Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,BI,All Rights Reserved,2005,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式文本样式文本,样式,第二级,第三级,第四级,第五级,BI,All Rights Reserved,2005,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,BI,All Rights Reserved,2005,*,Flexible Bronchoscopy Step by Step：灵活的一步一步的支气管镜检查,Flexible Bronchoscopy Step by,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.,11/15/2024,2,BI,All Rights Reserved,2005,Main ObjectivesTo learn bronch,Art of Bronchoscopy,11/15/2024,3,BI,All Rights Reserved,2005,Art of Bronchoscopy10/10/20233,Flexible-Bronchoscopy-Step-by-Step：灵活的一步一步的支气管镜检课件,Flexible-Bronchoscopy-Step-by-Step：灵活的一步一步的支气管镜检课件,Flexible-Bronchoscopy-Step-by-Step：灵活的一步一步的支气管镜检课件,Background A:Flexion-Extension,Extension,Flexion,11/15/2024,7,BI,All Rights Reserved,2005,Background A:Flexion-Extensio,Background B:Down-Neutral-Up positions,Lever down,Lever straight(Neutral),Lever up,11/15/2024,8,BI,All Rights Reserved,2005,Background B:Down-Neutral-Up,Group 1 Exercises,11/15/2024,9,BI,All Rights Reserved,2005,Group 1 Exercises10/10/20239BI,Step 1:nose to larynx,The scope is advanced from the nose to the larynx.,This step includes local anesthesia.,From the head,Click HERE to view video,Click to continue,11/15/2024,10,BI,All Rights Reserved,2005,Step 1:nose to larynxThe scop,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.,From the front,Click to continue,Click HERE to view video,11/15/2024,11,BI,All Rights Reserved,2005,Step 2:larynx to subglottisFr,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.,From the head,Click to continue,Click HERE to view video,11/15/2024,12,BI,All Rights Reserved,2005,Step 3:Follow the curve to th,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.,From head,Click to continue,Click HERE to view video,11/15/2024,13,BI,All Rights Reserved,2005,Step 4a:Carina to left main b,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.,From head,Click to continue,Click HERE to view video,11/15/2024,14,BI,All Rights Reserved,2005,Step 4b:Carina to right main,Step 4c:Left-right-neutral,From the neutral position the left and right main bronchi are entered alternatively just by twisting the wrist and advancing the scope for few cm.,From head,Click to continue,Click HERE to view video,11/15/2024,15,BI,All Rights Reserved,2005,Step 4c:Left-right-neutral Fr,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.,From the front,Click to continue,Click HERE to view video,11/15/2024,16,BI,All Rights Reserved,2005,Step 5a:Down-up-left main bro,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.,From the front,Click to continue,Click HERE to view video,11/15/2024,17,BI,All Rights Reserved,2005,Step 5b:Down-up right main br,Group 2 Exercises,11/15/2024,18,BI,All Rights Reserved,2005,Group 2 Exercises10/10/202318B,Step 6a:Left main to left upper lobe bronchus,From the LMB the scope is advanced to the entrance of the LUL bronchus.,From the front,Click to continue,Click HERE to view video,11/15/2024,19,BI,All Rights Reserved,2005,Step 6a:Left main to left upp,Step 6b:Left main to left lower lobe bronchus,The scope is advanced down the LMB to the entrance of the LLL bronchus.,From the front,Click to continue,Click HERE to view video,11/15/2024,20,BI,All Rights Reserved,2005,Step 6b:Left main to left low,Step 6c:Right main to right upper lobe bronchus,The scope is advanced down the RMB then with the wrist twisted 60 degrees from midline the scope is flexed up to the entrance of RUL.,From the front,Click to continue,Click HERE to view video,11/15/2024,21,BI,All Rights Reserved,2005,Step 6c:Right main to right u,Step 6d:Right main to bronchus intermedius,From the carina advance the scope down the RMB to the distal bronchus intermedius and visualize the entrance to RB456 and the basal pyramid.,From the front,Click to continue,Click HERE to view video,11/15/2024,22,BI,All Rights Reserved,2005,Step 6d:Right main to bronchu,Step