergency treatment of decompression illness


Bank of oxygen cylinders for recompression treatment or surface decompression


Navy Divers test built-in breathing masks inside a recompression chamber.


Side view of BIBS mask supported by straps


Chamber pressure gauge calibrated in msw and bar


How the HTi is calculated:  Only part of the IHT session is shown, the targeted  SpO2  value is 80% as an example. The filled part of the  SpO2  graph represents the amount of hypoxia delivered, “dosage”.


Depiction of the components of an incentive spirometer. The user is seated upright and holds the device in front of them. They breathe in air through the mouthpiece while watching the piston rise towards the goal marker.


Another example of an incentive spirometer


Different types of  dry powder inhalers


Nebulizer  with face mask


Penetro brand inhaler from mid 20th century Mexico, part of the permanent collection of the  Museo del Objeto del Objeto


Inhaler designed by John Mudge in 1778


Mouthpiece for an inhaler designed by Dr Beigel (1867)


Iron lung cylinder (black), patient head exposed through sealed opening. Diaphragm (yellow) mechanically extends/retracts, varying cylinder air pressure, causing patient chest to expand (inhale) (top) and contract (exhaling) (bottom)


An iron lung ward, as mocked-up for a film, circa 1953


Iron lung from the 1950s in the  Gütersloh Town Museum . In Germany, fewer than a dozen of these breathing machines are available to the public.


A Drinker iron lung displayed at the chapel of  Netley Hospital , 2018


Staff in a  Rhode Island  hospital examine a patient in an iron lung tank respirator during a polio epidemic in 1960.


Example of a liquid ventilator (Inolivent-5 research group Inolivent,  Université de Sherbrooke )


Example of the pumping cycle in a liquid ventilator (Inolivent-4, research group Inolivent,  Université de Sherbrooke )


Hospital staff examine a patient in an Iron lung tank respirator during the polio epidemic. The machine creates a negative pressure around the thoracic cavity, thereby causing air to rush into the lungs to equalize intrapulmonary pressure.


Respiratory therapist  (RT) examining a mechanically ventilated patient in an  intensive care unit . RTs participate in the optimization of ventilation management, adjustment, and weaning.


Image of endotracheal tube placement required to connect a patient's physiologic airway to the ventilator.


Carl Gunnar Engström  invented in 1950 one of the first intermittent positive pressure ventilator, which delivers air straight into the lungs using an endotracheal tube placed into the windpipe.


3100A Oscillator


Neonatal Jet ventilator


SMART BAG MO Bag-Valve-Mask Resuscitator


Another form of nebulization


A modern jet nebulizer


A vial of 0.5%  albuterol  sulfate inhalation solution for nebulizing


Sales-Girons pressurized nebulizer from 1858


Dr Siegle's steam nebulizer,  Thackray Museum of Medicine [ 27 ]


Iron lung  cylinder (black), patient head exposed through sealed opening. Diaphragm (yellow) mechanically extends, and then retracts, varying cylinder air pressure and causing the patient's chest to expand (top), and then contract (bottom)


The Open Source Ventilator's OpenLung project, an open source, low-resource, quick-deployment  mechanical ventilator  design utilizes a  bag valve mask  (BVM or Ambu-bag) as a core component. [ 1 ]


Mechanics of the OpenLung ventilator


Born of urgency, numerous alternative and  open design  ventilators were developed during the COVID-19 pandemic. These cheaper alternatives shown various balances between complete reproduction of state of the art  medical ventilators  with pressure curve,  humidification ,  mechanisation ,  vitals monitoring ,  cost effectiveness , supply chain availability for parts in time of  medical shortage , ease of assembly, and other aspects.


MIT E-Vent Unit 002 Setup, design by MIT [ 39 ]


A fire in an oxygen tube approaching an oxygen firebreak


A woman wearing an oxygen mask


Respiratory care devices image


A  T-37  pilot wearing a mask designed for both diluter- and pressure-demand breathing


Inner view of a military aviators mask showing face seal, facepiece and inhalation valves


Emergency oxygen masks deployed


US Navy Divers test built-in breathing masks inside a recompression chamber


Climber wearing an oxygen mask on the summit of Everest, 2019


An infant placed under an oxygen tent


Oxygen piping and regulator with flow meter, for oxygen therapy, mounted in an  ambulance


Pin-indexed  Oxygen Regulator for portable D-Cylinder, usually carried in an ambulance's resuscitation kit


High pressure gas cylinders containing oxygen to be used at home. When in use, a regulator is connected to the cylinder valve and delivers gas at a constant low pressure through a hose to a mask that fits over a person's nose and mouth.


