What is called the Line of Marriage is that mark or marks, as the case may be, found on the side of the Mount under the fourth finger. I will first proceed to give all the details possible about these lines, and then call my reader's atten... Read more of Signs Relating To Marriage at Palm Readings.orgInformational Site Network Informational
Privacy


Home


Medical Articles


Mother's Remedies


Household Tips


Medicine History


Forgotten Remedies


Search

Medical Articles

Limbs Inflamed

Entirely different treatment from the above is needed for such...

Paroxysmal Tachycardia Management

There is no specific treatment for paroxysmal tachycardia. Wh...

Extraction Of Soft Friable Foreign Bodies From The Tracheobronchial Tree

The difficulties here consist in the liability of crushing or...

The Future Of Life Extension

I beg the readers indulgence for a bit of futurology about wh...

Acute Mild Endocarditis

This inflammation of the endocardium is generally confined to...

The Woman At The Next Desk

IT may be the woman sewing in the next chair; it may ...

Neck Stiff

For this, rub the whole back with soap lather (see Lather; Soa...

Cicatricial Stenosis Of The Esophagus

Etiology.--The accidental swallowing of caustic alkali in sol...

Bedsores

There are cases in which the outer skin has been taken off by ...

Chloral

Emetic; warm coffee, and even an enema of coffee. Artificial r...

Conclusive Remarks Obstacles

Before concluding my article, I shall attempt to remove a few...

Illness

AS far as we make circumstances guides and not limitations, t...

Treatment Of Compression Stenoses Of The Trachea

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

Copper

Emetic, white of egg to follow. ...

Choice Of Time To Do Bronchoscopy For Foreign Body

The difficulties of removal usually increase from the time of...

The Lookout Department

Why the Eyes, Ears, and Nose are Near the Mouth. If you had n...

Lues Of The Esophagus

Esophageal syphilis is a rather rare affection, and may show ...

Chlorosis Green Sickness

This is a disease mostly or entirely peculiar to young women ...

Symptoms Of Tracheal And Bronchial Foreign Body

1. Tracheal foreign bodies are usually movable and their mo...

Leucorrhoea And Prolapsus Uteri - Whites Female Weakness

The disease depends in all cases upon _inflammation_ of the u...



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 1877