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Medical ArticlesFrom The Hygienic DictionaryDoctors. [1] In the matter of disease and healing, the peopl... Wounds And Bruises On this subject, I must necessarily be very brief. When a wou... Van Helmont JOHANN BAPTIST VAN HELMONT, a celebrated Belgian physician, s... Tea Tea should not be infused longer than three or four minutes, an... Diseases And Disturbances Of The Skin Their Chief Causes. Skin troubles are of two main kinds accor... The Inward And The Outward Current I have already said that when the conducting-cords are of equ... Eyes Spots On These spots are of two different kinds, and yet they are very ... Putrid Symptoms Next to those most dangerous forms--most dangerous, because t... Skin Care Of Among the vast majority of people air and water far too seldom... Prussic Acid Almost hopeless. Emetic; artificial respiration. ... Tapeworm The only sure sign of the presence of this parasite in the int... Head Massaging The This is so important in many cases of neuralgia, headache, and... Expectoration What is commonly called a "cough and spit" is sometimes due to... Water-treatment As Used By Currie Reuss Hesse Schoenlein &c Beside the above modes of treatment _cold_ and _tepid Water_ ... The Rational Care Of Self A WOMAN who had had some weeks of especially difficul... Dysmenorrhoea - Painful Menstruation For this disorder, I know of no one remedy so valuable as the... Nervous Strain In The Emotions THE most intense suffering which follows a misuse of ... Tolerance WHEN we are tolerant as a matter of course, the nervous syste... Stage 2 Passing the cricopharyngeus is the most difficult part of es... Fever In all fevers, to cool down the excessive heat of the patient ... |
Emergency TracheotomyCategory: TRACHEOTOMY Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery Stabbing of the cricothyroid membrane, or an attempted stabbing of the trachea, so long taught as an emergency tracheotomy, is a mistake. The author's two stage, finger guided method is safer, quicker, more efficient, and not likely to be followed by stenosis. To execute this promptly, the operator is required to forget his textbook anatomy and memorize the schema (Fig. 105). The larynx and trachea are steadied by the thumb and middle finger of the left hand, which at the same time push back the important nerves and vessels which parallel the trachea, and render the central safety line more prominent (Fig. 106). A long incision is now made from the thyroid notch almost to the suprasternal notch, and deep enough to reach the trachea. This completes the first stage. [FIG. 107.--Illustrating the author's method of quick tracheotomy. Second stage. The fingers are drawn ungloved for the sake of clearness. In operating the whole wound is full of blood, and the rings of the trachea are felt with the left index which is then moved slightly to the patient's left, while the knife is slid down along the left index to exactly the middle line when the trachea is incised.] Second stage. The entire wound is full of blood and the trachea cannot be seen, but its corrugations can be very readily felt by the tip of the free left index finger. The left index finger is now moved a little to the patient's left in order that the knife shall come precisely in the midline of the trachea, and three rings of the trachea are divided from above downward (Fig. 107). The Trousseau dilator should now be inserted, the head of the table should be lowered, and the patient should be turned on the side to allow the blood to run away from the wound. If respiration has ceased, a cannula is slipped in, and artificial respiration is begun. Oxygen insufflation will aid in the restoration of respiration, and a pearl of amyl nitrite should be crushed in gauze and blown in with the oxygen. In all such cases, excessive pressure of oxygen should be avoided because of the danger of producing ischemia of the lungs. Hope of restoring respiration should not be abandoned for half an hour at least. One of the author's assistants, Dr. Phillip Stout, saved a patient's life by keeping up artificial respiration for twenty minutes before the patient could do his own breathing. The after-care of the tracheotomic wound is of the utmost importance. A special day and night nurse are required. The inner tube of the cannula must be removed and cleaned as soon as it contains secretion. Secretion coughed out must be wiped away quickly, but gently, before it is again aspirated. The gauze dressing covering the wound must be changed as soon as soiled with secretions from the wound and the air-passages. Each fresh pad should be moistened with very weak bichloride of mercury solution (1:10,000). The outer tube must be changed every twenty-four hours, and oftener if the bronchial secretion is abundant. Student-physicians who have been taught my methods and who have seen the cases in care of our nurses have often expressed amazement at the neglect unknowingly inflicted on such cases elsewhere, in the course of ordinary routine surgery. It is not unusual for a patient to be sent to the Bronchoscopic Clinic who has worn his cannula without a single changing for one or two years. In some cases the tube had broken and a portion had been aspirated into the trachea. [FIG. 108.--Method of dressing a tracheotomic wound. A broad quadruple, in-folded pad of gauze is cut to its centre so that it can be slipped astride of the tube of the cannula back of the shield. No strings, ravellings or strips of gauze are permissible because of the risk of their getting down into the trachea.] If the respiratory rate increases, instead of attributing it to pulmonary complications, the entire cannula should be removed, the wound dilated with the Trousseau forceps, the interior of the trachea inspected, and all secretions cleaned away. Then the tracheal mucosa below the wound should be gently touched with a sterile bent probe, to induce cough to rid the lower air passages of accumulated secretions. In many cases it is a life-saving procedure to insert a sterile long malleable aspirating tube to remove secretions from the lower air-passages. When all is clear, a fresh sterile cannula which has been carefully inspected to see that its lumen has been thoroughly cleaned, is inserted, and its tapes tied. Good plumbing, that is, the maintenance at all times of a clear, clean passage in all the pipes, natural and artificial, is the reason why the mortality in the Bronchoscopic Clinic has been less than half of one per cent, while in ordinary routine surgical care in all hospitals collectively it ranges from 10 to 20 per cent. Next: Bronchial Aspiration Previous: Technic
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