InformationalPrivacy
| A young couple got married and left on their honeymoon. When they got back, the bride immediately called her mother. "Well, how was the honeymoon?" asked the mother. "Oh mamma!" she exclaimed. "The honeymoon was wonderful! So romantic!" N... Read more of The honeymoon is over at Free Jokes.ca | Informational Privacy |
 |
Home |
Medical Articles |
Mother's Remedies |
Household Tips |
Medicine History |
Search |
Medical ArticlesDecannulationWhen the tracheal incision is placed below the first ring, n... The Surgical Dissection Of The Popliteal Space And The Posterior Crural Region On comparing the bend of the knee with the bend of the elbow,... Air-tight Covering The covering of oiled silk, or guttapercha, so frequently plac... Pulmonary Phthisis Consumption After tubercles have been formed extensively in the lungs, an... Second Stage The spatular end of the laryngoscope should now be tipped ba... Chest Protectors These are often piled on the front of the body, while the far ... The Repugnant Bowel I don't know why, but people of our culture have a deep-seate... Fruits And Vegetables The Special Uses of Fruits and Vegetables. We come now to t... On The Unadherent Eschar The eschar is generally adherent in cases of recent injuries,... Angina Pectoris Symptoms The pain of true angina pectoris generally starts in the regi... Period Of Efflorescence Or Standing Out Of The Rash During the first day or two of the period of efflorescence, w... Scarlet Fever This fever assumes two principal forms: Simple or mild, and M... The Half-bath The Sitz- Or Hip-bath Should the half-bath or shallow-bath (which are technical ter... Punctures Case Viii This case illustrates the mode of treatment by the lunar caus... Paracelsus THEOPHRASTUS BOMBASTUS VON HOHENHEIM, commonly known as Parac... The Care Of The Heart-pump The Effect of Work upon the Heart. Whatever else in this body... The Cause Of Disease Ever since natural medicine arose in opposition to the violen... Agrippa HEINRICH CORNELIUS AGRIPPA VON NETTESHEIM, a German alchemist... Abscess Let us suppose a swelling appears on some part of the body or ... Lacing Tight This produces such serious deformity, and in many ways so inte... |
Site Of LodgmentCategory: FOREIGN BODIES IN THE LARYNX AND TRACHEOBRONCHIAL TREE Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery The majority of foreign bodies in the air passages occur in children. The right bronchus is more frequently invaded than the left because of the following factors: I. Its greater diameter. 2. Its lesser angle of deviation from the tracheal axis. 3. The situation of the carina to the left of the mid-line of the trachea. 4. The action of the trachealis muscle. 5. The greater volume of air going into the right bronchus on inspiration. The middle lobe bronchus is rarely invaded by foreign body, and, fortunately, in less than one per cent of the cases is the object in an upper lobe bronchus. Spontaneous Expulsion of Foreign Bodies from the Air Passages. A large, light, foreign body in the larynx or trachea may occasionally be coughed out, but the frequent newspaper accounts of the sudden death of children known to have aspirated objects should teach us never to wait for this occurrence. The cause of death in these cases is usually the impaction of a large foreign body in the glottis producing sudden asphyxiation, and in a certain proportion of these cases the impaction has occurred on the reverse journey, when cough forced the intruder upward from below. The danger of subglottic impaction renders it imperative that attempts to aid spontaneous expulsion by inverting the patient should be discouraged. Sharp objects, such as pins, are rarely coughed out. The tendency of all foreign bodies is to migrate down and out to the periphery as their size and shape will allow. Most of the reported cases of bechic expulsion of bronchially lodged foreign bodies have occurred after a prolonged sojourn of the object, associated which much lung pathology; and in some cases the object has been carried out along with an accumulation of pus suddenly liberated from an abscess cavity, and expelled by cough. This is a rare sequence compared to the usual formation of fibrous stricture above the foreign body that prevents the possibility of bechic expulsion. To delay bronchoscopy with the hope of such a solution of the problem is comparable to the former dependence on nature for the cure of appendiceal abscess. We do our full duty when we tell the patient or parents that while the foreign body may be coughed up, it is very dangerous to wait; and, further, that the difficulty of removal usually increases with the time the foreign body is allowed to remain in the air passages. Mortality and morbidity of bronchoscopy vary directly with the degree of skill and experience of the operator, and the conditions for which the endoscopies are performed. The simple insertion of the bronchoscope is devoid of harm if carefully done. The danger lies in misdirected efforts at removal of the intruder and in repeating bronchoscopies in children at too frequent intervals, or in prolonging the procedure unduly. In children under one year endoscopy should be limited to twenty minutes, and should not be repeated sooner than one week after, unless urgently indicated. A child of 5 years will bear 40 to 60 minutes work, while the adult offers no unvarying time limit. More can be ultimately accomplished, and less reaction will follow short endoscopies repeated at proper intervals than in one long procedure. Indications for bronchoscopy for suspected foreign body may be thus summarized: 1. The appearance of a suspicious shadow in the radiograph, in the line of a bronchus. 2. In any case in which lung symptoms followed a clear history of the patient having choked on a foreign body. 3. In any case showing signs of obstruction in the trachea or of a bronchus. 4. In suspected bronchiectasis. 5. Symptoms of pulmonary tuberculosis with sputum constantly negative for tubercle bacilli. If the physical signs are at the base, particularly the right base, the indication becomes very strong even in the absence of any foreign body circumstance in the history. 6. In all cases of doubt, bronchoscopy should be done anyway. There is no absolute contraindication to bronchoscopy for foreign bodies. Extreme exhaustion or reaction from previous efforts at removal may call for delay for recuperation, but pulmonary abscess and even the rarer complications, bronchopneumonia and gangrene of the lung, are improved by the early removal of the foreign body. Next: Choice Of Time To Do Bronchoscopy For Foreign Body Previous: Foreign Bodies In The Larynx And Tracheobronchial Tree
Viewed 471 |
||||||||||||||||||||
