Chapter 1 session 2

the receptors for sense of smell, and it is located near the middle and superior terminates. Your sense of taste is very closely related to smell. Okay? We can have patients where we sometimes, no matter what's going on with them, disease process, obviously if we have a lot of inflammation or if we have a lot of mucus that's going on, that ultractoring region can be affected, right? Sometimes you're like, ooh, I can't smell anything. I can't taste anything, right? Usually if you can't smell anything, you can't taste anything. You can just taste like maybe the saltiness or the sweetness of something, but you can't make those really good, oh, this has milk, pepper and tobacco, right? So like wine tasting, things like that, okay? But we know that the sense of taste is closely related to the snow, okay? If the nasal mucosa is irritated, we get AC's reflex, okay? So sometimes we have some really big particles that get into our nose that will cause us to see. Okay? So, just below, the superior, is your superior. It's a little small, terminate. Disappear, you're in the middle terminates. We find the opening to the paradasal sinuses, okay? And if you see here that we're right there, and so we've got some paranamal sinuses. They are airfield, cavity, and bones, every soil that communicate with, and brain, and GPD is all cavity, okay? And so, we've got all of these things here. We've got, and I want you to notice here, this orchit of the Eustachian tube, you know, call the new station 254, but we'll talk about it here in a minute. I just want to just know them as you station too. So because I learned them back in the day, right? But here here terminates, frontal sinus, sphenoid sinus, and then we have your, um, that perinasal sinus right there, because that the airfield cabins, okay? Um, that drain into the nasal cavity. Here, again, paranasal sinuses. Um, act as a resident chambers for sound production. Okay? This is how I have the voice, I have, how you have the voice, you have, how some people can sing really well, have the voices, and the not, right? Is that resonant in there? And we know that when we have, um, sinus infections sound differently, or if we have steppy noses we sound differently, because, uh, we have different resonance, uh, resonating chambers. They are the differences in the rest of the chambers. And so we have A, is your frontal sinus right here? We have your B, is your F moi sinuses, all back in here. Okay? Spinoid sinus is C, which is a screen one a little bit further back, and then you have this an axillary sinus. Does anybody get bad sinus infections in here? Ooh, sometimes I do flips smoke gives me sign problem. And it's just like you just wouldn't press, right? You just want to press it on your sinuses. You just want to like crack them opening. Like, I just want to open it up to let the pressure release, right? So sometimes if we get real, if we get very swollen in our sinuses, we have air in there already and then we have like this swelling that happens and it compresses, right?ress that's where that pressure comes from. The air that's already in there, and then we have all this, um, tissue that's lying design asleep that swells up, right? And it causes pressure changes. And so sometimes it can be pressure that's pushing. And then sometimes you're, um, I read, it's in the book and I really didn't think about this until I started teaching this class. You're the air that is, if your sinuses swell up and like cut off all the air, the air will like eventually get, um, absorbed in there and it will leave a vacuum. So sometimes it's a vacuum that's causing your sinus headache. Yeah, just ridiculous. That's why the good meds are locked behind the counters, right? But you gotta give your driver's license for those, okay? So here are your sinuses. It's important for us because a lot of times people will have the science infections and then they get drainage. And if you are laying down while you sleep, you may not be coughing or it may not be realizing that you need to be swallowing it and then it gets down into your lungs. And we get a lower respiratory infection, okay? So nobody. What about your perinatal sinuses? The nucleus drained into the nasal academy, the openings beneath the concha, or the conke. The sinuses are symmetrical. Yes. Yeah, yeah. Was there? No, interesting. I heard I thought I heard somebody. Mm. Digital?? Okay. Okay. Um, oh, it might have been his computer in there. There is a guy that's back there, Mr. uh, Mr. Charlie Cameron. He might have been... So sometimes he'll li the uh the blinds and he'll look at us to hear. Your sinuses are symmetrical. We are very symmetrical as humans, we are very symmetrical, okay? One side should kind of mirror the other. And