Bonus Material-24_CHEST Pulmonary Board Review-Combined Talk-Wahidi-2025

Pdf Summary

This comprehensive review by Dr. Momen M. Wahidi covers diagnostic bronchoscopy focusing on pre-procedure evaluation, procedural considerations, complications, and management of large airway disorders.<br /><br />Pre-procedure assessment involves careful patient evaluation including airway difficulty, co-morbidities, and medication review, often guided by ASA classification and Mallampati score to anticipate risks. Special populations such as COPD, asthma, and morbid obesity require tailored approaches including nebulized bronchodilators for asthma and anesthesia support for obese patients. Topical anesthesia with lidocaine is preferred due to its efficacy and safety, with dosing carefully monitored to avoid toxicity. Anticholinergics have no proven benefit in secretion control. Antiplatelet management recommends stopping clopidogrel 5-7 days prior, while aspirin need not be stopped.<br /><br />Bronchoscopy is overall very safe, with low mortality (0.01-0.04%) and complications, though risks rise with transbronchial biopsies. Bleeding prevention emphasizes targeted coagulation testing in high-risk patients. Bleeding management includes airway stabilization, bronchoscopic isolation, and interventions like iced saline or epinephrine, with advanced measures such as bronchial blockers or lung intubation if needed.<br /><br />Large airway disorders reviewed include tracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC), which share similar symptoms but differ morphologically. Diagnosis requires dynamic inspiratory-expiratory CT and flexible bronchoscopy assessing airway collapse during forced exhalation. Treatment begins conservatively with managing coexisting conditions, airway clearance, and CPAP. Surgical options like tracheobronchoplasty are reserved for selected cases due to morbidity.<br /><br />Central airway obstruction from benign or malignant causes requires bronchoscopic evaluation to define stenosis extent for treatment planning. Surgical resection offers best outcomes but may be contraindicated by lesion location or length; bronchoscopic debulking, dilation, laser, and stenting are alternatives, with recurrence common.<br /><br />Foreign body aspiration, common in children and some adults, demands high suspicion due to varied symptoms. Imaging (CXR, CT) assists diagnosis, but bronchoscopy—flexible or rigid—is the mainstay of removal. Rigid bronchoscopy offers better access for large objects or difficult cases.<br /><br />Key clinical points highlight the importance of detailed pre-assessment, tailored sedation and topical anesthesia, coordinated management of bleeding risks, awareness of subtle airway disorders, and multidisciplinary approaches in managing complex airway pathologies.

Meta Tag

Concept Bronchoscopy

Concept Preprocedural Evaluation

Concept Airway Difficulty

Concept Lidocaine

Concept Airway Obstruction

Keywords

diagnostic bronchoscopy

pre-procedure assessment

lidocaine topical anesthesia

bronchoscopy complications

bleeding management

tracheobronchomalacia

excessive dynamic airway collapse

central airway obstruction

foreign body aspiration

airway disorders

Bronchoscopy

Preprocedural Evaluation

Airway Difficulty

Lidocaine

Airway Obstruction