Bronchoscopic Oxygen Insufflation


Categories: POSITION OF THE PATIENT FOR PERORAL ENDOSCOPY
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Bronchoscopic oxygen insufflation is a life-saving measure equalled by

no other method known to the science of medicine, in all cases of

asphyxia, or apnea, present or impending. Its especial sphere of

usefulness is in severe cases of electric shock, hanging, smoke

asphyxia, strangulation, suffocation, thoracic or abdominal pressure,

apnea, acute traumatic pneumothorax, respiratory arrest from absence

of sufficient oxygen, or apnea from the presence of quantities of

irrespirable or irritant gases. Combined with bronchoscopic aspiration

of secretions it is the best method of treatment for poisoning by

chlorine gas, asphyxiating, and other war gases.



Bronchoscopic oxygen insufflation should be taught to every interne in

every hospital. The emergency or accident ward of every hospital

should have the necessary equipment and an interne familiar with its

use. The method is simple, once the knack is acquired. The patient

being limp and recumbent on a table, the larynx is exposed with the

laryngoscope, and the bronchoscope is inserted as hereinafter

described. The oxygen is turned on at the tank and the flow regulated

before the rubber tube from the wash-bottle of tank is attached to the

side-outlet of the bronchoscope. It is necessary to be certain that

the flow is gentle, so that, with a free return flow the introduced

pressure does not exceed the capillary pressure; otherwise the blood

will be forced out of the capillaries and the ischemia of the lungs

will be fatal. Another danger is that overdistension causes inhibition

of inspiration resulting in apnea continuing as long as the distension

is maintained, if not longer. The return flow from the bronchoscope

should be interrupted for 2 or 3 seconds several times a minute to

inflate the lungs, but the flow must not be occluded longer than 3

seconds, because the intrapulmonary pressure would rise. A pearl of

amyl nitrite may be broken in the wash bottle. Slow rhythmic

artificial respiratory movements are a useful adjunct, and unless the

operator is very skillful in gauging the alternate pressures and

releases with the thumb according to the oxygen pressure, it is

vitally necessary to fill and deflate the lungs rhythmically by one of

the well known methods of artificial respiration. Anyone skilled in

the introduction of the bronchoscope can do bronchoscopy in a few

seconds, and it is especially easy in cases of respiratory arrest,

because of the limp condition of the patient.



The foregoing applies to cases in which a pulmotor would be used, such

as apnea from electric shocks, etc. For obstructive dyspnea and

asphyxia, tracheotomy is the procedure of choice, and the skillful

tracheotomist would be justified in preferring tracheotomy for the

other class of cases, insufflating the oxygen and amyl nitrite through

the tracheotomic wound. The pulmotor and similar mechanisms are,

perhaps, the best things the use of which can be taught to laymen; but

as compared to bronchoscopic oxygen insufflation they are woefully

inefficient, because the intraoral pressure forces the tongue back

over the laryngeal orifice, obstructing the airway in this death

zone. By the introduction of the bronchoscope this death zone is

entirely eliminated, and a free airway established for piping the

oxygen directly into the lungs.










TITLE POSITION OF THE PATIENT FOR PERORAL ENDOSCOPY



It is the author's invariable practice to place the patient in the

dorsally recumbent position. The sitting position is less favorable.

While lying on a well-padded, flat table the patient is readily

controlled, the head is freely movable, secretions can be easily

removed, the view obtained by the endoscopist is truly direct (without

reversal of sides), and, most important, the employment of one

position only favors smoother and more efficient team work, and a

better endoscopic technic.





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