so we've talked about the frontal ethmois scenery and macillary bones and sinuses. They're lined with the same yucusucreting epithelium as the nasal cavity. So especially those back 2 thirds. It's the same kind of, um, tissue back there. Swelling causes impaired drainage and pressure. That's the sign is headache. Chronic sinus infections are because of bacteria, lane, secretions. And so it's great because that mucus that's in there can capture like some bacteria and some of the bad bugs that want to get back in there. But if it overwhelms and we don't have the immune properties to fight them off, it will cause infection and that's bad news there. Because where are all those sinuses located next to? your brain. Okay? Has anybody heard about people needing to get their sons washed out because they have chronic sinus infections? Some people can get mold up there and it's gone. I know. y'all, it's bad. One of our instructors had that one time from a long time ago, and she had to get a couple of washes and rinses out. And it's bad because if you keep that infection up there, it can eat through your bone. And like y'all said, there's your brain right there, okay? So you've got to be careful. You've got to be careful with that and keep taking care of yourself and make sure that your patients know that they need to get in, okay? And then also, if we've got bacteria laid secretion and we take some meds and like I said, we get some drainage, it can go, hopefully, you will cough it out or you're blowing it out right, but sometimes if you're sleeping, it's just draining. Who's woken up with a really sore throat, right? From sinus drainage at night? And some of that sign is we, like, as it's draining, we're swallowing it or we're coughing it out, but absolutely it can get to the trachea, get into your lower airway, and then cause lower respiratory infections. So we gotta be aware of that. Okay, here's some clinical connections that we might see when we have things going on with our nasal sinuses and in our nasal things here. Let's see if this will work then. So what we're trying to look at here is nasal clearing. Let's see if it's gonna corroborate with me. There we go. you. Okay, here. Is this supposed to be a PO? Yes, is it not showing? No. Last night I put it, it took me to YouTube and he played it that way. your baby, right? Mm hmm. Okay, let's see.s nasal. I can open it in. copy. And so this is one of the most, uh, super sternal attractions. a whole new amount of. Who got it? That's it. Who's got the sauce? I dont know. I guess it won't let me share it. go. What we're trying to look at here is nasal flaring. Let's see if she's got water. So moving here in the neighborhood. Okay, here. Okay. She was a creammature baby, right? Mm hmm. Yeah, so that's nasal fla on, so real dis may up on YouTube just as an example for teaching other doctors and nurses. what nasal curring can look like. So that nasal flaring is a very classic sign of distress, especially in your babies. especially in neomates and pediatric populations, she wasn't even knowing it's happening. Like you and I, we can we sit here and we can nasal flair ourselves, but it is just very early and very subtle. Um, I'm not embarrassed at all, but sometimes you're going to be treated. You're going to learn to assess a page and to notice that. It will hardly ever happen in adults, but if it does, that means you're a patient is struggling to breathe, but it will happen in baby's kids. Sometimes some older adults, um, but it's just it's your your airways is like, oh, I need more air. They're in respiratory distress. like, I need more air. And so it's opening that mayor to get more air under air. Okay? So that is something that can happen. Classic sign of respiratory disaster. Okay. Then we have AllR collapse, okay? And that's when you've got some sort of instruction in here and it causes a vacuum. You breathe in big and deep, and you know, in an adult, we have pretty, our noses are pretty structured, okay? And so if you get an LR collapse, you breathe in big and deep, that's fine, but if you're just trying to breathe in normally, or you're happy to breathe in big and deep, a lot to get any kind of air movement, sadness fairs. I play. So sometimes because we've got some swelling or some obstruction in your in your nose, usually there's an obstruction because of the swelling and that it's going to cause that kind of backing to close that near down because there may be an obstruction in this one. And so all of that pressure is going through only one mayor and it's causing it to collapse, okay? We have another thing, other nasal clinical connections that we can talk about epistaxis. He's read Harry Potter. invite, right? And there's a there's a spell that causes blood and