Ventilation / bronchoscopy tips for the intensivist

Basic bronchoscopy skills are considered a core component ability for all Intensive Care trainees. A few simple tricks to remember anatomy can make a relative bronch novice look like a seasoned pro. Remember 4 rules when looking down a bronchoscope: 

1. Walls to the back 

Every bronchus looks the same as every bronchus once you have already jumped in, so always identify the posterior wall to orientate yourself 

1. Carina is your friend – visit her often. 

Everyone gets lost. When this happens, don’t go on, go back to the carina 

1. The right middle lobe and lingula are anterior anatomical structures 

When you look down a scope, the right middle lobe is not in the middle, medial or any other stupid word beginning with ‘m’……….it is anterior, seriously! 

1. The apical segment of the lower lobes is a posterior anatomical structure. 

The fact that you even know this thing exists will so impress your colleagues and boss that no one will dare ask you any other bronchoscopy anatomy questions.