anesthesia and today we're going to go through this little device now this device will save
you on countless occasions whenever you're going to possibly call difficult airlines the ability
to use this quickly effectively is absolutely important so what we're going to do we're going to
go through some of the features of the endoscope a quick checklist some of the movements so you know
exactly how to maneuver this to get to the site you want to get to get down through those chords
into the trachea and then a few troubleshooting steps as well so let's get started first of all
the pieces now this can either be a fibrous skirt or one with a camera it doesn't really
matter to me too much um the features are that first of all i've got this structure here which
allows me to visualize through an eye piece or a screen like this i've got this control lever here
which changes regression flexing retroflex off the tip this port here is our suction or oxygen
this is a trigger that activates that process so either activating suction oxygen i've got
a working channel so this little port here i can either put liquids uh saline and local anaesthetic
through there finally i've got this end so as you can see it places in retroplexes it's also got
a light source that allows me to make sure you can see what i'm seeing and it's got the guide
on the camera of the fiber optic tip at the side over there that's about it so let's get started
first thing i checked is a light source and this is as simple as making sure that there's a bright
light from there as well as maybe i go down onto a piece of script and just making sure that i can
see it well at the same time i can check the focus so make sure i can read the letters i read again
the next part of this process is simply flexing and retro flexing the tip and that way i can make
sure that the focus is good at all sites and i can read the writing that i'm moving it down on screen
now this oxygen suction port is something i also checked so i connect this here
and then i connect this other end to the oxygen board so i press this and i can feel
oxygen flowing from there so that's how you check that that channel is working as well and finally
the working channel so what this is it's a way that i can deliver especially the anaesthetic
context local anaesthetic to the region i need that local anesthetic in so for example
i'm doing a weight fiber optic and i just want a good spray of local anesthetic where i'm
directing my scope with this working channel you're able to thread an epidural catheter
and it takes a bit of effort to do so on these disposable scopes and so it's a
really good idea to keep it you know absolutely vertical like this as you thread the catheter
to avoid resistance and you'll see that it can just emerge out from there and i pre-prepare
this before i'm about to do the away fiber optic now what i do then is i hook this onto the end
and clasp that and that way i can fit a lualox syringe on the end of that or normal syringe
and then this can spray really effectively any of the areas and that way you can get a nice
spray just like that you can get a nice spray like that so that's if you thread the epidural catheter
on the proper non-disposable scopes it's much easier to thread the cathode through
now that can take a bit of time so you might want to outsource that to someone else to do
and have that prepared if you're doing this a weight fiber optic reasonably electively
now you can also use the working channel with just a normal five mil syringe i
use two mils of your local anesthetic and make sure i've got about three mils of air
i then put it like so and push it into the working channel what this air does is as i press down you
get a bit of back pressure that allows the local anaesthetic just to spray out to cover a good
area where you're working with so what i'm going to do there is just press pretty firmly to allow
it to spray out like so sometimes i have maybe five of these five mil syringes with two mils
of low clients there just i can spray as i go to whatever whatever area needs local anesthetic and
that's all that's the working channel with this scope i've just got a few movements i need to
worry about that is flex and retroflex which we mentioned before i can then do rotation you can
see how in that movement i'm able to rotate the flex tip or the retroflex tip the way i want it
to be and then final two movements are just pushing forward so advancing and retracting
one really important thing if you're at extremes of focus and retroflexion you may
have difficulty advancing with this if you've got a tip like that it's far more difficult to advance
that tip that's roughly straight or have minimal deviation likewise have a severely angulated tip
you'll be potentially dangerous to withdraw it's one of those things it's really important to know
so those are really your movements your aim is therefore as you orientate yourself within the
truth here you find your target you put your target on the axis of your flexing retroflex
and then i flex my tip towards that and then i advance each time doing this micro adjustments