Direct laryngoscopy

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Information about Direct laryngoscopy

Published on June 15, 2019

Author: RaafiulZargar

Source: slideshare.net

1. DIRECT LARYNGOSCOPY A B C D E F G

2. I N T R O D U C T I O N D I R E C T V I S U A L I S AT I O N O F S T R U C T U R E S O F L A R Y N X A N D H Y P O P H A R Y N X

3. ANATOMY OF LARYNX & PHARYNX

4. INDICATIONS DIAGNOSTIC Infants & young children Examine hidden areas of Hypopharynx and Larynx Find extent of growth and take Biopsy Symptoms- Hoarseness, Dyspnoea, Stridor & Dysphagia Strong gag reflex & overhanging Epiglottis

5. INDICATIONS THERAPEUTIC Removal of Benign lesions of Larynx Foreign body removal Dilatation of laryngeal strictures

6. CONTRAINDICATIONS DISEASES/INJURIES OF CERVICAL SPINE STRIDOR (UNLESS AIRWAY PROVIDED BY TRACHEOSTOMY) RECENT CORONARY OCCLUSION CARDIAC DECOMPENSATION

7. ANESTHESIA • Usually done under general anesthetic. • Infants and young children don’t require any anesthetic for diagnostic DLS.

8. POSITION • ADULTS: Barking dog position. Supine position Head elevated 10-15cm Neck flexed on thorax Head extended on AOJ • INFANTS: Slight elevation of shoulders • CHILDREN: Slight extension of head

9. EQUIPMENT:LARYNGOSCOPE 1. MILLER BLADE a).Straight blade. b).The side of flange is reduced to minimize trauma. c).Curve at the tip is extended to improve lifting of epiglottis. d).Useful in difficult to incubate patients. CONSISTS OF:1.HANDLE 2.BLADE BLADES 2. MACINTOSH BLADE a).Curved blade. b).Tip of the blade rests in valecula, indirectly lifting epiglottis.

10. P R O C E D U R E PROTECTION & HOLDING OF SCOPE • GAUZE PLACED ON UPPER TEETH. • LARYNGOSCOPE LUBRICATED WITH LIQUID PARRAFIN OR XYLOCAINE JELLY.

11. P R O C E D U R E INTRODCTION • INTRODUCED BY RIGHT SIDE OF TONGUE • THEN MOVED TO MIDLINE • LIFTED FORWARD TO BRING THE EPIGLOTIS IN VIEW (WITHOUT LEVERING IT ON UPPER TEETH OR JAW)

12. P R O C E D U R E VISUALISATION • ORAL AXIS A LINE DRAWN HORIZONTALLYACROSS THE TOP OF THE TONGUE. • PHARYNGEAL AXIS A LINE TANGENTIAL FROM THE UVULA TO THE POSTERIOR SURFACE OFTHE EPIGLOTTIS. • LARYNGEAL AXIS A LINE DRAWN AT A RIGHT ANGLE TO THE VOCAL CORDS.

13. P R O C E D U R E ANTERIOR COMMISURE LARYNGOSCOPE • TIP CAN FURTHER BE ADVANCED BETWEEN VENTRICULAR BANDS TO EXAMINE VENTRICLE AND ANTERIOR COMMISURE • PASSED BETWEEN VOCAL CORDS TO EXAMINE SUBGLOTTIC REGION

14. P R O C E D U R E STRUCTURES SEEN BASE OF THE TONGUE SERIALLY

15. P R O C E D U R E STRUCTURES SEEN • VALLECULAE • EPIGLOTIS

16. P R O C E D U R E STRUCTURES SEEN • PYRIFORM FOSSA

17. P R O C E D U R E STRUCTURES SEEN • STRUCTURES EXAMINED SERIALLY • ARYEPIGLOTIC FOLDS • ARYTENOIDS • POSTCRICOID REGION

18. STRUCTURES SEEN • VOCAL CORDS • COMMISURES • GLOTIS P R O C E D U R E

19. RESPIRATIONRECOVERY POSITION TRAUMATO LARYNX PREVENT ASPIRATION OF BLOOD LARYNGEAL ODEMA RESPIRATORY DISTESS LARYNGEAL SPASM CYANOSIS POSTOPERATIVE CARE

20. INJURY TO LIPS TONGUE AND TEETH BLEEDING LARYNGEAL SPASM & ODEMA C O M P L I C AT I O N S

21. DIRECT VS INDIRECT LARYNGOSCOPY LARYNGEAL MIRROR USED INVERTED IMAGE FORSHORTENING OF AP DIAMETER OPD PROCEDURE APPEAR IN CONTACT WITH EACH OTHER D I R E C T I N D I R E C T NO MIRROR USED DIRECT VISUALISATION NO FORSHORTENING OF AP DIAMETER DONE IN OT TRUE & FALSE VC’S SEPARATED BY VENTRICLES

22. R A A F I U L B A S H E E R Z A R G A R THANK YOU

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