has staxis in it or something like that. I think anyway, at least that, it's a clinical term for nosebleeds, okay? They occur most often under low humidity conditions. So if you are used to being in 150% humidity here and you go to the desert for a couple of days, you might get a nosebleed because it is so dry and that dry humidity, or that dry air will cause nosebleed because it's our nasal mucosis, just not used to it, okay? Um, We will, we supplement patient's oxygen, and the oxygen is coming straight out of the wall from a medical device and from and from 0 humidity, pretty much. okay? So sometimes when we put nasal canulas and we put this supplemental oxygen, it can dry up the nasal mucosa. So we can cause nosebleeds sometimes. okay? Usually that happens because there's very dry conditions and it's in the anterior part that anterior 13rd that is usually causing that the low humidity that dry mucosa nosebleed. They are most common in children 2 to 10 years old and then also older adults. Older adults because your skin gets a little thin and the mucosa gets thin and will cause any kind of trauma or any kind of movement sometimes will cause the capillarity to break. Okay? Um, So like I said, anterior nose, if it's in from the front of your nose, it's a little less serious. is because there's capillaries that are breaking in involvement. You can treat at home. We want to put pressure on it. Okay, until it stops, and then use some sort of water-based lubricant to kind of, um, make your nose noise. I think there's a couple they sell, you can use like the KY jelly, the water-based lubricant. There's one called like AR, AYR. I'm not if you've ever seen that, but there's metal lubrication used to moisten the mucosa of your nose. If you do have something and you can kind of tell it's bleeding from the posterior that those last 2 thirds of your nose, it's a little bit more serious, usually because there's like arterial weeding and not just calculated, okay? And so sometimes that they will bleed forever and ever and ever. And even though no matter how much pressure you put it put on it from the outside, it doesn't stop too much, okay? Um, and so those are more common in older adults or if you've had some sort of trauma to the midface. okay? Because you get really up in there. Sometimes treatment will resolve. It will involve packing. Sometimes we'll have to pack you with some tissue. There are actual, it looks like a tampon, they're called nasal rockets, and they stick it up your nose and it kind of inflates so that it puts pressure where we can't get it from the outside, because, you know, we have like our nasal bone right there, and I'm like, oh, that's where the bleeding is. I can't put pressure on that part from the inside. Okay? And then if it's bad enough and it keeps on bleeding, we might have to go in and cauterize the vessel. to treat those types of most foods. Okay? Rhinitis, anyone want to guess what that means? Congestion, inflammation. I T I S is inflammation, but yes, it does cause congestion. So inflammation of amicus membranes of the nasal cavity, it can be caused by lots of different things, which can be caused by RSV. It can be caused by allergies, things like that. And then sinusite is inflammation of the mucous membranes in the sinuses. Okay? So if you've got rhinitis and sinusitis at the same time, you're pretty miserable. Pretty miserable. Rhinorrhea, what do you think that is? No, really knows, absolutely. Okay? Or any notes can happen for lots of different things. It can be just because of temperature change, and because of some infection you've got. Um, We have lachrymal ground, uh, uh, lachrymal lands, um, going from our, uh, eyes into the nose. And so when you cry, does anybody get a ray nose? I know I do. And so that's why you can get on my nose. when you cry because the glands drain from the eye cavity into the nasal cavity. Okay? And then nasal polyps is this right here, and that's usually when we get, um, when there's a lot of infection or a lot of trauma, um, sometimes an inflammation to the nasal eucosa, and what will cause is the repeated inflammation or the repeated trauma was, was ever happening there. will cause an overgrowth of the neucosa. And it will, let's see, it will cause these polyps to, like, kind of grow down into the nasal cavity. Do you think you're getting good airflow when you've got these nasal polyps there? No. Okay. So sometimes it can be just one big one. It can be a lot of little ones. A lot of times our patients with cystic fibrosis will come to us with naylo polyps, and that's one of the things we have to treat them for is nasal polyps. So, um, What will happen is we'll have to go in and cautorize them out or cut them out, and a lot of the time if you had