Informational Site NetworkInformational Site Network
Privacy
 


Home


Medical Articles


Mother's Remedies


Household Tips


Medicine History


Forgotten Remedies


Search

Medical Articles

The Progress Of Disease: Irritation, Enervation, Toxemia

Disease routinely lies at the end of a three-part chain that ...

Aortic Insufficiency Aortic Regurgitation

This lesion, though not so common as the mitral lesion, is of...

Indications For Esophagoscopy In Disease

Any persistent abnormal sensation or disturbance of function...

Ankle Twisted Or Crushed

Place the foot as soon as possible in warm water, as hot as ca...

To Prevent Itch

A dose of _Sulphur_, or rubbing a little flour of sulphur on ...

Inward Rotation Method

When the point is found to be buried in the mucosa, the best...

Mild Reaction Erethic

If the poison is not virulent, and the body of the patient in...

Sprains Or Racks

A sprain is usually the result of some involuntary stress comi...

Removal Of Foreign Bodies From The Larynx

Symptoms and Diagnosis.--The history of a sudden choking atta...

Resume Of Emergency Tracheotomy

The following notes should be memorized. 1. Essentials: Kn...

Diet And Baths In Heart Disease

The diet in cardiac diseases has already incidentally been ...

Endoscopy On The Human Being

Dog work offers but little practice in laryngoscopy. Because...

Treatment Of Compression Stenoses Of The Trachea

If the thymus be at fault, rapid amelioration of symptoms fo...

Prophylaxis

If one put into his mouth nothing but food, foreign body acc...

Brain Exercise

Proper exercise for the brain is most important. But this is n...

Decannulation After Cure Of Laryngeal Stenosis

In order to train the patient to breathe again through the la...

Hair Coming Off

There are many forms of this disfiguring trouble, both in the ...

Stage I Entering The Right Pyriform Sinus

The operator standing (as in Fig. 66), inserts the esophagos...

Punctures Case Xiii

Am old man applied leeches to the instep for inflammation occ...

Varioloid

is small pox modified by vaccination. It is to be treated as ...



Anchoring The Foreign Body Against The Tube Mouth





Category: MECHANICAL PROBLEMS OF BRONCHOSCOPIC FOREIGN BODY EXTRACTION
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery

If withdrawal be
made a bimanual procedure it is almost certain that the foreign body
will trail a centimeter or more beyond the tube mouth, and that the
closure of the glottic chink as soon as the distal end of the
bronchoscope emerges will strip the foreign body from the forceps
grasp, when the foreign body reaches the cords. This is avoided by
anchoring the foreign body against the tube mouth as soon as the
foreign body is grasped, as shown in Fig. 79. The left index finger
and thumb grasp the shaft of the forceps close to the ocular end of
the tube, while the other fingers encircle the tube; closure of the
forceps is maintained by the fingers of the right hand, while all
traction for withdrawal is made with the left hand, which firmly
clamps forceps and bronchoscope as one piece. Thus the three units are
brought out as one; the bronchoscope keeping the cords apart until the
foreign body has entered the glottis.

[FIG. 79--Method of anchoring the foreign body against the tube mouth
After the object has been drawn firmly against the lip of the
endoscopic tube the left finger and thumb grasp the forceps cannula
and lock it against the ocular end of the tube, the other fingers of
the left hand encircle the tube. Withdrawal is then done with the left
hand; the fingers of the right hand maintaining closure of the
forceps.]

[164] Bringing the Foreign Body Through the Glottis.--Stripping of
the foreign body from the forceps at the glottis may be due to:
1. Not keeping the object against the tube mouth as just mentioned.
2. Not bringing the greatest diameter of the foreign body into the
sagittal plane of the glottic chink.
3. Faulty application of the forceps on the foreign body.
4. Mechanically imperfect forceps.

Should the foreign body be lost at the glottis it may, if large become
impacted and threaten asphyxia. Prompt insertion of the laryngoscope
will usually allow removal of the object by means of the laryngeal
grasping forceps. The object may be dropped or expelled into the
pharynx and be swallowed. It may even be coughed into the naso-pharynx
or it may be re-aspirated. In the latter event the bronchoscope is to
be re-inserted and the trachea carefully searched. Care must be used
not to override the object. If much inflammatory reaction has occurred
in the first invaded bronchus, temporarily suspending the aerating
function of the corresponding lung, reaspiration of a dislodged
foreign body is liable to carry it into the opposite main bronchus, by
reason of the greater inspiratory volume of air entering that side.
This may produce sudden death by blocking the only aerating organ.

Extraction of Pins, Needles and Similar Long Pointed Objects.--When
searching for such objects especial care must be taken not to override
them. Pins are almost always found point upward, and the dictum can
therefore be made, Search not for the pin, but for the point of the
pin. If the point be found free, it should be worked into the lumen
of the bronchoscope by manipulation with the lip of the tube. It may
then be seized with the forceps and withdrawn. Should the pin be
grasped by the shaft, it is almost certain to turn crosswise of the
tube mouth, where one pull may cause the point to perforate,
enormously increasing the difficulties by transfixation, and perhaps
resulting fatally (Fig. 80).

[FIG. 80.--Schematic illustration of a serious phase of the error of
hastily seizing a transfixed pin near its middle, when first seen as
at M. Traction with the forceps in the direction of the dart in Schema
B will rip open the esophagus or bronchus inflicting fatal trauma, and
probably the pin will be stripped off at the glottic or the
cricopharyngeal level, respectively. The point of the pin must be
disembedded and gotten into the tube mouth as at A, to make forceps
traction safe.]

[FIG. 81.--Schema illustrating the mechanical problem of extracting a
pin, a large part of whose shaft is buried in the bronchial wall, B.
The pin must be pushed downward and if the orifice of the branches, C,
D, are too small to admit the head of the pin some other orifice (as
at A) must be found by palpation (not by violent pushing) to admit the
head, so that the pin can be pushed downward permitting the point to
emerge (E). The point is then manipulated into the bronchoscopic
tube-mouth by means of co-ordinated movements of the bronchoscopic lip
and the side-curved forceps, as shown at F.]





Next: Inward Rotation Method

Previous: The Use Of Forceps In Endoscopic Foreign Body Extraction



Add to del.icio.us Add to Reddit Add to Digg Add to Del.icio.us Add to Google Add to Twitter Add to Stumble Upon
Add to Informational Site Network
Report
Privacy
SHAREADD TO EBOOK


Viewed 1111