Bronchoscopy

Question 1

Management of pulmonary hemorrhage on bronchoscopy?

Answer 1

• Ice cold saline (10-15 mL)
• Epinephine 1:100,000 dilution, 2 mL
• Tamponade with balloon (eg. foley catheter)

Practical:
- otrivin

Question 2

Best method of entry to assess airway dynamics?

Answer 2

• Nasal
• Oral
• Face mask

Question 3

Best option to avoid contamination of lower airway specimen?

Answer 3

ETT

it seems like LMA would be relatively equivalent, but ETT is the preferred answer

Question 4

The size of the scope–>what diameter does this refer t? Is it the same diameter over length of scope?
How does this compare to EET?

Answer 4

• Bronchoscope: diameter refers to the outer diameter, the diameter actually over the lengthe of the scope, but the largest diameter is the one stated (eg. 3.1 mm scope–>larges diameter is 3.1 mm. It sounds like the outer diameter measurement is not perfectly accurate)
• ETT diameter: this is the INTERNAL diameter

Question 5

What is my harmonized approach to volume per alliquot, number of alliquots, how to send samples and dwell time?

Answer 5

• Alliquot volume: 1 cc/kg to max of 50 cc
• Max of 3 alliquots per location
• No dwell time
• I will probably do trap method most commonly, but if I do syringe method, then I would send first sample for culture and last sample for cell count

Question 6

what stain is used for lipid laden macrophages?

Answer 6

oil red O stain

Question 7

what stain is used for hemosiderin laden macrophages?

Answer 7

prussian blue stain

Question 8

Bronchoscopy in CF patient, what should be minimum number of lobes sampled?

Answer 8

• minimum of 2, as per ERS statement

Question 9

What lobes to sample on bronchoscopy?

Answer 9

• go for where the money is –>go for disease location
• if diffuse disease, then go for RML or lingula since they tend to have highest yield
• there tends to be lower yield from lower lobes since they are dependent (but aspiration is more likely in lower lobes, so may want to sample that anyways)

Question 10

Best bronchoscopic approach to visualize airway dynamics?

Answer 10

• Flexible is better than rigid for airway dynamics (even though we don’t use our flexible scopes for that purpose)
• Lower level of sedation (eg. conscious sedation_
• Method of entry: natural airway (transoral, trans-nasal) or facemask

Question 11

Usual % return after bronchoscopy?

Answer 11

40% to 60% of the instilled fluid will be recovered

Question 12

Maximum amount of lidocaine that can be used during bronchoscopy?

Answer 12

Maximum dose is 4 mg/kg

Lidocaine concentration
Lidocaine 2% = 20 mg/ml
Lidocaine 1% = 10 mg/ml