Sponge-pumping
Categories: INSTRUMENTARIUMSources: A Manual Of Peroral Endoscopy And Laryngeal Surgery
While the usually thin, watery esophageal and
gastric secretions, if free from food, are readily aspirated through a
drainage canal, the secretions of the bronchi are often thick and
mucilaginous and aspirated with difficulty. Further-more, bronchial
secretions as a rule are not collected in pools, but are distributed
over the walls of the larger bronchi and continuously well up from
smaller bronchi during cough. The a
used whenever their very slight additional area of cross-section is
unobjectionable. In most cases, however, the most advantageous way to
remove bronchial secretion has been found to be by introducing a gauze
swab on a long sponge carrier (Fig. 14), so that the sponge extends
beyond the distal end of the bronchoscope, causing cough. Then
withdrawal of the sponge carrier will remove all of the secretion in
the tube just as the plunger in a pump will lift all of the water
above it. By this maneuver the walls of the bronchus are wiped free
from secretions, and the lamp itself is cleansed.
[FIG. 14.--Sponge carrier with long collar for carrying the small
sponges shown in Fig. 15. The collar screws down as in the Coolidge
cotton carrier. About a dozen of these are needed and they should all
be small enough to go through the 4 mm. (diameter) bronchoscope and
long enough to reach through the 53 cm. (length) esophagoscope, so
that one set will do for all tubes. The schema shows method of
sponging. The carrier C, armed with the sponge, S, when rotated as
shown by the dart, D, wipes the field, P, at the same time wiping the
lamp, L. The lamp does not need ever to be withdrawn for cleaning
during bronchoscopy. It is protected in a recess so that it does not
catch in the sponges.]
[FIG 15.--Exact size to which the bandage-gauze is cut to make
endoscopic sponges. Each rectangle is the size for the tubal diameter
given. The dimensions of the respective rectangles are not given
because it is easier for the nurse or any one to cut a cardboard
pattern of each size directly from this drawing. The gauze rectangles
are folded up endwise as shown at A, then once in the middle as at B,
then strung one dozen on a safety pin. In America gauze bandages run
about 16 threads to the centimeter. Different material might require a
slightly different size and the pattern could be made to suit.]
[32] The gauze sponges are made by the instrument nurse as directed in
Fig. 15, and are strung on safety pins, wrapped in paper, the size
indicated by a figure on the wrapper, and then sterilized in an
autoclave. The sterile packages are opened only as needed. These
bronchoscopic sponges are also made by Johnston and Johnston, of New
Brunswick, N. J. and are sold in the shops.
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Rules For Insertion Of The Catheter For Insufflation Anesthesia
1. The patient should be fully under the anesthetic by the open method so as to get full relaxation of the muscles of the neck. 2. The patient's head must be in full extension with the vertex firmly pushed down toward the feet of the patient, so... Rules For The Application Of Water In Typhoid Cases
As a general rule, in typhoid cases, bathing should form one of the principal features of the treatment; i. e. the patient should have more baths than packs in proportion to the treatment of other cases. The temperature of the baths should be in... Running The Human Automobile
The Body-Automobile. If you were to start to-morrow morning on a long-distance ride in an automobile, the first thing that you would do would be to find out just how that automobile was built; how often it must have fresh gasoline; how its differe... Rupture And Trauma Of The Esophagus
These may be spontaneous or may ensue from the passage of an instrument, or foreign body, or of both combined, as exemplified in the blind attempts to remove a foreign body or to push it downwards. Digestion of the esophagus and perforation may resu... Safety-pin Closer
There are a number of methods for the endoscopic removal of open safety-pins when the point is up, one of which is by closing the pin with the instrument shown in Fig. 37 in the following manner. The oval ring is passed through the endoscope until i... Scald Head
of children, where there is a discharge of yellow and watery pus from the sores, and the eruption extends to the ears or face, like the disease called the _crusta lactea_ (milk crust), the same washes as for itch, are the most effectual, while at th... Scarlatina Anginosa Or Sore-throat Scarlet-fever
