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The Black Hole of Calcutta is an object lesson of how necessary...
Dysphagia is the most frequent complaint in cases of esophag...
Very great good can often be done by a little careful syringin...
The spatular end of the laryngoscope is introduced in the ri...
Skin Care Of
Among the vast majority of people air and water far too seldom...
When a limb becomes swelled and white, pouring hot water very ...
The Woman At The Next Desk
IT may be the woman sewing in the next chair; it may ...
Demonstrations Of The Origin And Progress Of Femoral Hernia Its Diagnosis The Taxis And The Operation
PLATE 45, Fig. 1.--The point, 3, from which an external ingui...
Breath And The Heart
Stout people are usually more or less "scant of breath." Accum...
Direct Laryngoscopy Adult Patient
Before starting, every detail in regard to instrumental equi...
Aortic narrowing or stenosis is a frequent occurrence in the ...
Purple Spots On Skin
These arise first as small swellings. The swellings fall, and ...
The Relation Of The Principal Bloodvessels Of The Thorax And Abdomen To The Osseous Skeleton Etc
The arterial system of vessels assumes, in all cases, somewha...
The Triviality Of Trivialities
LIFE is clearer, happier, and easier for us as things assume ...
The Healing Influence Of Music Continued
Dr. Herbert Lilly, in a monograph on musical therapeutics, ...
The Stiffening Rods Of The Body-machine
What Bones Are. The bones are not the solid foundation and fr...
In many cases of severe illness, the stomach rejects all food,...
Aphonia Loss Of Voice
This affection requires treatment variously, as it depends on...
The Surgical Dissection Of The Wrist And Hand
A member of such vast importance as the human hand necessaril...
Mechanical Effect Of Each Pole
The mechanical effect of the forward end of the current, or t...
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
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
Next: Resume Of Tracheotomy
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