nasal callup surgery, you'll still keep it with 2 big old, those nasal rockets in their nose, just looking at you. Okay. We got to be real careful with that. And that is what they look like. They're very vascular. You can see they're just a big old piece of vascular tissue there. Okay. And they do cause a lot of bleeding, basically. If you like stick something up your nose, you're like, oh, just feel something in there. it can really cause some harm. Okay? Something there's some other nasal political connections. that you can think of. okay? Now let's get into the oral cavity. The oral cavity is an accessory respiratory passage. Okay, our main respiratory passage, we consider the nose, so the oral is an accessory respiratory passage, and it is lined with non ciliated, stratified, squamous epithelium cells. Okay, where do we find those as well? In the interior nose. Why do you think we find those in our mouth? There's lots of mechanical stuff going on there. We're chewing, we're biking, we're swallowing, right? And so the lining of your mouth, at the feeling of your mouth can be easily replaced, okay? It loses a lot of cells every day as we drink and swallow and eat and talk. Okay, in your oral cavity, there is a vestibule as well, and that is a space in between your lips and your teeth. The outer portion between the tips and then, like, the teeth and the lips. Okay, we've got a hard palate. right here, made of the palatine process of the maxilla and palatine bones. Okay, you can feel, you can take your tongue and feel up and feel that hard palate. Then there's a soft palette way back in the back here. It is a flexible mass of densely packed collagen fibers that project back and down. Okay? And you can kind of feel your soft palate as well. And there's a ubula. You can see a you do a there. Okay, and that is the end of the soft palette. The soft palate can move, which is great, and do they protective mechanism? Okay? It closes by moving upward and back during swallowing, sucking, blowing, and speaking. Okay? That movement allows us for protection of airways, for speaking reformation, to eat, to drink. There are muscles that involve, and those muscles are the levitator, vella palatinum, muscle, and it elevates the soft palette. You have the palato pharyngeal muscle that moves the soft palate down and forward. And then the palatal muscle closes the posterior opening of the nasal cavity during swallowing and coughing. Okay, here we also have the palato colossal arch. And we have a palatine tonsil. Who's ever been infected and seeing those tonsils swollen and not too good? Yeah, absolutely okay. So we're gonna go, ah, those are some of the things that, um, that you can see. And a tonsil is limpoid tissue, and it involved, it catches, um, some of the germs and stuff, and it kind of tastes what's going on in our body and what germs we have coming in so that it can activate our immune response. Okay? Tonsils are super important for immun- immunological defense. What happens when we remove consiles? I mean, lose that defense, huh? But a lot of times, because of people get who's, you might have had, does anybody have their tonsils removed? My boyfriend has. Have seen it? Yeah. Does anybody did anybody have it as an adult? They say it's a bad surgery as an adult. It April. That's why they do it when you're young. But, and so, um, I think some parents now are like, well, can we treat it other ways instead of removing tonsils because it is very important for your immune defense, okay? And then there's also the fellow, the phallophryngeal arch right there. Okay? So all this stuff. Why do you think it's important for us to look down there and know what's going on? If there's any information, any pus pockets on the back of the fur, that cause a good fit of drainage or irritation pain. Absolutely. And, um, that is, it's an airway still, and we will do intubations, and we have to look at someone's mouth, and we have to say, ooh, you're going to be okay to intubate, or you're going to be kind of a tough intubation. Okay, so we need to know what normal anatomy looks like. Um, because we will store some people called the Malum Potty School. You don't have to know that. We'll know that in a couple months, okay? So there's a mountain potty score that we will give someone based on how close structures are. If structures are falling into where they don't need to be, how much of the back of the throat of the oralfarex that we can that we can see. Okay? So, um, that's why it's important for us to know the kind of anatomy there. Now let's talk about the tongue. The tongue is formed by interlacing bundles of skeletal muscle fibers. So your time, you made big muscle, there are intrinsic and extrinsic muscles. The intrinsic muscles are