Wherever the _throat_ is affected, which is almost always the case, the disease is called _scarlatina anginosa_, or _sore-throat scarlet-fever_. This is the form described at the commencement of this article. There are several varieties, however, of... Scarlatina Miliaris
Sometimes the red patches of the rash are covered with small vesicles of the size of mustard-seed, which either dry up or discharge a watery liquid, leaving thin white scurfs, that come away with the cuticle during desquamation. Although this form, ... Scarlatina Simplex Or Simple Scarlet-fever
In the _mildest form_ of the disease, called _scarlatina simplex_, or _simple scarlet-fever_, there is no inflammation of the throat, the fever is moderate, and the patient suffers very little. Unfortunately this form is so rare, that many experienc... Scarlatina Sine Exanthemate
There are also mild cases of scarlet-fever, when little or no rash appears, and the throat is very little affected. These are the result of a particularly mild character of the epidemy, together with a peculiar condition of the skin, the desquamatio... Scarlet Fever
This fever assumes two principal forms: Simple or mild, and Malignant. In the _Simple form_, there is great heat of the surface, extremely quick and frequent pulse, headache, and some sense of pain and soreness in the throat. After a day or two, the... Scarlet-fever Or Scarlatina
is an eruptive fever, produced by a peculiar contagious poison, and distinguished by extreme heat, a rapid pulse, a severe affection of the mucous membranes, especially those of the mouth and throat, and by a burning scarlet eruption on the skin. ... Sciatica
This is neuralgia in an ischiatic nerve, commonly the great ischiatic. Use the B D current, strong as the patient can well bear. Place the foot in warm water with N. P., or place the sponge-roll N. P. at the sole of the foot, (the former is the be... Sea-sickness
_Nux Vomica_ should be used once in about four hours, for twelve hours before sailing, as a preventive to sea-sickness. If, however, symptoms, such as dizziness or blur before the eyes, and headache, begin to come on, a dose of _Nux_ should be tak... Second Stage
The spatular end of the laryngoscope should now be tipped back toward the posterior wall of the pharynx, passed posterior to the epiglottis, and advanced about 1 cm. The larynx is now exposed by a motion that is best described as a suspension of the... Secondary Eliminations Are Disease
However the exact form the chain from irritation or malnutrition to enervation progresses, the ultimate result is an increased level of toxemia, placing an eliminatory burden on the liver and kidneys in excess of their ability. Eventually these orga... Self-consciousness
SELF-CONSCIOUSNESS may be truly defined as a person's inability to get out of his own way. There are, however, some people who are so entirely and absolutely self-conscious that everything they do, even though it may appear spontaneous and i... Self-control
TO most people self-control means the control of appearances and not the control of realities. This is a radical mistake, and must be corrected, if we are to get a clear idea of self-control, and if we are to make a fair start in acquiring i... Sentiment _versus_ Sentimentality
FREEDOM from sentimentality opens the way for true sentiment. An immense amount of time, thought, and nervous force is wasted in sentimentalizing about "being good." With many, the amount of talk about their evils and their desire to overcome them... Shock
The treatment of shock will probably always be unsatisfactory as the cause is so varied, and, although circulatory prostration and vasomotor paresis always constitute the acute condition, the physiologic health of the heart and blood vessels is so v... Signs Of Heart Weakness
It should be remembered that a normal heart may slow to about 60 during sleep, and all nervous acceleration of the pulse may be differentiated during sleep by the fact that if the heart does not markedly slow, there is cardiac weakness or some gener... Simple Dilatation
The term "simple dilatation" may be applied to the dilatation of one or both ventricles when there is no valvular lesion and when the condition may not be called broken compensation. The compensation has been sufficiently discussed. Dilatation of th... Simple Hypertrophy
