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As the patient should have a constant supply of pure air for ...
are the following: Absence of internal inflammation; a bright...
All too many of my cases are what I privately refer to as oni...
Resume Of Emergency Tracheotomy
The following notes should be memorized. 1. Essentials: Kn...
Skin Care Of
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Hepatitis Inflammation Of Liver
Use the B D current, with what force the patient can bear. Pl...
General Tonic Treatment
Take the B D current, (A D is very good), of fair medium stre...
See Digestion; Nourishment. ...
Cancer In Foot
We have noted one case in which "Cancerous Gangrene" in the fo...
Anesthesia For Peroral Endoscopy
A dyspneic patient should never be given a general anesthetic...
An expectant mother should lead a quiet, orderly and healthful...
Preparation Of Medicine
As it often becomes necessary for the practitioner to make mo...
The Digestibility of Fats. We have now come to the last group...
Nerve Centres Failing
Many diseases flow from this cause, but at present we only con...
Hope And Healing
The mind has always an influence on the body. Life rises and f...
Bronchoscopic Appearances In Disease
The first look should note the color of the bronchial mucosa...
Biliary Calculi Gravel In Liver
Take A C current, strong as can be borne; and treat the infla...
The Surgical Form Of The Superficial Cervical And Facial Regions And The Relative Position Of The Principal Blood-vessels And Nerves
When the neck is extended in surgical position, as seen in Pl...
Bruises Case Xvii
An old man, aged 60, received a bruise upon the occiput from ...
Racks From Lifting
See Muscular Pains; Sprains. ...
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