muscles in your tongue that are not attached to any bony points. They are only located in the tongue. And they allow the tongue to change shape. This is especially used during speech and swallowing. Okay, can anybody, like, my little nephews and nieces can do this, they can, like, make the clover or whatever with the tongue, they can, like, maybe put your tongue into different positions and stuff. And so they're, they're like, miss, hey, Lindsay, can you do that? I'm like, no, it cannot. cannot do that. didn't get that skill. And so extrinsic muscles are attached to the skull bones or to the soft palate and allow the tongue to change position as in, like, sticking out, going back, lifting up. Okay? During chewing the tongue holds foods in place and mixes it with saliva, and that's the beginning of the digestion process. Then it forms a bolus that is moved to the back of the orovarans for swallowing. And that's important because if our tongue cannot form a bolus correctly, and then move it to the back of the aurofarings, and then if our soft palate can't move correctly, we're at risk for aspiration, and we call that someone who cannot protect their airway. Okay? And so it's important. Sometimes people can lose, um, loss of tongue muscle, um, because of surgery, because of cancer. I dont know if anybody had known anybody with mouth cancer. Sometimes they have to lop off a big part of your tongue and then your tongue is not able to move and form boluses correctly. And then they have a lot of trouble eating, okay? A lot of those people will go on somewhat like semi liquid diets, um, with thickened liquids or something like that because it's easier to um, to do that than to like eat steak. Because your tongue really does. Now you'll notice it when you're eating. you like, what's not time doing as it moves your food around and kind of massage this thing into a bolus? Anyways, the town also helps with KDNT sounds. okay? We also have a fredulum, which is, oh, I guess it's national on this one, or Fernulum is right here. It is a new coastal food that secures the tongue to the floor and prevents swallowing the tongue. Okay? This also can affect babies as, if we have, if you have too much of a prennial or too strong or they can affect their latch for breastfeeding, they can affect their speech and everything. Okay? So sometimes that's an assessment they need to do. When we're when we're talking about like airway stuff, especially with the upper airway, a speech language pathologist is a very important fringe to have in the hospital, okay? One of my best friends in speech, I wish mythologist, and we are kind of the airweight experts. Okay? So you will work with them a lot if you've got patients with stuff going on in their upper area. Okay? There are also taste buds on your tongue that you can see. There's taste buds that are called papillae, and they make the tongue build up. And of course, there are the bitter, sour, soft, sweet and umami flavors that you can taste with your tongue there. Okay, now let's talk about the pharynx. So once air passes either through the nasal cavity or the oro, the oral cavity, which is our accessory pathway, it enters something polypherin. And pharynx is Greek fourth root. Okay, so our throat beer. And we have three parts. We have our naso ferrets, which is kind of the back of the nose, there in your throat. The auropharynx, which is where your mouth is, your oral cavity is, back in throat, and then your laryngeopharynx. You be right by your lair. Okay, the divisions, your naval fans, like I was just saying, is behind the naval cavity down to the soft palate. Behind the nasal cavity, down to your soft palate. Pseudos drive by, ciliated, kilometer and helium are line the, um, your nasofherix. We have adenoid, also known as pharyngeal tonsils located in our posterior nasopharynx. Okay? Those are some other tonsils that can be removed. If severely swollen, if anything happens, trauma, or if you're pharyngeotonsils are swollen, airflow can be completely blocked from the nose to the throat. And that's why you see those mountainers happen. Because they can't, there's, there's swollen back in the, in that nasofarin, and that air can't get through, okay? Your autoference is behind the oral cavity, from the soft palette to the base of the tongue. At the hyoid level. OK, we have a hyoid cartrelation. And hyoid bone that it attaches to. You see here. I need a h old one. Mm. Your tongue will, um, the base of the tongue attaches to that, okay? So that's your autoference. What else do I have to say about that? Let's see, the Palatine tonsils and lingual, their lingual tonsils are located in this region. This is made up of non-ciliated stratified squamous epithelium. Okay, because there's a lot of mechanical