Like any other muscular tissue, the heart hypertrophies when it has more work to do, provided this work is gradually increased and the heart is not strained by sudden exertion. To hypertrophy properly the heart must go into training. This training... Site Of Lodgement
Almost all foreign bodies are arrested in the cervical esophagus at the level of the superior aperture of the thorax. A physiologic narrowing is present at this level, produced in part by muscular contraction, and mainly by the crowding of the adja... Site Of Lodgment
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. ... Sitz-bath Anchor Of Safety
If there be much delirium, the sitz-bath may be required longer, and the pack shorter, as indicated above (81). In all such cases the packs and sitz-baths, alternately, ought to be continued, till the nervous symptoms disappear altogether, and shoul... Sleep And Rest
Why We Need Rest. A most important element in a life of healthful exercise, study, and play is rest. Even when we are hard at work, we need frequent breathing spells and changes of occupation and amusement to keep one part of our muscles, or our bra... Small Pox - Variola
This disease begins with pain in the head and back, chilly sensations, followed by a high fever, so similar in all respects to a severe attack of Bilious or "winter" fever, that it is difficult or impossible to distinguish it with certainty, as Smal... Small-pox
_Small-pox_, by far the most dangerous of them, has found a barrier in its destructive progress in Dr. Jenner's discovery. Vaccination is an almost sure prophylactic against it; but, notwithstanding, many, with whom the preservative was neglected or... Social/cultural/psychological Obstacles To Fasting
Numerous attitudes make it difficult to fast or to provide moral support to friends or loved ones that are fasting. Many people harbor fears of losing weight because they think that if times were really tough, if there was a famine or they became il... Sore Nipples
This affection of nursing women frequently comes on before the birth of the child, but generally does not make its appearance until after the suckling has continued for a week or more. It seems in some cases to be connected with the aphthae (sore mo... Spasmodic Stenosis Of The Esophagus
Etiology - The functional activity of the esophagus is dependent upon reflex action. The food is propulsed in a peristaltic wave by the same mechanism as, and through an innervation (Auerbach and Meissner plexus) similar to that which controls intes... Spatula-protected Method
Safety-pins in children, point upward, when lodged high in the cervical esophagus may be readily removed with the aid of the laryngoscope, or esophageal speculum. The keeper end is grasped with the alligator forceps, while the spatular tip of the l... Spectacles
If the operator has no refractive error he will need two pairs of plane protective spectacles with very large eyes. If ametropic, corrective lenses are necessary, and duplicate spectacles must be in charge of a nurse. For presbyopia two pairs of spe... Specular Esophagoscopy
Inspection of the hypopharynx and upper esophagus is readily made with the esophageal speculum shown in Fig. 4. High lesions and foreign bodies lodged behind the larynx are thus discovered with ease, and such a condition as a retropharyngeal absces... Spermatorrhea
The points to be gained are, to reduce the action of the amatorial organs of the brain and the secretion of the testes, and to contract and strengthen the tissue of the seminal vesicles and the prostrate gland. Take the B D current. First, treat ... Sponge-pumping
While the usually thin, watery esophageal and gastric secretions, if free from food, are readily aspirated through a drainage canal, the secretions of the bronchi are often thick and mucilaginous and aspirated with difficulty. Further-more, bronchia... Stage 2
Passing the cricopharyngeus is the most difficult part of esophagoscopy, especially if the patient is unanesthetized. Local anesthesia helps little, if at all. The handle of the esophagoscope is still pointing upward and consequently we are sure tha... Stage 3 Passing Through The Thoracic Esophagus
The thoracic esophagus will be seen to expand during inspiration and contract during expiration, due to the change in thoracic pressure. The esophagoscope usually glides easily through the thoracic esophagus if the patient's position is correct. Af... Stage 4 Passing Through The Hiatus Esophageus
