InformationalPrivacy
| There is at present living in the neighbourhood of --- an old lady, about seventy years of age. Her maiden name is ---, {140} and she is a native of Braemar, but left that district when about twenty years old, and has never been back to it eve... Read more of Concerning The Murder Of Sergeant Davies at Scary Stories.ca | Informational Privacy |
 |
Home |
Medical Articles |
Mother's Remedies |
Household Tips |
Medicine History |
Forgotten Remedies |
Search |
Medical ArticlesSite Of LodgmentThe majority of foreign bodies in the air passages occur in ... Leucorrhoea And Prolapsus Uteri - Whites Female Weakness The disease depends in all cases upon _inflammation_ of the u... Water-treatment As Used By Currie Reuss Hesse Schoenlein &c Beside the above modes of treatment _cold_ and _tepid Water_ ... A Summing Up GIVE up resentment, give up unhealthy resistance. ... Baths During rheumatism the peripheral blood vessels are generally ... Punctures Case I A.B. received a severe punctured wound by a hook of the size ... Stage 4 Passing Through The Hiatus Esophageus When the head is dropped, it must at the same time be moved ... Ankle Twisted Or Crushed Place the foot as soon as possible in warm water, as hot as ca... Flushings Hot These are often a really serious trouble, especially to women,... Lues Of The Tracheobronchial Tree Compared to laryngeal involvement, syphilis of the tracheobr... Tolerance WHEN we are tolerant as a matter of course, the nervous syste... Paroxysmal Tachycardia This condition is generally termed by the patient a "palpitat... Ulcers An ulcer is an "eating sore": that is, a sore containing matte... Nursing Sore Mouth Sore mouth of nursing women, as the name of the disease indic... Opium As so many times repeated, real pain must be stopped, and mor... Barley If this grain is well grown and thoroughly well cooked, it wil... The Surgical Form Of The Superficial Cervical And Facial Regions And The Relative Position Of The Principal Blood-vessels And Nerves When the neck is extended in surgical position, as seen in Pl... Treatment Of Compression Stenoses Of The Trachea If the thymus be at fault, rapid amelioration of symptoms fo... Urinary Troubles A healthy man usually evacuates about 30-40 ozs. of urine dail... Diagnosis After what has been said about the symptoms of scarlatina, it... |
Second StageCategory: DIRECT LARYNGOSCOPY Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery The spatular end of the laryngoscope should now be tipped back toward the posterior wall of the pharynx, passed posterior to the epiglottis, and advanced about 1 cm. The larynx is now exposed by a motion that is best described as a suspension of the head and all the structures attached to the hyoid bone on the tip of the spatular end of the laryngoscope (Fig. 55). Particular care must be taken at this stage not to pry on the upper teeth; but rather to impart a lifting motion with the tip of the speculum without depressing the proximal tubular orifice. It is to be emphasized that while some pressure is necessary in the lifting motion, great force should never be used; the art is a gentle one. The first view is apt to find the larynx in state of spasm, and affords an excellent demonstration of the fact that the larynx can he completely closed without the aid of the epiglottis. Usually little more is seen than the two rounded arytenoid masses, and, anterior to them, the ventricular bands in more or less close apposition hiding the cords (Fig. 56). With deep general anesthesia or thorough local anesthesia the spasm may not be present. By asking the patient to take a deep breath and maintain steady breathing, or perhaps by requesting a phonatory effort, the larynx will open widely and the cords be revealed. If the anterior commissure of the larynx is not readily seen, the lifting motion and elevation of the head should be increased, and if there is still difficulty in exposing the anterior commissure the assistant holding the head should with the index finger externally on the neck depress the thyroid cartilage. If by this technic the larynx fails to be revealed the endoscopist should ask himself which of the following rules he has violated. [FIG. 55.--Schema illustrating the technic of direct laryngoscopy on the recumbent patient. The motion is imparted to the tip of the laryngoscope as if to lift the patient by his hyoid hone. The portion of the table indicated by the dotted line may be dropped or not, but the back of the head must never go lower than here shown, for direct laryngoscopy; and it is better to have it at least 10 cm. above the level of the table. The table may be used as a rest for the operator's left elbow to take the weight of the head. (Note that in bronchoscopy and esophagoscopy the head section of the table must be dropped, so as to leave the head and neck of the patient out in the air, supported by the second assistant.)] [FIG. 56.--Endoscopic view at the end of the second stage of direct laryngoscopy. Recumbent patient. Larynx exposed waiting for larynx to relax its spasmodic contraction.] Next: Rules For Direct Laryngoscopy Previous: First Stage
Viewed 1038 |
||||||||||||||||||||
