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: 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 Carina is your friend – visit her often. Everyone gets lost. When this happens, don’t go on, go back to the carina 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! 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.

1. The Alfred Intensive Care Unit, Melbourne, Australia
Bronchoscopy for trainees
Tricks to make it look like you know what you’re doing
David Pilcher
Intensivist, Alfred Health
@IntensiveDave
d.pilcher@alfred.org.au

2. The Alfred Intensive Care Unit, Melbourne, Australia
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
Carina is your friend – visit her often.
Everyone gets lost. When this happens, don’t go on, go back to carina
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!
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.
Use volume control
This is the safest way to ensure adequate alveolar ventilation
Use paralysis
This is the safest way to avoid a broken bronchoscope or broken patient.
Use a friend
Have someone else there with you
The Four Rules of Bronchoscopy

3. The Alfred Intensive Care Unit, Melbourne, Australia
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
Carina is your friend – visit her often.
Everyone gets lost. When this happens, don’t go on, go back to carina
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!
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.
Use volume control
This is the safest way to ensure adequate alveolar ventilation
Use paralysis
This is the safest way to avoid a broken bronchoscope or broken patient.
Use a friend
Have someone else there with you
The Four Rules of Bronchoscopy

4. The Alfred Intensive Care Unit, Melbourne, Australia
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
Carina is your friend – visit her often.
Everyone gets lost. When this happens, don’t go on, go back to carina
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!
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.
Use volume control
This is the safest way to ensure adequate alveolar ventilation
Use paralysis
This is the safest way to avoid a broken bronchoscope or broken patient.
Use a friend
Have someone else there with you
The Four Rules of Bronchoscopy

5. The Alfred Intensive Care Unit, Melbourne, Australia

6. The Alfred Intensive Care Unit, Melbourne, Australia

7. The Alfred Intensive Care Unit, Melbourne, Australia

8. The Alfred Intensive Care Unit, Melbourne, Australia
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
Carina is your friend – visit her often.
Everyone gets lost. When this happens, don’t go on, go back to carina
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!
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.
Use volume control
This is the safest way to ensure adequate alveolar ventilation
Use paralysis
This is the safest way to avoid a broken bronchoscope or broken patient.
Use a friend
Have someone else there with you
The Four Rules of Bronchoscopy

9. The Alfred Intensive Care Unit, Melbourne, Australia
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
Carina is your friend – visit her often.
Everyone gets lost. When this happens, don’t go on, go back to carina
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!
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.
Use volume control
This is the safest way to ensure adequate alveolar ventilation
Use paralysis
This is the safest way to avoid a broken bronchoscope or broken patient.
Use a friend
Have someone else there with you
The Four Rules of Bronchoscopy
Posterior
Anterior

10. The Alfred Intensive Care Unit, Melbourne, Australia
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
Carina is your friend – visit her often.
Everyone gets lost. When this happens, don’t go on, go back to carina
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!
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.
Use volume control
This is the safest way to ensure adequate alveolar ventilation
Use paralysis
This is the safest way to avoid a broken bronchoscope or broken patient.
Use a friend
Have someone else there with you
The Four Rules of Bronchoscopy
Posterior
Anterior

11. The Alfred Intensive Care Unit, Melbourne, Australia
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
Carina is your friend – visit her often.
Everyone gets lost. When this happens, don’t go on, go back to carina
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!
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.
Use volume control
This is the safest way to ensure adequate alveolar ventilation
Use paralysis
This is the safest way to avoid a broken bronchoscope or broken patient.
Use a friend
Have someone else there with you
The Four Rules of Bronchoscopy
Posterior
Anterior

12. The Alfred Intensive Care Unit, Melbourne, Australia
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
Carina is your friend – visit her often.
Everyone gets lost. When this happens, don’t go on, go back to carina
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!
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.
Use volume control
This is the safest way to ensure adequate alveolar ventilation
Use paralysis
This is the safest way to avoid a broken bronchoscope or broken patient.
Use a friend
Have someone else there with you
The Four Rules of Bronchoscopy
Posterior
Anterior

13. The Alfred Intensive Care Unit, Melbourne, Australia
Use volume control
Safest way to ensure adequate alveolar ventilation
Use paralysis
Safest way to avoid a broken bronchoscope or broken patient.
Use a friend
Best way to improve up your skills
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
Carina is your friend – visit her often.
Everyone gets lost. When this happens, don’t go on, go back to carina
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!
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.

14. The Alfred Intensive Care Unit, Melbourne, Australia
Use volume control
Safest way to ensure adequate alveolar ventilation
Use paralysis
Safest way to avoid a broken bronchoscope or broken patient.
Use a friend
Best way to improve up your skills
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
Carina is your friend – visit her often.
Everyone gets lost. When this happens, don’t go on, go back to carina
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!
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.

15. The Alfred Intensive Care Unit, Melbourne, Australia
THANK YOU
David Pilcher
@IntensiveDave
d.pilcher@alfred.org.au