The object of the following chapters is to give clear and unmistakable instruction on the lines and markings of the hands, both from the student's standpoint and from that of the general reader. This is not usually the course adopted in books p... Read more of The Line Of Head Or The Indications Of The Mentality at Palm Readings.orgInformational Site Network Informational
Privacy


Home


Medical Articles


Mother's Remedies


Household Tips


Medicine History


Forgotten Remedies


Search

Medical Articles

The Surgical Dissection Of The Subclavian And Carotid Regions The Relative Anatomy Of Their Contents

A perfect knowledge of the relative anatomy of any of the s...

Hypertension

Arterial hypertension may be divided into stages. In the fi...

Plain Every-day Common Sense

PLAIN common sense! When we come to sift everything d...

List Of Instruments

The following list has been compiled as a convenient basis f...

Nostrils The

The disease called Polypus, affecting the mouth or nostril wit...

Eyes Danger To Sight Of

Where inflammation has gone so far as to lead to suppuration, ...

Plate V Laryngeal And Tracheal Stenoses:

1, Indirect view, sitting position; postdiphtheric cicatricia...

Stomach Ulcers

Generally the tongue will tell whether the stomach is ulcerate...

The Malignant Forms Of Scarlet-fever

are caused by the character of the epidemy, but, perhaps, mor...

Hands Dry And Hard

Pack the hands in SOAP LATHER (see) mixed with a little fine o...

Turnip Poultice

Part of a raw turnip is grated down to a pulp. As much of this...

Physics Of Mitral Stenosis

Mitral stenosis, though less common than mitral regurgitation...

Skin A Wintry

Something like an epidemic of skin trouble is often experience...

Bone Soft

Often, in the young, the bones are so soft that they bend more...

Highly Inflamed Throat Croup

If the _throat_ is in a highly inflamed condition, repeated p...

Nourishment Heat In

Heat is absorbed in building up the bodily tissues, and given ...

Poisoning

The following are the antidotes and remedies for some of the m...

Temperature Of The Water Double Sheet Changing Sheet

The water for the wet-sheet pack, in this violent form, ought...

Plate Iv

A, Gastroscopic view of a gastrojejunostomy opening drawn pat...

Foreign Bodies In The Larynx

Laryngeally lodged foreign bodies produce a wheezing respirat...



Complications And After-effects Of Bronchoscopy





Category: REMOVAL OF FOREIGN BODIES FROM THE LARYNX
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery

All foreign body cases should be watched day and night by special
nurses until all danger of complications is passed. Complications are
rare after careful work, but if they do occur, they may require
immediate attention. This applies especially to the subglottic edema
associated with arachidic bronchitis in children under 2 years of age.

General Reaction.--There is usually no elevation in temperature
following a short bronchoscopy for the removal of a recently lodged
metallic foreign body. If, however, an inflammatory condition of the
bronchi existed previous to the bronchoscopy, as for instance the
intense diffuse, purulent laryngotracheobronchitis associated with
the aspiration of nut kernels, or in the presence of pulmonary abscess
from long retained foreign bodies, a moderate temporary rise of
temperature may be expected. These cases almost always have had
irregular fever before bronchoscopy. Disturbance of the epithelium in
the presence of pus without abscess usually permits enough absorption
to elevate the temperature slightly for a few days.

Surgical shock in its true form has never followed a carefully
performed and time-limited bronchoscopy. Severe fatigue resulting in
deep sleep may be seen in children after prolonged work.

Local reaction is ordinarily noted by slight laryngeal congestion
causing some hoarseness and disappearing in a few days. If dyspnea
occur it is usually due to (1) Drowning of the patient in his own
secretions. (2) Subglottic edema. (3) Laryngeal edema.

Drowning of the Patient in His Own Secretions.--The accumulation of
secretions in the bronchi due to faulty bechic powers and seen most
frequently in children, is quickly relievable by bronchoscopic
sponge-pumping or aspiration through the tracheotomic wound, in cases
in which the tracheotomy may be deemed necessary. In other cases, the
aspirating bronchoscope with side drainage canal (Fig. 1, E) may be
used through the larynx. Frequent peroral passage of the bronchoscope
for this purpose is contraindicated only in case of children under 3
years of age, because of the likelihood of provoking subglottic edema.
In such cases instead of inserting a bronchoscope the aspirating tube
(Fig. 9) should be inserted through the direct laryngoscope, or a low
tracheotomy should be done.

Supraglottic edema is rarely responsible for dyspnea except when
associated with advanced nephritis.

Subglottic edema is a complication rarely seen except in children
under 3 years of age. They have a peculiar histologic structure in
this region, as is shown by Logan Turner. Even at the predisposing age
subglottic edema is a very unusual sequence to bronchoscopy if this
region was previously normal. The passage of a bronchoscope through an
already inflamed subglottic area is liable to be followed by a
temporary increase in the swelling. If the foreign body be associated
with but slight amount of secretion, the child can usually obtain
sufficient air through the temporarily narrowed lumen. If, however, as
in cases of arachidic bronchitis, large amounts of purulent secretion
must be expelled, it will be found in certain cases that the decreased
glottic lumen and impaired laryngeal motility will render tracheotomy
necessary to drain the lungs and prevent drowning in the retained
secretions. Subglottic edema occurring in a previously normal larynx
may result from: 1. The use of over-sized tubes. 2. Prolonged
bronchoscopy. 3. Faulty position of the patient, the axis of the tube
not being in that of the trachea. 4. Trauma from undue force or
improper direction in the insertion of the bronchoscope. 5. The
manipulation of instruments. 6. Trauma inflicted in the extraction of
the foreign body.

Diagnosis must be made without waiting for cyanosis which may never
appear. Pallor, restlessness, startled awakening after a few minutes
sleep, occurring in a child with croupy cough, indrawing around the
clavicles, in the intercostal spaces, at the suprasternal notch and at
the epigastrium, call for tracheotomy which should always be low. Such
a case should not be left unwatched. The child will become exhausted
in its fight for air and will give up and die. The respiratory rate
naturally increases because of air hunger, accumulating secretions
that cannot be expelled because of impaired glottic motility give
signs wrongly interpreted as pneumonia. Many children whose lives
could have been saved by tracheotomy have died under this erroneous
diagnosis.

Treatment.--Intubation is not so safe because the secretions cannot
easily be expelled through the tube and postintubational stenosis may
be produced. Low tracheotomy, the tracheal incision always below the
second ring, is the safest and best method of treatment.





Next: Removal Of Foreign Bodies From The Larynx

Previous: Choice Of Time To Do Bronchoscopy For Foreign Body



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 1488