If the patient is weak, the circulation depressed, the blood ...
[As I have never practiced farther South than Cincinnati, and...
The author wishes to caution the reader not to rely merely on...
If an attack comes on from sudden cold, take _Aconite_ and _I...
Flour, And Other Matters Relating To Seeds
One of the largest degradations to human health was caused by...
Bowels Glands Of
Symptoms of glandular trouble in the bowels are--weariness and...
From The Hygienic Dictionary
Doctors.  In the matter of disease and healing, the peopl...
The Form Of The Thoracic Cavity And The Position Of The Lungs Heart And Larger Bloodvessels
In the human body there does not exist any such space as cavi...
On The Treatment By Eschar And Poultice
In many cases in which it is impossible to adopt either the m...
This is a matter of great importance to the sick. Nor is anyth...
As this inflammation is generally secondary to some other c...
Some most distressing troubles come as the result of frights. ...
The spinal cord is continuous with the back part of the brain....
Delicacy of touch and manipulation are an absolute necessity...
Errors To Avoid In Suspected Foreign Body Cases
1. Do not reach for the foreign body with the fingers, lest...
To Prevent Colds
Keep the _arms_, _hands_ and _chest_ well clothed and warm. ...
Contraindications To Esophagoscopy
In the presence of aneurysm, advanced organic disease, exten...
Punctures Case Ii
Mrs. Middleton, aged 40, wounded her wrist, on the ulnar side...
Breast Swelling In
A blow on the breast, or the drain of nursing a child, along w...
Rubbing Sheet Substitute For The Half-bath
It cannot be difficult to procure a wash-tub. Should you be s...
Practice On The Rubber-tube Manikin
Category: ACQUIRING SKILL
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
This must be carried out in
1. General practice with all sorts of objects for the education of
the eye and the fingers.
2. Before undertaking a foreign body case, practice should be had
with a duplicate of the foreign body.
It is not possible to have a cadaver for daily practice, but
fortunately the eye and fingers may be trained quite as effectually by
simulating foreign body conditions in a small red rubber tube and
solving these mechanical problems with the bronchoscope and forceps.
The tubing may be placed on the desk and held by a small vise (Fig.
72) so that at odd moments during the day or evening the fascinating
work may be picked up and put aside without loss of time. Complicated
rubber manikins are of no value in the practice of introduction, and
foreign body problems can be equally well studied in a piece of rubber
tubing about 10 inches long. No endoscopist has enough practice on the
living subject, because the cases are too infrequent and furthermore
the tube is inserted for too short a space of time. Practice on the
rubber tube trains the eye to recognize objects and to gauge distance;
it develops the tactile sense so that a knowledge of the character of
the object grasped or the nature of the tissues palpated may be
acquired. Before attempting the removal of a particular foreign body
from a living patient, the anticipated problem should be simulated
with a duplicate of the foreign body in a rubber tube. In this way the
endoscopist may precede each case with a practical experience
equivalent to any number of cases of precisely the same kind of
foreign body. If the object cannot be removed from the rubber tube
without violence, it is obvious that no attempt should be made on the
patient until further practice has shown a definite method of harmless
removal. During practice work the value of the beveled lip of the
bronchoscope and esophagoscope in solving mechanical problems will be
evidenced. With it alone, a foreign body may be turned into favorable
positions for extraction, and folds can always be held out of the way.
Sufficient combined practice with the bronchoscope and the forceps
enable the endoscopist easily to do things that at first seem
impossible. It is to be remembered that lateral motion of the long
slender tube-forceps cannot be controlled accurately by the handle,
this is obtained by a change in position of the endoscopic tube, the
object being so centered that it is grasped without side motion of the
forceps. When necessary, the distal end of the forceps may be pushed
laterally by the manipulation of the bronchoscope.
[FIG. 72.--A simple manikin. The weight of the small vise serves to
steady the rubber tubing. By the use of tubing of the size of the
invaded bronchus and a duplicate of the foreign body, any mechanical
problem can he simulated for solution or for practice, study of all
possible presentations, etc.]
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