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Medical ArticlesTracheotomyIndications.--Tracheotomy is indicated in dyspnea of laryngot... Ankle Swelling When long continued in connection with disease or accident, th... Paralysis Of The Esophagus The passage of liquids and solids through the esophagus is a ... The Relation Of The Principal Bloodvessels Of The Thorax And Abdomen To The Osseous Skeleton Etc The arterial system of vessels assumes, in all cases, somewha... Trauma The chief traumatic factors in chronic laryngeal stenosis ar... Fall A After a fall from a height, where there is no apparent outward... Functional Hiatal Stenosis Hiatal Esophagismus Phrenospasm Diaphragmatic Pinchcock Stenosis There is no sphincteric muscular arrangement at the cardiac o... Diseases And Disturbances Of The Skin Their Chief Causes. Skin troubles are of two main kinds accor... Cardiac Drugs Whether any drug should be used which acts directly on the he... Phylacteries They ware in their foreheads scrowles of parchment, wher... Bruises For slight bruises, such as children frequently get by falling... Cayenne And Mustard Mustard spread on a cold towel and applied to the spine or lum... Pericarditis Symptoms And Signs If there is pain or much aching in the cardiac region, it ten... Bruises Case Xx It frequently occurs to surgeons to receive slight wounds upo... Bowels Reversed See Bowels, Locking of, above. ... Stomach Ulcers Generally the tongue will tell whether the stomach is ulcerate... Band Flannel A piece of fine new flannel made to cover the whole back, and ... Other Sequels Dropsy &c Beside the ulceration of glands and deafness, some of the seq... 3 Treatment Of Torpid Forms Of Scarlatina Difference In The TREATMENT POINTED OUT. When the _reaction_ is _torpid_, the ... Rose See Erysipelas. ... |
Difficulties In The Introduction Of The BronchoscopeCategory: INTRODUCTION OF THE BRONCHOSCOPE Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery The beginner 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
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