To begin, enter the airways through the mouth or nostrils, then pass the vocal cords and enter the trachea. Locate the four landmarks systematically from landmarks one to four, and note the correct angle of the endoscope in each position. Next, according to the four landmarks, find the segments chronologically from one to 10 from the right side first, and then from the left side.
At landmark one, locate the bronchoscope in the distal part of the trachea at a zero degree angle, maintaining a neutral position. Then at landmark two, turn the endoscope 90 degrees to the right while simultaneously flexing the distal end of the bronchoscope upward by pushing the left thumb down to investigate the upper lobe. While visualizing the Mercedes star, defer from the 90 degree angle to inspect segments one, two, and three.
Next at landmark three, move on to the bronchus intermedius by placing the distal end of the endoscope at a 45 degree angle to the right to view segments four and five. Temporarily defer from the 45 degree angle to examine segments four and five. Then return to the 45 degree angle and extend the tip of the endoscope by pushing the stewing lever up with the left thumb to inspect segment six.
Turn the scope to a zero degree angle and proceed to the lower lobe to locate segments seven, eight, nine, and 10. Then defer from the zero degree angle to inspect segments seven to 10. At landmark four, move the bronchoscope to the left main bronchus at a 90 degree angle upward to view the upper lobe and downward to view the lower lobe.
Retain the scope at a 90 degree angle and inspect the left upper lobe with the lingular. Then defer from the 90 degree angle to examine segments one plus two and three from the left upper lobe, and segments four and five from the lingular. Then return to the left main bronchus.
Turn the scope to a 45 degree angle and extend the end of the bronchoscope to inspect segment six, which is opposite segments four and five. Finally turn the scope to a zero degree angle to visualize the lower lobe. Then defer from the zero degree angle to inspect segments eight, nine, and 10.
The most important factors for the completion of a simulation-based course in flexible bronchoscopy are shown here. The total of responses is greater than 100%as some participants mentioned more than one factor. Of those who completed the course, 57%found it clinically relevant and 47%found the course valuable.
