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Choice Of Time To Do Bronchoscopy For Foreign Body
Category: FOREIGN BODIES IN THE LARYNX AND TRACHEOBRONCHIAL TREE
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
The difficulties of removal usually increase from the time of aspiration
of the object. It tends to work downward and outward, while the mucosa
becomes edematous, partly closing over the foreign body, and even
completely obliterating the lumen of smaller bronchi. Later,
granulation tissue and the formation of stricture further hide the
object. The patient's health deteriorates with the onset of pulmonary
pathology, and renders him a less favorable subject for bronchoscopy.
Organic foreign bodies, which produce early and intense inflammatory
reaction and are liable to swell, call for prompt bronchoscopy. When a
bronchus is completely obstructed by the bulk of the foreign body
itself immediate removal is urgently demanded to prevent serious lung
changes, resulting from atelectasis and want of drainage. In short,
removal of the foreign body should be accomplished as soon as possible
after its entrance. This, however, does not justify hasty,
ill-planned, and poorly equipped bronchoscopy, which in most cases is
doomed to failure in removal of the object. The bronchoscopist should
not permit himself to be stampeded into a bronchoscopy late at night,
when he is fatigued after a hard day's work.
Bronchoscopic finding of a foreign body is not especially difficult
if the aspiration has been recent. If secondary processes have
developed, or the object be small and in a bronchus too small to admit
the tube-mouth, considerable experience may be necessary to discover
it. There is usually inflammatory reaction around the orifice of the
invaded bronchus, which in a measure serves to localize the intruder.
We must not forget, however, that objects may have moved to another
location, and also that the irritation may have been the result of
previous efforts at removal. Care must be exercised not to mistake the
sharp, shining, interbronchial spurs for bright thin objects like new
pins just aspirated; after a few days pins become blackened. If these
spurs be torn pneumothorax may ensue. If a number of small bronchi are
to be searched, the bronchoscope must be brought into the line of the
axis of the bronchus to be examined, and any intervening tissue gently
pushed aside with the lip of the bronchoscope. Blind probing for
exploration is very dangerous unless carefully done. The straight
forceps, introduced closed, form the best probe and are ready for
grasping if the object is felt. Once the bronchoscope has been
introduced, it should not be withdrawn until the procedure is
completed. The light carrier alone may be removed from its canal if
the illumination be faulty.
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