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Where this is advised medically, it is often taken in a manner...
The Relative Position Of The Cranial Nasal Oral And Pharyngeal Cavities
On making a section (vertically through the median line) of t...
Vegetables Green And Fruit
We would strongly recommend our readers to continually have th...
Diagnosis Of Foreign Body In The Air Or Food Passages
The questions arising are: I. Is a foreign body present? ...
Physical Signs Of Tracheal Foreign Body
If fixed in the trachea the only objective sign of foreign bo...
under a well conducted course of hydriatic treatment is, in g...
Entering The Bronchi
The lip of the bronchoscope should be turned in the directio...
See Cancer in Foot. ...
The lodgement of foreign bodies in the esophagus is influenc...
Scarlet-fever Or Scarlatina
is an eruptive fever, produced by a peculiar contagious poiso...
Secondary Eliminations Are Disease
However the exact form the chain from irritation or malnutrit...
Difficulties In The Introduction Of The Bronchoscope
The beginner may enter the esophagus instead of the trachea:...
The covering of oiled silk, or guttapercha, so frequently plac...
Habit And Nervous Strain
PEOPLE form habits which cause nervous strain. When t...
The Relative Position Of The Superficial Organs Of The Thorax And Abdomen
In the osseous skeleton, the thorax and abdomen constitute a ...
Frictions With Lard
were used already by Caelius Aurelianus, and recently re-intr...
Extraction Of Open Safety-pins From The Esophagus
An open safety pin with the point down offers no particular ...
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For all kinds of burning inflammatory pain in the eyes, the fo...
Removal Of Open Safety Pins From The Trachea And Bronchi
Category: MECHANICAL PROBLEMS OF BRONCHOSCOPIC FOREIGN BODY EXTRACTION
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
Removal of a closed safety pin presents no difficulty if it is grasped
at one or the other end. A grasp in the middle produces a toggle
and ring action which would prevent extraction. When the
safety pin is open with the point downward care must be exercised
not to override it with the bronchoscope or to push the point through
the wall. The spring or near end is to be grasped with the side-curved
or the rotation forceps (Figs. 19, 20 and 31) and pulled into the
bronchoscope, thus closing the pin. An open safety pin lodged point up
presents an entirely different and a very difficult problem. If
traction is made without closing the pin or protecting the point
severe and probably fatal trauma will be produced. The pin may be
closed with the pin-closer as illustrated in Fig. 37, and then removed
with forceps. Arrowsmith's pin-closer is excellent. Another method
(Fig. 87) consists in bringing the point of the safety pin into the
bronchoscope, after disengaging the point with the side curved
forceps, by the author's inward rotation method. The forceps-jaws
(Fig. 21) devised recently by my assistant, Dr. Gabriel Tucker, are
ideal for this maneuver. As the point is now protected, the spring,
seen just off the tube mouth, is best grasped with the rotation
forceps, which afford the securest hold. The keeper and its shaft are
outside the bronchoscope, but its rounded portion is uppermost and
will glide over the tissues without trauma upon careful withdrawal of
the tube and safety pin. Care must be taken to rotate the pin so that
it lies in the sagittal plane of the glottis with the keeper placed
posteriorly, for the reason that the base of the glottic triangle is
posterior, and that the posterior wall of the larynx is membranous
above the cricoid cartilage, and will yield. A small safety-pin may be
removed by version, the point being turned into a branch bronchial
orifice. No one should think of attempting the extraction of a safety
pin lodged point upward without having practiced for at least a
hundred hours on the rubber tube manikin. This practice should be
carried out by anyone expecting to do endoscopy, because it affords
excellent education of the eye and the fingers in the endoscopic
manipulation of any kind of foreign body. Then, when a safety pin case
is encountered, the bronchoscopist will be prepared to cope with its
difficulties, and he will be able to determine which of the methods
will be best suited to his personal equation in the particular case.
[FIG. 86.--Schema illustrating the upper-lobe-bronchus problem,
combined with the mushroom-anchor problem and the author's method
for their solution. The patient being recumbent, the bronchoscopist
looking down the right main bronchus, M, sees the point of the tack
projecting from the right upper-lobe-bronchus, A. He seizes the point
with the side-curved forceps; then slides down the bronchoscope to the
position shown dotted at B. Next he pushes the bronchoscopic
tube-mouth downward and medianward, simultaneously moving the
patient's head to the right, thus swinging the bronchoscopic level on
its fulcrum, and dragging the tack downward and inward out of its bed,
to the position, 1). Traction, as shown at C, will then safely and
easily withdraw the tack. A very small bronchoscope is essential. The
lip of the bronchoscopic tube-mouth must be used to pry the forceps
down and over, and the lip must be brought close to the tack just
before the prying-pushing movement. S, right stem-bronchus.]
[FIG. 87.--One method of dealing with an open safety pin without
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