Malignant disease of the esophagus is rarely seen early, bec...
Amaurosis Paralysis Of The Optic Nerve
Use B D current, moderate force, three or four times, and the...
Of Punctures Etc
In cases of recent punctured wounds the orifice and surroundi...
Structure and Action of the Heart. Now what is it that keeps ...
It is well to remember that over-feeding is a relative term. T...
Temperature Of The Water Double Sheet Changing Sheet
The water for the wet-sheet pack, in this violent form, ought...
The Child As An Ideal
WHILE the path of progress in the gaining of repose c...
How And Why We Breathe
Life is Shown by Breathing. If you wanted to find out whether...
See Pain. ...
See Rash. ...
Hope And Healing
The mind has always an influence on the body. Life rises and f...
Bronchoscopy In Diseases Of The Trachea And Bronchi
The indications for bronchoscopy in disease are becoming inc...
Tests Of Heart Strength
If both systolic and diastolic blood pressure are taken, and ...
Is simply an inflammation due to impurity of the blood. These ...
Soaping The Head
See Head, Soaping. ...
The Surgical Dissection Of The First Second Third And Fourth Layers Of The Inguinal Region In Connexion With Those Of The Thigh
The common integument or first layer of the inguino-femoral r...
The spinal cord is continuous with the back part of the brain....
The Digestive System
How the Food Reaches the Stomach. Our body, then, has an open...
Physical Signs Of Bronchial Foreign Body
In most cases there will be limitation of expansion on the in...
With the forceps illustrated in Fig. 28 specimens of tissue ...
Resume Of Tracheotomy
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
Tracheotomic cannulae (proper kind)
Half area cross-section trachea.
Proper curve: Radius too short will press ant. tracheal wall; too
long, post. wall.
Tapes for cannulae
Infiltration syringe and solution
Indications: Laryngeal dyspnea.
(Indrawing guttural and clavicular fossae and at epigastrium.
Pallor. Restlessness. Drowning in his own secretions.)
Do it early. Don't wait for cyanosis.
 Never use general anesthesia on dyspneic patient.
Forget about high and low distinctions until trachea is exposed.
Memorize Jackson's tracheotomic triangle.
Patient recumbent, sand bag under shoulders or neck. Nose to zenith.
Incise from Adam's apple to guttural fossa.
Keep in middle line.
Feel for trachea.
Expose isthmus of thyroid gland.
Draw it upward or downward or cut it.
Ligature, torsion, etc. before incising trachea.
Hold trachea with tenaculum.
Incise trachea below first ring.
Avoid cutting cricoid or first ring. Cut 3 rings vertically. Don't
hack. Don't cut posterior wall which almost touches the anterior wall
during cough. Spread carefully, with Trousseau dilator.
Insert cannula; see it enter tracheal lumen; remove pilot; tie
Don't suture wound. Dress with large squares.
Don't give morphine.
Decannulation by corking partially, after changing to smaller
Do not remove cannula permanently until patient sleeps without
indrawing with corked cannula.
Next: Resume Of Emergency Tracheotomy