InformationalPrivacy
| Are you on a small budget, but you want to purchase a home? If you are on a small budget, and you want to get a home, to start living as a family in an area that you love, look towards homes that have recently been foreclosed. A foreclosure is one th... Read more of Foreclosure Homes for Sale at Tax Sale Property.org | Informational Privacy |
 |
Home |
Medical Articles |
Mother's Remedies |
Household Tips |
Medicine History |
Search |
Medical ArticlesWhere The Temperature Is Too Low That Is Below 98-2/5 Degrub all over with warm olive oil, and clothe in good soft flan... Infection Few things have so great and distressing effect as the fear of... Neuralgia This is severe pain in one part or other of the body, sometime... My Own 56 Day Long Fast Fasters go through a lot of different emotional states, these... Stammering This trouble is simply a loss of command of the vocal organs, ... Nephritis Inflammation Of Kidneys 1. Acute. If the urinary secretion be reddish and scant, with... Eyes Failing Sight This often comes as the result simply of an over-wearied body ... Perspiration By this term we mean not only the sensible perspiration which ... Worms Where the juices and organs of the body are thoroughly healthy,... Chloroform Or Ether (swallowed) Emetic; enema of hot coffee; keep awake. If necessary, artific... Auricular Fibrillation Prognosis The prognosis depends on the condition of the myocardium of t... Punctures Case Iv The present case is somewhat more severe than those which hav... Appetite Should be an indication that food in general or some certain k... Sitz-bath Anchor Of Safety If there be much delirium, the sitz-bath may be required long... Nerves Spinal The spinal cord is continuous with the back part of the brain.... Inducing A Child To Open Its Mouth (author's Method) The wounding of the child's mouth, gums, and lips, in the of... Diagnosis From Measles In scarlatina the heat is much greater, and the pulse is much... The Lower Animals It may, by some, be objected that, if we regard sensation as ... About Frights HERE are two true stories and a remarkable contrast. ... Acute Esophagitis This is usually of traumatic or cauterant origin. If severe o... |
Mechanical Problems Of Bronchoscopic Foreign Body Extraction*Category: MECHANICAL PROBLEMS OF BRONCHOSCOPIC FOREIGN BODY EXTRACTION Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery * For more extensive consideration of mechanical problems than is here possible the reader is referred to the Bibliography, page 311, especially reference numbers 1, 11, 37 and 56. The endoscopic extraction of a foreign body is a mechanical problem pure and simple, and must be studied from this viewpoint. Hasty, ill-equipped, ill-planned, or violent endoscopy on the erroneous principle that if not immediately removed the foreign body will be fatal, is never justifiable. While the lodgement of an organic foreign body (such as a nut kernel) in the bronchus calls for prompt removal and might be included under the list of emergency operations, time is always available for complete preparation, for thorough study of the patient, and localization of the intruder. The patient is better off with the foreign body in the lung than if in its removal a mediastinitis, rupture into the pleura, or tearing of a thoracic blood vessel has resulted. The motto of the endoscopist should be I will do no harm. If no harm be inflicted, any number of bronchoscopies can be done at suitable intervals, and eventually success will be achieved, whereas if mortality results, all opportunity ceases. The first step in the solution of the mechanical problem is the study of the roentgenograms made in at least three planes; (1) anteroposterior, (2) lateral, and (3) the plane corresponding to the greatest plane of the foreign body. The next step is to put a duplicate of the foreign body into the rubber-tube manikin previously referred to, and try to simulate the probable position shown by the ray, so as to get an idea of the bronchoscopic appearance of the probable presentation. Then the duplicate foreign body is turned into as many different positions as possible, so as to educate the eye to assist in the comprehension of the largest possible number of presentations that may be encountered at the bronchoscopy on the patient. For each of these presentations a method of disimpaction, disengagement, disentanglement or version and seizure is worked out, according to the kind of foreign body. Prepared by this practice and the radiographic study, the bronchoscope is introduced into the patient. The location of the foreign body is approached slowly and carefully to avoid overriding or displacement. A study of the presentation is as necessary for the bronchoscopist as for the obstetrician. It should be made with a view to determining the following points: 1. The relation of the presenting part to the surrounding tissues. 2. The probable position of the unseen portion, as determined by the appearance of the presenting part taken in connection with the knowledge obtained by the previous ray study, and by inspection of the ray plate upside down on view in front of the bronchoscopist. 3. The version or other manipulation necessary to convert an unfavorable into a favorable presentation for grasping and disengagement. 4. The best instruments to use, and which to use first, as, hook, pincloser, forceps, etc. 5. The presence and position of the forceps spaces of which there must be two for all ordinary forceps, one for each jaw, or the insertion space for any other instrument. Until all of these points are determined it is a grave error to insert any kind of instrument. If possible even swabbing of the foreign body should be avoided by swabbing out the bronchus, when necessary, before the region of the intruder is reached. When the operator has determined the instrument to be used, and the method of using it, the instrument is cautiously inserted, under guidance of the eye. [160] The lip of the bronchoscope is one of the most valuable aids in the solution of foreign-body problems. With it partial or complete version of an object can be accomplished so as to convert an unfavorable presentation into one favorable for grasping with the forceps; edematous mucosa may be displaced, angles straightened and space made at the side of the foreign body for the forceps' jaw. It forms a shield or protector that can be slipped under the point of a sharp foreign body and can make counterpressure on the tissues while the forceps are disembedding the point of the foreign body. With the bronchoscopic lip and the forceps or other instrument inserted through the tube, the bronchoscopist has bimanual, eye-guided control, which if it has been sufficiently practiced to afford the facility in coordinate use common to everyone with knife and fork, will accomplish maneuvers that seem marvelous to anyone who has not developed facility in this coordinate use of the bronchoscopic instruments. The relation of the tube mouth and foreign body is of vital importance. Generally considered, the tube mouth should be as near the foreign body as possible, and the object must be placed in the center of the bronchoscopic field, so that the ends of the open jaws of the forceps will pass sufficiently far over the object. But little lateral control is had of the long instruments inserted through the tube; sidewise motion is obtained by a shifting of the end of the bronchoscope. When the foreign body has been centered in the bronchoscopic field and placed in a position favorable for grasping, it is important that this position be maintained by anchoring the tube to the upper teeth with the left, third, and fourth fingers hooked over the patient's upper alveolus (Fig. 63) Next: The Light Reflex On The Forceps Previous: Removal Of Foreign Bodies From The Larynx
Viewed 453 |
||||||||||||||||||||
