Direct laryngoscopy

Google drive:-https://www.youtube.com/redirect?q=https%3A%2F%2Fdrive.google.com%2Fopen%3Fid%3D1ZET4JzZalyUfM1KWXemKZsQQXMzrYpcJ&v=WHOggpW5Ee8&event=video_description&redir_token=77oOekaJs8_u0RLfrUH8z68tJFt8MTU2MDY1Njc4N0AxNTYwNTcwMzg3
Youtube:-https://www.youtube.com/watch?v=WHOggpW5Ee8

1. DIRECT LARYNGOSCOPY A B C D E F G

2. INTRODUCTION DIRECT VISUALISATION OF STRUCTURES OF LARYNX AND HYPOPHARYNX

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 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 MACINTOSH BLADE a).Curved blade. b).Tip of the blade rests in valecula , indirectly lifting epiglottis.

10. PROCEDURE PROTECTION & HOLDING OF SCOPE GAUZE PLACED ON UPPER TEETH. LARYNGOSCOPE LUBRICATED WITH LIQUID PARRAFIN OR XYLOCAINE JELLY.

11. PROCEDURE 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. PROCEDURE VISUALISATION ORAL AXIS A LINE DRAWN HORIZONTALLY ACROSS 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. PROCEDURE 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. PROCEDURE STRUCTURES SEEN BASE OF THE TONGUE SERIALLY

15. PROCEDURE STRUCTURES SEEN VALLECULAE EPIGLOTIS

16. PROCEDURE STRUCTURES SEEN PYRIFORM FOSSA

17. PROCEDURE STRUCTURES SEEN STRUCTURES EXAMINED SERIALLY ARYEPIGLOTIC FOLDS ARYTENOIDS POSTCRICOID REGION

18. STRUCTURES SEEN VOCAL CORDS COMMISURES GLOTIS PROCEDURE

19. RESPIRATION RECOVERY POSITION TRAUMA TO 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 COMPLICATIONS

21. DIRECT VS INDIRECT LARYNGOSCOPY LARYNGEAL MIRROR USED INVERTED IMAGE FORSHORTENING OF AP DIAMETER OPD PROCEDURE APPEAR IN CONTACT WITH EACH OTHER DIRECT INDIRECT NO MIRROR USED DIRECT VISUALISATION NO FORSHORTENING OF AP DIAMETER DONE IN OT TRUE & FALSE VC’S SEPARATED BY VENTRICLES

22. RAAFI UL BASHEER ZARGAR THANK YOU