Medical ArticlesDifficulties Of Esophagoscopy
The beginner may find the esophagoscope seemingly rigidly fi...
The Sitz-bath May Be Taken In A Small Wash-tub If There Is No
proper sitz-bath-tub at hand. It should be large enough to allo...
Sleep And Rest
Why We Need Rest. A most important element in a life of healt...
Diets To Heal The Critically Ill
A critically ill person is someone who could expire at any mo...
Notes On Nursing Tracheotomized Patients
Bedside tray should contain: Duplicate cannula Scalpel ...
Physical Signs In Esophageal Foreign Body
There are no constant physical signs associated with uncompli...
Finding Your Ideal Dietary
Anyone that is genuinely interested in having the best possib...
Structure of the Ear. Next after sight, hearing is our most i...
Burns And Scalds
No matter what the nature and extent of the burn may be, the ...
Esophagoscopy is demanded in every case in which a foreign b...
Angioneurotic edema manifests itself by a pale or red swolle...
Eyes Danger To Sight Of
Where inflammation has gone so far as to lead to suppuration, ...
No dyspneic patient should be given a general anesthetic; be...
Bronchoscopic And Esophagoscopic Grasping Forceps
are of the tubular type, that is, a stylet carrying the jaws...
Breathing And Bronchia
The bronchia are the branching small tubes which lead from the...
The Care Of The Heart-pump
The Effect of Work upon the Heart. Whatever else in this body...
The various articles under Nerves and Nervousness should be re...
Clinical Interpretation Of Pulse Tracings
A moment may be spent on clinical interpretation of pulse tra...
See Whooping Cough. ...
Alice was a middle-aged woman who couldn't understand why she...
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
Next: Removal Of Double Pointed Tacks
Previous: Extraction Of Tacks Nails And Large Headed Foreign Bodies From The Tracheobronchial Tree