Medical ArticlesBruises Case Xvi
J. Jennings, bricklayer, aged 26, fell through the roof of a ...
Burns Case Xxxiii
A little girl, aged 10, scalded her breast a week ago and has...
The Stages Of Fasting
The best way to understand what happens when we fast is to br...
These will be found treated under the various heads of Colds, ...
Theory Of Man
Let the question now be raised--What is man? The answer will ...
Teething Of Children
Affections arising from teething of children, are often of a ...
The Inward And The Outward Current
I have already said that when the conducting-cords are of equ...
Palpitation Of The Heart
This is commonly a symptomatic or sympathetic affection--rare...
Where this arises from a more or less putrid wound, what is ai...
Eyes Failing Sight
This often comes as the result simply of an over-wearied body ...
See Nostrils. ...
_Tis a gift to be simple Tis a gift to be free, Tis a gift ...
Chronic Myocarditis Fibrous
Chronic myocarditis may develop on an acute myocarditis, but ...
Tea should not be infused longer than three or four minutes, an...
Water-treatment As Used By Currie Reuss Hesse Schoenlein &c
Beside the above modes of treatment _cold_ and _tepid Water_ ...
The Roentgenographic Signs Of Expiratory-valve-like Bronchial Obstruction
The roentgenray signs in expiratory valve-like obstruction of...
They ware in their foreheads scrowles of parchment, wher...
Foreign Bodies In The Larynx And Tracheobronchial Tree
The protective reflexes preventing the entrance of foreign bo...
An infant's clothing should be soft, warm, and light in weight...
Safety-pins in children, point upward, when lodged high in t...
Difficulties In The Introduction Of The Bronchoscope
Category: INTRODUCTION OF THE BRONCHOSCOPE
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
may enter the esophagus instead of the trachea: this might be
a dangerous accident in a dyspneic case, for the tube could, by
pressure on the trachea, cause respiratory arrest. A bronchoscope thus
misplaced should be resterilized before introducing it into the air
passages, for while the lower air passages are usually free from
bacteria, the esophagus is a septic canal. If the given technic is
carefully carried out the bronchoscope will not be contaminated with
mouth secretions. The trachea is recognized as an open tube, with
whitish rings, and the expiratory blast can be felt and tubular
breathing heard; while if by mistake the bronchoscope has entered the
gullet it will be observed that the cervical esophagus has collapsed
walls. A puff of air may be felt and a fluttering sound heard when the
tube is in the esophagus, but these lack the intensity of the tracheal
blast. Usually a free flow of secretion is met with in the esophagus.
In diseased states the tracheal rings may not be visible because of
swollen mucosa, or the trachea itself may be in partial collapse from
external pressure. The true expiratory blast will, however, always be
recognized when the tube is in the trachea. Wide gagging of the mouth
renders exposure of the larynx difficult.
[FIG. 62.--Insertion of the bronchoscope. Note direction of the
trachea as indicated by the bronchoscope. Note that the patient's head
is held above the level of the table. The assistant's left hand should
be at the patient's mouth holding the bite-block. This is removed and
the assistant is on the wrong side of the table in the illustration in
order not to hide the position of the operator's hands. Note the
handle of the bronchoscope is to the right.]
[FIG. 63.--The heavy laryngoscope has been removed leaving the light
bronchoscope in position. The operator is inserting forceps. Note how
the left hand of the operator holds the tube lightly between the thumb
and first two fingers of the left hand, while the last two fingers are
hooked over the upper teeth of the patient anchoring the tube to
prevent it moving in or out or otherwise changing the relation of the
distal tube-mouth to a foreign body or a growth while forceps are
being used. Thus, also, any desired location of the tube can be
maintained in systematic exploration. The assistant's left hand is
dropped out of the way to show the operator's method. The assistant
during bronchoscopy holds the bite-block like a thimble on the index
finger of the left hand, and the assistant should be on the right side
of the patient. He is here put wrongly on the left side so as not to
hide the instruments and the manner of holding them.]
Next: Examination Of The Trachea And Bronchi
Previous: Technic Of Bronchoscopy