When the head is dropped, it must at the same time be moved horizontally to the right in order that the axis of the tube shall correspond to the axis of the lower third of the esophagus, which deviates to the left and turns anteriorly. The head and... Stage I Entering The Right Pyriform Sinus
The operator standing (as in Fig. 66), inserts the esophagoscope along the right side of the tongue as far as and down the posterior pharyngeal wall. A lifting motion imparted to the tip of the esophagoscope by the left thumb will bring the rounded... Starches
Sources of Starch. The starches are valuable and wholesome foods. They form the largest part, both in bulk and in fuel value, of our diet, and have done so ever since man learned how to cultivate the soil and grow crops of grain. The reason is clear... Starvation
It is true that ethical medical doctors use the least-risky procedure they are allowed to use. But this does not mean there are no risks to allopathic treatment. The medical doctor justifies taking the risks by saying that the risk/reward ratio is t... Stings Of Insects
The effect produced by the sting of Bees, Wasps, and Hornets of all kinds, is so nearly, if not quite identical, that I shall make no distinction between them. There are very few, if any persons, who do not know the symptoms, at least the local effe... Stokes Adams Disease Heart Block
Stokes-Adams disease, or the Stokes-Adams syndrome, is a name applied to a combination of symptoms which was described by Stokes in 1846, and had been observed by Adams in 1827. The disease is characterized by bradycardia and cerebral attacks, eithe... Stokes Adams Treatment
The treatment of true Stokes-Adams disease is unsuccessful. If general arteriosclerosis is present, that condition should be treated. Digitalis would seem almost invariably contraindicated, although it is of value in extrasystoles without heartblock... Strabismus Discordance Of The Eyes
If neither of the rectus muscles have been cut and cicatrized, and if the deformity be not congenital, it may ordinarily be cured. Take B D current, with small pointed electrodes. If the eye be turned inward, insert P. P. in the outer angle of the... Strychnin
The question of the advisability of strychnin is a constant subject for discussion. Strychnin is overused in the cases of most patients who are seriously ill. In a patient in whom we are trying to cause nervous and muscular rest, strychnin is certai... Styptic Charms
Fancy can save or kill; it hath closed up wounds, when the balsam could not, and without the aid of salves, to think hath been a cure. CARTWRIGHT. With bandage firm Ulyss... Sudden Invasion Of The Nervous Centres
Of the different forms of scarlatina maligna the most dangerous is the sudden invasion of the nervous system, particularly the _brain_, the _cerebellum_ and the _spine_, by which the patient's life is sometimes extinguished in a few hours. In other ... Sugars
Where Sugar is Obtained. The other great member of the starch, or carbohydrate, group of foods is sugar. This is a scarcer and more expensive food than starch because, instead of being found in solid masses in grains and roots like starch, it is sca... Suggestions For The Control Of Athletics
1. Gymnasiums and athletic grounds in connection with all colleges, preparatory schools, seminaries and high schools are essential, and they should be added to grammar schools whenever possible. 2. Physical training and athletic games, and perhaps... Suppression Of The Menses Amenorrhoea
For sudden suppression from taking cold, as by wetting the feet, there being headache, more or less fever, the pulse frequent and variable, pains in the small of the back and cramp like pains in the pelvic region, give, in alternation, _Aconite_ a... Sympathy
SYMPATHY, in its best sense, is the ability to take another's point of view. Not to mourn because he mourns; not to feel injured because he feels injured. There are times when we cannot agree with a friend in the necessity for mourning or feeling in... Symptomatology And Diagnosis Of Foreign Bodies In The Air And Food Passages
Initial symptoms are choking, gagging, coughing, and wheezing, often followed by a symptomless interval. The foreign body may be in the larynx, trachea, bronchi, nasal chambers, nasopharynx, fauces, tonsil, pharynx, hypopharynx, esophagus, stomach, ... Symptomatology And Treatment Of Chronic Valvular Lesions