action there, and we need to be able to replace that epiphelia. We have this fold right here. We have the epiglottis right here, which during eating and drinking will fold down to close to encloses the trachea so we don't get food or liquid into our lungs. Okay? And when it pops back up, there's this little space in between the tongue and the epiglottis, and that is called the velecula. V A L L E C U L A. So that'll let you, I'll spell it again. B-A-L-L-E C-U-L-A. And the molecular will be important to you because we use that as a landmark when we intubate. There is a specific intubation laryngoscope that goes straight into the molecular so we can lift up the airway so that we can see into it. Okay. So it's between the high weight and the base of the top. The base of the tongue, the base of the tongue, and the epiglottis. In between the base of the tongue and the epiglades. In fact, let me show you this. That's good. It's not. So that, you see, this is your base of your tongue right here. And then match your epiblottis and match your molecular, this little fold right there. Oh? Okay. And so we have, oh, my gosh, I have one of those too. This clinical connection you didn't even know you needed. And so, this is a Macintosh blade... right here. And what we use when we intubate with that, and we go down the time, it sits right in there. And it lifts it. And then this is a miller blade, and what will happen is we'll use the epiglottis for that when it directly lifts the epiglottis like that. okay. Dapple 12, all right? Okay. Do what? No, I'm Miller. And you hold it in your left hand. We'll get to that eventually. Okay. One of you are welcome. Then you have gotten the strength that you need already. I was just trying to Okay, let's see. What else you talking about here? The larynge fangers is below the base of the tongue and above the larynx. It is also known as the hypofare, below, right? I go f. Below the base of the tongue, above the larynx. And remember, what happens at the layer and below? Lower rest torture system. Okay? Deliverance interference, they say hypoference is where the digestive and respiratory tract separates, okay? Because we have our trachea that comes to the anterior, and our esophagus is to the posterior. OK? And so this is where we have, um, the digestive tract, and here's our respiratory tract, okay? So that's where they separate. It is made up of non-ziliated, stratified, squamous epipilium. No goblet cells, no stilia there, okay? So, the oro and the hypo is might have done, so... I think we have that one next, and so that's your, um, I would probably know where you would find your ciliated, um, stratified, your pseudo stratified, ciliated, culinar ephelium, or your non ciliated stratified, okay? In the upper airway. Okay, and if you see here, this parents, it stops, 'cause we did have unciliated, um, cells here, but then it stopped, and it's parents, okay? And so, stops there until we get below the larynx. Okay? Okay. A little bit more about tonsils. Like I said, it's lymphatic tissues that offer immunological defenses. There are pharyngeal tonsils, palatine tonsils, and linguino tonsils. I can see here, we've got tonsils there, your adenoid, your, um, your adenoid or your pharyngeal tonsils, palatine, and then lingual tonsils here, and so that's your lingual tonsil right there. Um, and, uh, inflammatory issues and kind of talk about this already. You can have, you just have people that are just there, what is it, stress? Always get distracted, huh? And their tonsils are always, always inflamed. And so it can cause them to drool a lot. It's just miserable to be sick all the time. And so that's why some people will have them removed, okay? Um, we have something called pharyngeotympanic tubes. Also known as your eustachian tunes, okay? And so they connect to the middle ear with the lateral surface of the nasopharyn. So our ears and our eyes, right, drain into our nose. Is that great? It's a good time. And so normally, they are flat and closed. Usually these students, they do need to drain, they'll open up, but normally they are flat and closed. They will briefly open to equalize pressure. Usually that's what they use for, is to equalize pressure when you swallow. So when we swallow, they briefly open and we're able to get a little bit of pressure out of our ears, okay? Um, And, um, Swallen, and then also Yami. Okay? It happens also during yawning. Um, so we can get inflammation. We can get inflammation in that, um, in those eustachian tubes and those pharyngeo, um, tympanic tubes. So information in them can also get excess mucus production and they can block and hinder the pressure equalizing process. And so if I cannot equalize pressure, do you think that's nice and lovely or kind of