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Medical ArticlesPrecautions To Be ObservedAs long as compensation is complete, there are no medication ... My Beginning _Tis a gift to be simple Tis a gift to be free, Tis a gift ... Drugs In Hypertension The drugs that are mostly used to lower blood pressure are ni... During And After Desquamation The Treatment Should Be Continued As indicated in milder cases, except the throat continue troubleso... Feet Cold Continued coldness of the feet gives rise to many more serious... Pathologic Physiology The development of permanent injury to one or more valves o... Extraction Of Foreign Bodies From The Strictured Esophagus Foreign bodies of relatively small size will lodge in a stri... Oxalic Acid Neutralise by chalk or lime water, but not by soda or any alka... Of Burns The application of the lunar caustic in recent burns or scald... Spermatorrhea The points to be gained are, to reduce the action of the amat... To Prevent Yellow Fever Take _Aconite_, _Belladonna_ and _Macrotin_, 1st in rotation ... Safety-pin Closer There are a number of methods for the endoscopic removal of ... Water On The Chest Sometimes a large watery swelling appears in one part or anoth... Inflammation Of The Bowels - Enteritis This consists in inflammation of the muscular and peritoneal ... Alcohol This, in various forms, as brandy, whiskey, rum, wine, cordial... Positive And Negative Effort DID you ever have the grip? If you ever have you may ... The Fulcrum Of The Bronchoscopic Lever Is At The Upper Thoracic Aperture Disregard of this rule will cause subglottic edema and will ... Breath Hot This may be felt either because the breath is actually hot, or... Stone See Gravel. ... Putrid Symptoms Gargle Solution Of Chloride Of Soda Drink: Chlorate Of Potass Liquor Calcii-chloridi Should _putrid symptoms_ make their appearance (21), I would ... |
Entering The BronchiCategory: INTRODUCTION OF THE ESOPHAGOSCOPE Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery The lip of the bronchoscope should be turned in the direction of the bronchus to be explored, and the axis of the bronchoscope should be made to correspond as nearly as possible to the axis of this bronchus. The position of the lip is designated by the direction taken by the handle. Upon entering the right bronchus, the handle of the bronchoscope is turned horizontally to the right, and at the same time the assistant deflects the head to the left. The right upper-lobe bronchus is recognized by its vertical spur; the orifice is exposed by displacing the right lateral wall of the right main bronchus at the level of the carina. Usually this orifice will be thus brought into view. If not the bronchoscope may be advanced downward 1 or 2 cm., carefully to avoid overriding. This branch is sometimes found coming off the trachea itself, and even if it does not, the overriding of the orifice is certain if the right bronchus is entered before search is made for the upper-lobe-bronchial orifice. The head must be moved strongly to the left in order to view the orifice. A lumen image of the right upper-lobe bronchus is not obtainable because of the sharp angles at which it is given off. The left upper-lobe bronchus is entered by keeping the handle of the bronchoscope (and consequently the lip) to the left, and, by keeping the head of the patient strongly to the right as the bronchoscopist goes down the left main bronchus. This causes the lip of the bronchoscope to bear strongly on the left wall of the left main bronchus, consequently the left upper-lobe-bronchial orifice will not be overridden. The spur separating the upper-lobe-bronchial orifice from the stem bronchus is at an angle approximately from two to eight o'clock, as usually seen in the recumbent patient. A lumen image of a descending branch of the upper-lobe bronchus is often obtained, if the patient's head be borne strongly enough to the right. [FIG. 65.--Schema illustrating the entering of the anteriorly branching middle lobe bronchus. T, Trachea; B, orifice of left main bronchus at bifurcation of trachea. The bronchoscope, S, is in the right main bronchus, pointing in the direction of the right inferior lobe bronchus, I. In order to cause the lip to enter the middle lobe bronchus, M, it is necessary to drop the head so that the bronchoscope in the trachea TT, will point properly to enable the lip of the tube mouth to enter the middle lobe bronchus, as it is seen to have done at ML.] Branches of the stem bronchus in either lung are exposed, or their respective lumina presented, by manipulation of the lip of the bronchoscope, with movement of the head in the required direction. Posterior branches require the head quite high. A large one in the left stem just below the left upper-lobe bronchus is often invaded by foreign bodies. Anterior branches require lowering the head. The middle-lobe bronchus is the largest of all anterior branches. Its almost horizontal spur is brought into view by directing the lip of the bronchoscope upward, and dropping the head of the patient until the lip bears strongly on the anterior wall of the right bronchus (see Fig. 65). Next: Introduction Of The Esophagoscope Previous: The Fulcrum Of The Bronchoscopic Lever Is At The Upper Thoracic Aperture
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