Before discussing the treatment of broken compensation in general, it may be well to describe briefly the differences in the symptoms and treatment of the various valvular lesions. ... Symptoms
In hypertension, as long as the heart, which is probably hypertrophied, remains perfectly competent, there are few symptoms, and the person does not seek advice until he notices one or more of several possible conditions. He may be dizzy, his head m... Symptoms
The symptoms are increased tension, which means, sooner or later, hypertrophy of the left ventricle and an accentuated closure of the aortic valve. This alone means more and more tendency to aortic irritation and aortic valve irritation, with inflam... Symptoms
Malignant disease of the esophagus is rarely seen early, because of the absence, or mildness, of the symptoms. Dysphagia, the one common symptom of all esophageal disease, is often ignored by the patient until it becomes so marked as to prevent the ... Symptoms
Dysphagia is the most frequent complaint in cases of esophageally lodged foreign bodies. A very small object may excite sufficient spasm to cause aphagia, while a relatively large foreign body may be tolerated, after a time, so that the swallowing f... Symptoms And Signs Of Cardiac Disturbance
It is now recognized that any infection can cause weakness and degeneration of the heart muscle. The Streptococcus rheumaticus found in rheumatic joints is probably the cause of such heart injury in rheumatism. That prolonged fever from any cause in... Symptoms Of Gastric Foreign Body
Foreign body in the stomach ordinarily produces no symptoms. The roentgenogram and the fluoroscopic study with an opaque mixture are the chief means of diagnosis. ... Symptoms Of Laryngeal Foreign Body
1. Initial laryngeal spasm followed by wheezing respiration, croupy cough, and varying degrees of impairment of phonation. 2. Pain may be a symptom. If so, it is usually located in the laryngeal region, though in some cases it is referred to the... Symptoms Of Prolonged Foreign Body Sojourn In The Bronchus
1. The time of inhalation of a foreign body may be unknown or forgotten. 2. Cough and purulent expectoration ultimately result, although there may be a delusive protracted symptomless interval. [130] 3. Periodic attacks of fever, with chills ... Symptoms Of Tracheal And Bronchial Foreign Body
1. Tracheal foreign bodies are usually movable and their movements can usually be felt by the patient. 2. Cough is usually present at once, may disappear for a time and recur, or may be continuous, and may be so violent as to induce vomiting. I... Take Care Of Your Stomach
WE all know that we have a great deal to do. Some of us have to work all day to earn our bread and butter and then work a good part of the night to make our clothes. Some of us have to stand all day behind a counter. Some of us have to sit a... Taking A Laryngeal Specimen For Diagnosis
The diagnosis of carcinoma, sarcoma, and some other conditions can be made certain only by microscopic study of tissue removed from the growth. The specimen should be ample but will necessarily be small. If the suspected growth be small it should b... Talismans
A talisman may be described as an emblematical object or image, accredited with magical powers, by whose means its possessor is enabled to enlist the aid of supernatural beings. Frequently it is a precious stone, sometimes a piece of metal or parc... Technic
It is essential that the patient on whom the examination is to be made should be at rest, either comfortably seated, or lying down. All clothing should be removed from the arm, and there should be no constriction by sleeves, either of the upper arm ... Technic
The patient should be placed in the recumbent position, with the extended head held in the midline by an assistant. The shoulders, not the neck, should be slightly raised with a sand bag. The head should be somewhat lower than the feet, to lessen th... Technic For General Anesthesia
For esophagoscopy and gastroscopy, if general anesthesia is desired, ether may be started by the usual method and continued by dropping upon folded gauze laid over the mouth after the tube is introduced. Endo-tracheal administration of ether is, ho... Technic Of Bronchoscopy
Local anesthesia is usually employed in the adult. The patient is placed in the Boyce position shown in Fig. 51, with head and shoulders projecting over the edge of the table and supported by an assistant. The glottis is exposed by left-handed laryn...