painful? Kind of painful, right? And so, um, We call that Otitis media, an ear infection, when you get, um, mucus and you get inflammation in those eustation tubes. who has lots of ear infections from hyrophobia, babies, no babies, right? And usually this happens because if you notice here, the difference in the way that they are laid out for an infant, their head is more round. And so it causes their eustachian tube to be a little bit more horizontal. okay? More flat. And so it doesn't drain as well. And so it can kind of keep mucus and fluid and that's why they're always getting, um, those, those, uh, inflammations, those, uh, infections. Thank you. And so sometimes they will put tubes, right? These had tubes in their ears or had your, your kiddo had tubes in their ears. Absolutely right. And they kind of fall out in a year or so. But it helps drain so that they're not keeping all that mucus and nastiness in there to keep reinfecting themselves. And if you see here with the adult, we have a little bit more of an ovalhead, and so are you stationed to or pharyngeal, you panic tubes, drain a little bit better. Okay? Ooh, but ear infection is just misery. Oh, right, is it called high fevers in Vegas? Just the infection process. I mean, because if you think about a baby's, um, you've got enough kind of like everything with a baby, you're at temperature control, how much, like what that's causing and things like that, and then just infection. the way that you be infection is sometimes your body's any knowledgegeable response is to heat is to heat up. It's to cause a fee to cause the cells that are the bacteria is doing it. Does that make sense? Depending on if they're also hydrated or not, and, um, I guess lots of, there are so many other things that you guys can get out of with high temperatures. of what might be causing that. Their hydration status too. So because if they're having pain swallowing, they're probably not eating a lot and not hydrating what. And they've got this or highest media disinfection. So their body's like, oh, I need to warm you up. But then there's not a lot of fluid and hydration in our cells. and causing high infection. Is that answer your question? Okay. Have you go back to all the physiology review? Okay, ooh, tonsilitis. We can get infections in these tonsils, guys. Bad news fairs. You can see pus. Um, swelling that affects the airway, how well you can breathe. We're worried about things going on there. Bloody. Ooh, not that painful, y'all. And people can even, like, push out stones. As there are tonsil stones. Anybody watch those videos? Yeah, I've seen that. And they have special things nowadays. Like, that was not a thing until, like, probably 5, 7 years ago. There's special tools you can, you can do that. Yeah. I always, um, I always ask when I get my teacher. You see the taco stars, you remember? She was like, no. Okay. Um, and then here's your milk, your infection, and you kind of see here where you can, um, will look down with their scopes and see a normal eardrome, and a near jerk, and... Oh, that makes me hurt already. I'll my gosh. And so we can see here there's a couple of, especially the struct caucus pneumone and H influenza are going to be a lot of those things in the coffin, those bugs that cost the no air infection. The tubes, like, should they call the skull room on the tube? Oh, like on the eardrums? That's a good question I do not know. I do not know. I think it should close up, but I do not know if it's, if it causes scarring, and then if that will then affect hearing later on in life. I'm sure it's a, it's a, process, it's a side effect that can happen. Is that happen to you? Yeah, if you look at them, like they've been the same way, I've had 3 sets of times. That's probably why, well, but one, it'd have been fine, but then you had to go account, you had to be overachiever and have three. And so repeated insult to that tissue probably has a little something to do with that. Okay, um, 0 gosh, is this not gonna work for me either? Oh, there it goes. Let sleep it'll... No, it probably isn't, y'all. So this is, well, this is vodka and esophageal visualization, which we just saw. So if y'all want to watch that on your own, absolutely watch that on your own. Okay? But we just looked at that 5th thing right here. Okay, so that's that's what you're going to see when you intubate your patient is weighing down like this. okay? And then you're opening their mouth and you're seeing them like this, okay? And so that's that visualization that you're seeing. You can see that you have 2 openings. Is the top or the bottom, the one that we're looking for to intubate or to put an airway in? So how to the top, the top is going to be your trachea, the bottom is the esophagus, okay? And