Informational Site NetworkInformational Site Network
Privacy
 


Home


Medical Articles


Mother's Remedies


Household Tips


Medicine History


Forgotten Remedies


Search

Medical Articles

Chronic Esophagitis

This is usually a result of stagnation of food or secretion, ...

Headache

This symptom or affection, (if it can be classed as a disease...

Bruises Case Xvi

J. Jennings, bricklayer, aged 26, fell through the roof of a ...

Preparation Of Medicine

As it often becomes necessary for the practitioner to make mo...

Symptomatology And Treatment Of Chronic Valvular Lesions

Before discussing the treatment of broken compensation in gen...

Varieties Of Forms Of Scarlatina

The above is the description of scarlet-fever, as it most fre...

Tests

ADOPTING the phrase of our forefathers, with all its ...

Positive And Negative Manifestations

Acute diseases are to be regarded as electrically positive, a...

A Collection Of Gallbladders

Gallbladder cases are rather ho-hum to me; they are quick to ...

Pimples On The Face

See Face. ...

Interpretation Of Tracings

The interpretation of the arterial tracing shows that the nea...

Symptoms

Malignant disease of the esophagus is rarely seen early, bec...

Erysipelas

Take the A. D. current, medium force, in all forms of the dis...

Instructions To The Patient

Before beginning endoscopy the patient should be told that h...

Opium

See Narcotics. ...

Cardiovascular Renal Disease

With the strennousness of this era, this disease or conditi...

Erysipelas

This is a disease of the skin, producing redness, burning and...

Colic

The symptoms of this are cramping pains in the abdomen, witho...

Skin Creeping

A sensation sometimes very much annoys patients, which they de...

Ankle Swelling

When long continued in connection with disease or accident, th...



Decannulation





Category: TRACHEOTOMY
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery

When the tracheal incision is placed below the first
ring, no difficulty in decannulation should result from the operation
per se. When by temporarily occluding the cannula with the finger it
is evident that the laryngeal aperture has regained sufficient size to
allow free breathing, a smaller-sized tracheotomic tube should be
substituted to allow free passage of air around the cannula in the
trachea. In doing this, the amount of secretion and the handicap of
impaired glottic mobility in the expulsion of thick secretions must be
borne in mind. Babies labor under a special handicap in their
inefficient bechic expulsion and especially in their small cannulae
which are so readily occluded. If breathing is not free and quiet with
the smaller tube; the larger one must be replaced. If, however, there
is no trouble with secretions, and the breathing is free and quiet,
the inner cannula should be removed, and the external orifice of the
outer cannula firmly closed with a rubber cork. If the laryngeal
condition has been acute, decannulation can usually be safely done
after the patient has been able to sleep quietly for three nights with
a corked cannula. If free breathing cannot be obtained when the
cannula is corked, the larynx is stenosed, and special work will be
required to remove the tube. Children sometimes become panic stricken
when the cannula is completely corked at once and they are forced to
breathe through the larynx instead of the easier shortcut through the
neck. In such a case, the first step is partially to cork the cannula
with a half or two-thirds plug made from a pure rubber cord fashioned
in the desired shape by grinding with an emery wheel (Fig. 112). Thus
the patient is gradually taught to use the natural air-way, still
feeling that he has an anchor to windward in the opening in the
cannula. When some swelling of the laryngeal structures still exists,
this gradual corking has a therapeutic effect in lessening the
stenosis by exercising the muscles of abduction of the cords and
mobilizing the cricoarytenoid articulation during the inspiratory
effort. The forced respiration keeps the larynx freed from secretions,
which are more or less purulent and hence irritating. After removing
the cannula, in order that healing may proceed from the bottom upward,
the wound should be dressed in the following manner: A single
thickness of gauze should be placed over the wound and the front of
the neck, and a gauze wedge firmly inserted over this to the depths of
the tracheotomic wound, all of this dressing being held in place by a
bandage. If the skin-wound heals before the fibrous union of the
tracheal cartilages is complete, exuberant granulations are apt to
form and occlude the trachea, perhaps necessitating a new tracheotomy
for dyspnea.

It is so important to fix indelibly in the mind the cardinal points
concerning tracheotomy that I have appended to this chapter the
teaching notes that I have been for years giving my classes of
students and practitioners, hundreds of whom have thanked me for
giving them the clear-cut conception of tracheotomy that enabled them,
when their turn came to do an emergency tracheotomy, to save human
life.





Next: Resume Of Tracheotomy

Previous: Bronchial Aspiration



Add to del.icio.us Add to Reddit Add to Digg Add to Del.icio.us Add to Google Add to Twitter Add to Stumble Upon
Add to Informational Site Network
Report
Privacy
SHAREADD TO EBOOK


Viewed 994