The following instance is so extraordinary, that I should not repeat it if the account were not attested by more than one writer, and also preserved in the public monuments of a considerable town of Upper Saxony; this town is Hamelin in th... Read more of The Pied Piper at Scary Stories.caInformational Site Network Informational
Privacy


Home


Medical Articles


Mother's Remedies


Household Tips


Medicine History


Forgotten Remedies


Search

Medical Articles

Punctures Case X

Mr. Worth's daughter, aged six, was thrown down by a dog and ...

Scarlatina Miliaris

Sometimes the red patches of the rash are covered with small ...

Direct Laryngoscopy In Diseases Of The Larynx

The diagnosis of laryngeal disease in young children, impossi...

Nightmare

In serious cases of this trouble, the patient awakes some time...

Malignant Endocarditis Ulcerative Endocarditis

Since we have learned that bacteria are probably at the botto...

Ulcers Case Xxiii

Mr. Marshall, aged 60, had a troublesome ulcer under the oute...

Less-rigorous-than-water Fasts

There are gradations of fasting measures ranging from rigorou...

Sciatica

This is a severe pain in the lower back, shooting sharply down...

Teething Of Children

Affections arising from teething of children, are often of a ...

Palpitation Of The Heart

This is commonly a symptomatic or sympathetic affection--rare...

Rupture

The abdomen is formed of a series of rings containing the bowe...

Neuralgia And Rheumatism Of The Heart

If neuralgia, use B D current; if rheumatism, use A D. In eit...

Trauma

The chief traumatic factors in chronic laryngeal stenosis ar...

Cardiovascular Renal Disease

With the strennousness of this era, this disease or conditi...

Bread Wheaten

In some cases the bran in whole wheaten bread and Saltcoats bi...

Food In Illness

Light, easily digested food is of the first importance in many...

Strabismus Discordance Of The Eyes

If neither of the rectus muscles have been cut and cicatrized...

Aconite

Is applicable to inflamed eyes, in the early stage, where the...

Inflammation Of The Finger Case Xxxii

Miss B. aged 23, had a slight scratch on the inside of the in...

Santolina

This plant is the Chama Cyparissos, or ground cypress. It is o...



Bronchoscopic Oxygen Insufflation





Category: POSITION OF THE PATIENT FOR PERORAL ENDOSCOPY
Source: 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.





Next: General Principles Of Position

Previous: Rules For Insertion Of The Catheter For Insufflation Anesthesia



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 863