so a practitioner that you're going to be, when you get out of here, you'll have practice, you will get an intubation rotation. You'll get to go into a surgical suite. Usually Wills Night North, and you'll get to practice into dating. People who are nice, it's nice and calm. They're there for a surgery. They're getting the good drugs. It's not a traumatic experience. Okay, so you'll get to practice that. Because as respiratory therapist, intimation is within our school practice. Okay? Okay, and this is what it looks like when we get the tube in, okay? Do you see how it makes a nice, big curve because our airway is curved? And so here's what our airway looks like when we're flexed. And then also when we are normal, okay? We've got to get a tube from our mouth into our trachea, and it's got to make a big turn, okay? Which is why our ET tubes have to be made of that flexible plastic PVC plastic. But when we put the tube in, we hyper extend the neck. Why do you think we high threats in the net? Look, straighter... You know, you can get a good view, but we have to lift this airway up even. And so that's what that laryngoscope does. It helps us lift that part of the airway down. Okay? You got to have some strength. People's heads are heavy. Okay? So, and these intervation mannequins are they're good at training, but it's nothing like the real thing. Okay, so we try my own that. But that's why I put you through an invation location. Any questions on that? Okay, let's do a few more minutes, and then on to y'all, uh, a break. Okay, innervation of the larynga pharynx. This is important. Innovation will cause things to happen. There's different things going on. And so sensory wise, the glossopharyngeal nerve, which is your knife cranial nerve, glossopharyngeal nerve. So when you when you feel something in your, um, lorenzo ference, your body's like, woo, I just want air there. right? I just want air there. And so if you feel something in your Lorendo fair, what will happen is that your motor, your Vegas nerve will then take over. It will say, ooh, I got to do something so it will cause you to gag, to cough. Okay? And it will cause that epiglottis to close down real quick. Okay? And then the fridgial reflex. The ferrangial reflex is that GAD reflects, that cough reflects the closing of that epiglottis to protect the lower airway. What happens when you lose the fringeal reflex? What if I have lost, I took some meds or something was damaged and or had it sometimes happened with a stroke, sometimes a stroke will affect you. Dysphasia, right? Scrip will cause your nerves not to feel or to act right, okay? And so you're taking a big load of local water, and then all of a sudden you did something and you're it goes the wrong way, but instead of coughing, like you usually would. You're choking. It goes down into your airway. Yeah, aspirin. and you're aspirating. absolutely. This happened, what had a friend that worked in a nursing home, and it was after this guy had a stroke, and they were like, okay, he has to be supervised when he eats and he's on this type of diet. They will tell them what type of diet to be on. And they brought that man donuts. And not a day later, they took chest x-ray, who had donuts in his lung. Oh. That poor man, and then he got an infection. Because donuts are not supposed to be in your lungs, okay? So when we lose that varyngeal reflex, that gad reflects that cough, we lose the protection of the airway and we can get bad things down our long system. Okay? That can even, and it can even just be mucus. We can, because, you know, usually we're swallowing our mucus that comes up and comes down from the nose and comes up from the tracheal tree. Um, And so if we lose it, instead of, um, it can just stay down there and it can cost even more perfection. Okay? When we have lots of consciousness, we lose the reflex. So when we have someone that goes down, they fall out at the hot at the at the grocery store. Sometimes they've lost or they're comatose. They lost their reflect. So that's why we intubate them to protect their airplane. They still may be breathing on their own. That's fine, but they can't, if anything happens to them, they cannot protect their airway. And so we need to intubate them to do that. Okay? Any questions about that? Okay? So kind of know that your glossophringial nerve, the knife cranial nerve, um, is responsible for that parential reflect, and the motor, and that Vegas nerve interests your 10th grade cranial, okay? responsible for that pharyngeal reflex to protect the airway. Oh, we're about to get into the cartilage of the lance. Let's take a, you wanna take a break? Get it moving around and keep going. Yes, okay, so get it, move around. Let's take a break until I bore you with these...