Flexible Bronchoscopy Step by Step：灵活的一步一步的支气管镜检查.pptVIP

BI, All Rights Reserved, 2005 Flexible Bronchoscopy  Step by Step? Video exercises to learn bronchoscopy skills Prepared By Bronchoscopy International Contact us at BI@bronchoscopy.org Main Objectives To learn bronchoscopic techniques using an approach similar to learning to dance, play tennis or play a musical instrument. To develop “muscle memory” To develop a “systematic approach” to bronchoscopic inspection. To learn how to handle the flexible bronchoscope and to accurately identify and enter lobar and segmental bronchial segments with ease. 8 steps Bronchoscopy exercises Background A: Flexion-Extension Background B: Down-Neutral-Up positions Group 1 Exercises Step 1: nose to larynx The scope is advanced from the nose to the larynx . This step includes local anesthesia. Step 2: larynx to subglottis From the larynx the trachea is entered to the subglottic area. If from the head: once the vocal cords are passed the scope is slightly flexed downwards. If from the front: once the vocal cords are passed the scope is slightly flexed upwards. Step 3: Follow the curve to the carina The Trachea is not a “straight pipe”; It deviates posteriorly and slightly to the right when approaching the main carina. Step 4a: Carina to left main bronchus From the neutral position the LMB is entered just by twisting the wrist to the left and advancing for 1 -2 cm. Step 4b: Carina to right main bronchus From the neutral position the RMB is entered just by twisting the wrist to the right and advancing the scope for 1 -2 cm. Step 4c: Left-right-neutral Step 5a: Down-up-left main bronchus The scope is slowly advanced the pulled back up the LMB while always keeping it in the middle of the airway lumen. Step 5b: Down-up right main bronchus The scope is slowly advanced down the RMB to RLL and pulled back upwards while always keeping it in the middle of the airway lumen. Group 2 Exercises Step 6a: Left main to left upper lobe bronchus From the LMB the scope is advanced to the en