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Examination Of The Trachea And Bronchi

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

All bronchial orifices must

be identified seriatim; because this is the only way by which the

bronchoscopist can know what part of the tree he is examining.

Appearances alone are not enough. It is the order in which they are

exposed that enables the inexperienced operator to know the orifices.

After the removal of the laryngoscope, the bronchoscope is to be held

by the left hand like a billiard cue, the terminal phalan
es of the

left middle and ring fingers hooking over the upper teeth, while the

thumb and index finger hold the bronchoscope, clamping it to the teeth

tightly or loosely as required (Fig. 63). Thus the tube may be

anchored in any position, or at any depth, and the right hand which

was directing the tube may be used for the manipulation of

instruments. The grasp of the bronchoscope in the right hand should be

similar to that of holding a pen, that is, the thumb, first, and

second fingers, encircle the shaft of the tube. The bronchoscope

should never be held by the handle (Fig. 64) for this grasp does not

allow of tactile sense transmission, is rigid, awkward, and renders

rotation of the tube a wrist motion instead of but a gentle finger

action. Any secretion in the trachea is to be removed by sponge

pumping before the bronchoscope is advanced. The inspection of the

walls of the trachea is accomplished by weaving from side to side and,

if necessary, up and down; the head being deflected as required during

the search of the passages, so that the larynx be not made the fulcrum

in the lever-like action.

[FIG. 64.--At A is shown an incorrect manner of holding the

bronchoscope. The grasp is too rigid and the position of the hand is

awkward. B, Correct manner, the collar being held lightly between the

finger and the thumb The thumb must not occlude the tube mouth.]