Term
| what is the definition of bronchoscopy? |
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Definition
| a diagnostic and therapeutic procedure that permits direct visualization of the tracheobronchial lumen w/the help of a specialized optical device |
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Term
| what are the main two types of bronchoscopy? |
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Definition
| rigid and flexible bronchoscopy |
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Term
| who was the first to perform a bronchoscopy? |
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Definition
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Term
| how prevalent is bronchoscopy? |
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Definition
| bronchoscopy is the most commonly used invasive procedure done in clinical pulmonary medicine and flexible bronchoscopy is performed in 95% of all bronchoscopy procedures |
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Term
| what is a rigid bronchoscope? |
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Definition
| an open tube/ventilating bronchoscope that can function as an artificial airway for O2 and anesthetic gases (most often requires general anesthesia) as it has a large channel for extraction of material and insertion of devices. a flexible bronchoscope can also be inserted for distal airway assessment |
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Term
| when is rigid bronchoscopy done? |
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Definition
| by sx (ENT or CT) in the OR |
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Term
| what characterizes flexible bronchoscopy? |
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Definition
| flexible bronchoscopy is easier to learn and comprises 95% of all bronchoscopies. it can be inserted nasally, orally, or via trach stoma and can visualize apical segments of the upper lobes, segmental and subsegmental bronchi in all lobes. flexible bronchoscopy is a safe outpatient procedure done in an endoscopy suite or at pt bedsite w/local anesthesia and sedation. it can be performed by a pulmonary physician, CT sx, or ENT |
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Term
| what are the necessary pre-bronchoscopy orders? |
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Definition
| informed consent, NPO past midnight, the procedure is done in the endoscopy suite/bedside, hydromorphone (no cough)/atropine (dries up secretions) IM on call, IV NSS @KVO on call, nasopharynx and oropharynx are anesthetized w/lidocaine spray, the naris is lubricated w/lidocaine gel, and IV midazolam is given for sedation |
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Term
| what are the indications for flexible bronchoscopy? |
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Definition
| either diagnostic (86%) or therapeutic (10%) |
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Term
| what are the indications for diagnostic bronchoscopy? |
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Definition
| cough, hemoptysis, wheeze/stridor, abnormal chest radiograph, pulmonary infections (pneumocystis in HIV pts), diffuse lung disease (ILD), intrathoracic adenopathy or mass, pulmonary nodules, bronchogenic carcinoma, metastatic carcinoma, esophageal/mediastinal tumors (may erode into the trachea), suspected foreign body, tracheobronchial strictures/stenosis, chemical and thermal burns, thoracic trauma, vocal cord paralysis/hoarsenss, diaphragmatic paralysis (often due to tracheal tumors interfering w/the phrenic nerve), pleural effusion, persistent pneumothorax, tracheoesophageal/bronchoesophageal fistulas, bronchopleural fistulas, assess airway trauma from endotracheal tube, postop assessments of anastamosis, and endobronchial ultrasound |
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Term
| what can be performed during a diagnostic bronchoscopy? |
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Definition
| direct visualization, bronchial washings, bronchoalveolar lavage, bronchial brushing, protected specimen brushing, bronchial bx, transbronchial bx, and transbronchial needle aspiration |
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Term
| what is the difference between bronchoalveolar lavage and bronchial washings? |
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Definition
| bronchoalveolar lavage: gets cells from alveolar airspaces (where pneumocystis pneumonia would be). bronchial washings: just cells from the proximal airway |
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Term
| what is bronchial brushing used for? what is protected specimen brushing? |
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Definition
| bronchial brushing: getting cells from tumors. protected specimen brushing: sterile brushings from one specific location in the lungs |
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Term
| what is a transbronchial bx? |
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Definition
| a transbronchial bx allows you to go out peripherally inside a lung segment using x-ray guidance to more distal targets (can cause pneumothorax) |
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Term
| what are indications for therapeutic bronchoscopy? |
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Definition
| airway secretions, mucous plugs, clots, necrotic debris, atelectasis, neoplasms, bronchoscopic debridement, laser therapy, argon plasma coagulator, electrocautery, cryotherapy, brachytherapy, balloon dilitation, stent placement, photodynamic therapy, bronchoscopic drainage, bronchoscopic therapy (PTX, BP fistula), ET tube placement or change, thoracic trauma, therapeutic lavage, mucoid impaction syndromes, foreign body, and bronchoscopic lung volume reduction |
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Term
| what are contraindications to bronchoscopy? |
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Definition
| unstable CV status, cardiac arrhythmias, refractory hypoxemia, uncooperative pts, inadequately trained bronchoscopist/bronchoscopy team, unstable neck/ankylosed C spine/restricted TMJ (rigid bronchoscopy), and be careful w/coagulopathy |
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Term
| what are complications associated with bronchoscopy? |
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Definition
| bleeding/hemoptysis, pneumothorax, respiratory depression/hypoxemia, cardiorespiratory arrest, arrhythmia, fever, bronchoscopy-induced infection, death, laryngospasm/bronchospasm, and increased intracranial pressure |
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