Friday, 24 February 2012

Bronchoscopy Part One: 2 patients presenting with haemoptysis


Yesterday morning I stumbled into the hospital with my ward partner, located the bronchoscopy room, and then proceeded to resist the urge to fall asleep whilst waiting outside for the doctor to arrive.

The GP (for my gp placement), and the 5th years at the hospital have been warning me with their experiences of watching bronchoscopy, but being the ever so slightly odd medical student... i was really looking forward to finding out what the fuss was all about! To be honest.. it really wasn't that bad, mucus doesn't really phase me, if anything, i found the scared and distressed patient more uncomfortable to watch than anything else.

Patient 1:

The first patient was terrified, and had been referred for the procedure, having recently been coughing up blood.

This was her 4th Bronchoscopy procedure attempt, having failed to complete the bronchoscopy 3 times previously. The last time, she struggled and yanked the broncoscope out herself, mid procedure. However, she was willing to give it one more go, "i've had enough", starting to get slightly tearful as she propped herself onto the bed.

We popped apron, mask and gloves on, and in a flash the Dr had popped the cannula into the patient's hand, and administered the sedatives. However, although sedated, the patient was still quite distressed, she wanted to carry on, but was struggling to stay calm as the bronchoscope meandered its way through the conducting airways. I felt terrible, as the Dr asked the other student and myself to hold the patient's hands, and keep her calm and still, when she was clearly quite distressed. However, the patient's bravery got her through the procedure, and finally on her 4th attempt, they managed to have a good look, and take samples for testing. The patient was simply relieved to finally having it done, and not needing to go in again.

Patient 2

A very similar presenting story as patient 1, but this lady was very different! She was calm, almost a complete 180 of the previous patient; smiling, relaxed and just wanted to get the investigation over and done with.

This was a slightly more complicated procedure, as the Dr had to take biopsies from the lung, and whilst this sounds incredibly stupid, i honestly had no clue how they managed to do that, until i finally saw it being performed! A very very thin wire with a "clamp" at the end is inserted in a separate tunnel attached to the bronchoscope, and comes out the other end adjacent to the camera. The assisting nurse then opens the clamp as the Dr positions it, and closes the clamp upon the Dr's instruction, grabbing onto a bit of the bronchiole, before a sharp yank is applied to remove the specimen. This was almost always followed with some bleeding, but that's a common side effect of bronchoscopy.

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