VIEW THE MOBILE VERSION of www.homemedicine.ca Informational Site Network Informational
Privacy


Home


Medical Articles


Mother's Remedies


Household Tips


Medicine History


Forgotten Remedies


Search

Medical Articles

Ulcers Case Xxiii

Mr. Marshall, aged 60, had a troublesome ulcer under the oute...

The Habit Of Illness

IT is surprising how many invalids there are who have...

Venous Pressure

The venous pressure, after a long neglect, is now again being...

Symptomatology And Diagnosis Of Foreign Bodies In The Air And Food Passages

Initial symptoms are choking, gagging, coughing, and wheezing...

Introduction Of The Bronchoscope

No one should do bronchoscopy until he is able to expose the ...

Alcohol

Enough has already been said of the value and limitations of ...

Our Relations With Others

EVERY one will admit that our relations to others sho...

The Teeth The Ivory Keepers Of The Gate

Why the Teeth are Important. The teeth are a very important...

Blood Poisoning

(See Blood, Purifying; Sores). ...

Sugars

Where Sugar is Obtained. The other great member of the starch...

Pulse Counting The

Most valuable information as to the nature and progress of dis...

The Glands In The Skin

Sweat Glands. Like all the pavement (epithelial) surfaces of ...

Etiology Treatment

A subacute or a chronic infective endocarditis should be trea...

Damp Beds

An ordinary bed which has not been slept in for some weeks, al...

Carbolic

Readily identified by smell of tar or carbolic. Wash mouth wel...

Symptoms And Signs Of Cardiac Disturbance

It is now recognized that any infection can cause weakness an...

Rotation Forceps

It is sometimes desired to make traction on an irregularly s...

Ulcers Case Xxi

Mrs. Butcher, aged 52, has two ulcers a little above the oute...

Earache

In the common form this is purely neuralgic. The nerves are in...

Clinical Interpretation Of Pulse Tracings

A moment may be spent on clinical interpretation of pulse tra...



Entering The Bronchi





Category: 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



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 1382