At the outset, it must ever be remembered that this is not a d...
What Effect Could Be Expected From A Warm Wet-sheet?
The first impression of the wet-sheet is, as I stated before,...
Rheumatism is the cause of most instances of cardiac disease ...
Mechanical Effect Of Each Pole
The mechanical effect of the forward end of the current, or t...
Soapy Blanket The
It seems necessary, in getting people to use the best means fo...
The flat rubber bags of various shapes, to be had from all rub...
Children And Teachers
Children are of the utmost value to society; through any one o...
Ulcers Case Xxv
The following case illustrates the superior efficacy of the l...
Cancer In Foot
We have noted one case in which "Cancerous Gangrene" in the fo...
Chloroform Or Ether (inhaled)
Fresh air. Pull tongue forward, and begin artificial respirati...
Butter, Margarine And Fats In General
Recently, enormous propaganda has been generated against eati...
With the forceps illustrated in Fig. 28 specimens of tissue ...
TO argue with nervous anxiety, either in ourselves or...
Anesthesia For Peroral Endoscopy
A dyspneic patient should never be given a general anesthetic...
By inserting the window plug shown in Fig. 6 the esophagus m...
As mentioned above, bronchial aspiration is often necessary....
Remedial Virtues Ascribed To Relics
A relic has been defined as an object held in reverence or ...
Ablutions And Rubbing With Iced Water Or Snow
In a few very obstinate cases, when no rash would appear afte...
Resume Of Emergency Tracheotomy
The following notes should be memorized. 1. Essentials: Kn...
Perversions In The Guidance Of The Body
SO evident are the various, the numberless perversion...
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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