A home oxygen concentrator for a person with  emphysema


Nasal cannula


Non-rebreather mask


Peak flow meter (made in USA)


Normal values, shown on EU scale. [ 3 ]


Spirometry


Thorpe oxygen flowmeter at a Canadian hospital (color-coded white)


Laryngoscope handles with an assortment of Miller blades (large adult, small adult, child, infant and newborn)


Laryngoscope handle with an assortment of  Macintosh  blades (large adult, small adult, child, infant and newborn)


Laryngoscopy


An endotracheal tube stylet, useful in facilitating orotracheal intubation


A cuffed endotracheal tube, constructed of  polyvinyl chloride


A Carlens double-lumen endotracheal tube, used for  thoracic surgical  operations such as  VATS lobectomy


An endotracheal tube in good position on CXR. Arrow marks the tip.


An endotracheal tube not deep enough. Arrow marks the tip.


Laryngoscopes prepared for emergency anaesthesia


In cricothyrotomy, the incision or puncture is made through the  cricothyroid membrane  in between the  thyroid cartilage  and the  cricoid cartilage


Cricothyrotomy  kit


Diagram of a  tracheostomy tube  in the trachea:  1 -  Vocal folds  2 -  Thyroid cartilage  3 -  Cricoid cartilage  4 -  Tracheal rings  5 - Balloon cuff


A  premature infant  weighing 990 grams (35 ounces), intubated and requiring  mechanical ventilation  in the  neonatal intensive-care unit


Tracheal intubation is anticipated to be difficult in this child with a massive  ameloblastoma


The laryngoscopy. From  García , 1884


A standard setup for a ventilator in a hospital room. The ventilator pushes warm, moist air (or air with increased oxygen) to the patient. Exhaled air flows away from the patient.


Ventilator pressures labeled


An East-Radcliffe respirator model from the mid-twentieth century


Spherical meniscus with wetting angle less than 90°


Illustration of capillary rise. Red=contact angle less than 90°; blue=contact angle greater than 90°


Surgeon operating


Axial thoracic CT scan of a person with an Eloesser flap. Courtesy of Radiopaedia.org. From the case  https://radiopaedia.org/cases/11383


Doctors at the Sklifosovsky Institute start a lung transplantation operation. The operation will last about 12 hours.


Incision scarring from a double lung transplant


Micrograph  showing  lung transplant  rejection. Lung  biopsy .  H&E stain .


X-ray of a person who has had their right lung removed. Note how fluid has replaced the lung


Diagram showing the parts removed in a pneumonectomy


Large saddle thromboembolus in the pulmonary arteries (white arrows)


Dissection of the right superior  pulmonary vein  with VATS


Dissection of the anterior trunk of the right  pulmonary artery  with VATS


Preparing to divide the anterior trunk of the right  pulmonary artery  with the endoscopic stapler


Placing the resected lobe into a water-tight bag for removal from the chest


Views during a VATS lobectomy procedure


Blalock–Thomas–Taussig shunt – A) original procedure – B) modified procedure


Portable electronic system


Left-sided pneumothorax (right side of image) on CT scan of the chest with chest tube in place.


Size of chest tube:  Adult male = 28–32  Fr Pp Adult female = 28 Fr  Child = 18 Fr  Newborn = 12–14 Fr   [ 15 ]


Chest tube drainage holes


Chest tube drainage system diagram, with parts labeled in


A custom made operating thoracoscope, used for the endoscopic thoracic sympathectomy procedure.


A thermal image of an ETS patient 2 years after surgery.


Gas exchange in the alveolus


Atelectasis: normal vs. blocked bronchiole


Pulmonary oedema


Bronchoscopy in action


Coronal CT image in a 19-year-old patient with tricuspid atresia treated with bidirectional Glenn shunt and Fontan.


Plastic bronchitis


Francis Fontan (left) and Guillermo Kreutzer (right) in 2009


Example of a median sternotomy on a young adult male, around 72 hours following the procedure


Iatrogenic hemothorax resulting from the Nuss procedure. A showing no hemothorax, b showing hemothorax, and c showing resolution after treatment.


Visual scale for the quantification of hyperhidrosis


Gross anatomy of the lungs. Note the five lung lobes divided by the three lung fissures and the main, lobar and segmental bronchi.


The mechanical arm module of a surgical robot.


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