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Medical ArticlesResume Of TracheotomyInstruments. Headlight Sandbag Scalpel Hemostats ... The Surgical Dissection Of The Bend Of The Elbow And The Forearm Showing The Relative Position Of The Arteries Veins And Nerves The farther the surgical region happens to be removed from th... Wounds And Bruises On this subject, I must necessarily be very brief. When a wou... Hypotension A low systolic pressure and a low diastolic pressure may no... Instructions To The Patient Before beginning endoscopy the patient should be told that h... The Need Of Pure Air Free Air is Pure. As air, in the form of wind, actually sweep... Testing For Electric Defects These tests should be made beforehand; not when about to com... Cases During an epidemic of scarlatina in 1836 two of my children w... Weight Loss By Fasting Loss of weight indicates, almost guarantees, that detoxificat... Aconite Often in cases where our treatment fails to cure, the failure ... Treatment Of Broken Compensation The consideration of this subject will include the following ... Dyspepsia See Indigestion. ... Fomentation Some general remarks on this important treatment we give here.... Myocardial Disturbances While the myocardium is the most important muscle structure... Measles _Measles_, which may be easily distinguished from scarlatina,... Legs Pricking Pains In Sometimes curious pricking pains are felt in the legs, becomin... Feet Cold Continued coldness of the feet gives rise to many more serious... Treatment Acute esophagitis calls for rest in bed, sterile liquid food... Bronchoscopic Appearances In Disease The first look should note the color of the bronchial mucosa... Prussic Acid Almost hopeless. Emetic; artificial respiration. ... |
Preparation Of The Patient For Peroral EndoscopyCategory: ANESTHESIA FOR PERORAL ENDOSCOPY Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery The suggestions of the author in the earlier volumes in regard to preparation of the patient, as for any operation, by a bath, laxative, etc., and especially by special cleansing of the mouth with 25 per cent alcohol, have received general endorsement. Care should be taken not to set up undue reaction by vigorous scrubbing of gums unaccustomed to it. Artificial dentures should be removed. Even if no anesthetic is to be used, the patient should be fasted for five hours if possible, even for direct laryngoscopy in order to forestall vomiting. Except in emergency cases every patient should be gone over by an internist for organic disease in any form. If an endolaryngeal operation is needed by a nephritic, preparatory treatment may prevent laryngeal edema or other complications. Hemophilia should be thought of. It is quite common for the first symptom of an aortic aneurysm to be an impaired power to swallow, or the lodgment of a bolus of meat or other foreign body. If aneurysm is present and esophagoscopy is necessary, as it always is in foreign body cases, to be fore-warned is to be forearmed. Pulmonary tuberculosis is often unsuspected in very young children. There is great danger from tracheal pressure by an esophageal diverticulum or dilatation distended with food; or the food maybe regurgitated and aspirated into the larynx and trachea. Therefore, in all esophageal cases the esophagus should be emptied by regurgitation induced by titillating the fauces with the finger after swallowing a tumblerful of water, pressure on the neck, etc. Aspiration will succeed in some cases. In others it is absolutely necessary to remove food with the esophagoscope. If the aspirating tube becomes clogged by solid food, the method of swab aspiration mentioned under bronchoscopy will succeed. Of course there is usually no cough to aid, but the involuntary abdominal and thoracic compression helps. Should a patient arrive in a serious state of water-hunger, as part of the preparation the patient must be given water by hypodermoclysis and enteroclysis, and if necessary the endoscopy, except in dyspneic cases, must be delayed until the danger of water-starvation is past. As pointed out by Ellen J. Patterson the size of the thymus gland should be studied before an esophagoscopy is done on a child. Every patient should be examined by indirect, mirror laryngoscopy as a preliminary to peroral endoscopy for any purpose whatsoever. This becomes doubly necessary in cases that are to be anesthetized. Next: Anesthesia For Peroral Endoscopy Previous: Direction Of The Esophagus
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