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Moving down, the trachea breaks into two and we have the left and the right lung. The left lung has two lobes, the right lung has three lobes. And as you'll notice on the mannequin, the lungs themselves more or less cover and certainly surround the heart. So, any damage we have to lung tissue or any swelling we get or damage to a lung, fluids filling up, blood filling up, air leaking out, can create a problem with the heart, and we can actually cardiac arrest due to damage to the lungs stopping including the heart beating. Smack between the two lungs is where the heart sits in an area called the cardiac notch. So, if we remove a lung actually away from the chest, you can now clearly see, the heart sits underneath and the lung either side of the heart itself. So, all of that needs to function properly. We also need to be able to create the vacuum. So if we have a heavy weight sitting on the chest, if we have somebody trapped in a car where they're trapped against the steering wheel or some heavyweights fall on the chest or a car for instance, classic one, where somebody is lying under a car, working on the car and the jack slip out and the car drops on the chest, if the chest cannot expand, and the diaphragm fall, you cannot physically breathe. You could be buried in a ditch. It happened a lot or used to happen a lot when people were digging ditches by hand and the walls collapsed in.

Your head and neck can be out of the ditch, but if your chest can't expand and your diaphragm fall, you have no physical way of breathing. Oxygen can't go in if there's no vacuum created. However, if we did mouth-to-mouth, or we used bag and mask on the patient and positive pressure re-ventilated, so in other words, we blow air in, then we can refill the lungs until we can lift the weight or dig the patient out of the ditch that they're trapped in. So, we need to have the ability for the chest to rise and fall, the ability for the diaphragm to fall, the airway needs to be clear, the tongue needs to be clear from the back of the throat and there needs to be no blockage in those pipeways at all for the oxygenation to take place. Remember also, the patient needs to breathe out because that's getting rid of the waste products that the cells use when they metabolize or when they use up the oxygen, waste products are kicked out and you breathe those out into the air. So, clear the airway, chest needs to be able to rise and fall, diaphragm needs to be able to fall to get oxygen in.

If we get a puncture in the lung, if it bursts, air runs into the cavity around the lung, and this creates a problem which we call a tension pneumothorax, pneumo being air, thorax being the area and a tension because it pressurises. There's no way for that oxygen or air to get out, so it starts to build up inside the cavity and it crushes and squashes, and eventually will stop the heart beating. This is a technique or the technique that's used to eradicate this problem, is to decompress the chest, and you will see paramedics popping needles through the chest to allow the air out, to allow everything to go back to its proper position in a central position and the pressure to be relieved. We can also get a similar problem if we get a bleed into the lung, which is called hemothorax. Hemo being blood, thorax being the area, that happens when blood starts to fill the cavity up and replace where oxygen should be. This will be seen by things like poor air entry. Stethoscopes need to be used to decide or decipher what's going on inside the chest.

And the positions we listen to is a midclavicular line, just below the clavicles. You'll notice the lung comes right up, almost behind your clavicle. So, we listen just below the clavicular line mid-point, which is giving us the top of the lungs. Lungs collapse from the top down, they fill with fluid from the bottom up. So, we listen to the top and compare it to the top. We then go underneath the armpit to listen to the bottom and compare the other armpit to the bottom, listening for bubbles, gurgles, crackles, wheezes, or for the top, we listen for silent chests. We also look at the colour the patient is going. If their lungs are not working properly and they're not getting oxygenated, they tend to go blue, cyanosis takes place, lack of oxygen, they will also have lack of oxygen to the brain. So, they can become a little bit combative, a little bit aggressive because their brain is being starved of oxygen and they are fighting that oxygen-deprived brain tissue.

So, we need to check it. We need to look at what we can see. What's the colour of the patient, what's their mental capacity, what's their AVPU like: Alert, verbal, pain, unresponsive? How were they acting to us, how were they communicating with us? What did they look like, what is their body colour? What is their lip colour, their ears, their fingertips, looking for cyanosis? Can they breathe properly? Is their chest expanding normally? Is it expanding equally on both sides? We can also use a thing called percussion, where we place two fingers on the chest and tap on the back of the fingers. The area inside here should be full of air, so when we tap on it, we should get a hollow sound, like a plasterboard wall in your house. If that sound is solid, then that's telling us it's filled up, it's mass, there is blood or something solid in there giving us a poor echo back from it. If it sounds nice and hollow on both sides, it's normally full of air. We confirm with the stethoscopes, but percussion is a very good way of denoting whether something is full and solid, or whether it's clear and full of air.