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Full text of "Diseases Of The Nose Throat And Ear"

TRACHEO'STOMY
TECHNIQUE OF LARYNGOTOMY

169

Our views on emergency tracheostomy have been expressed previously. If an
inexperienced doctor is called to this situation he should do a laryngotomy to
obtain an airway which will save life until an anaesthetist can come and
intubate the patient, or a more experienced surgeon can come and do a
tracheostomy. The first step in a laryngotomy is to palpate the cricoid and then

Laryngotomy

•Tracheostomy

Fig. 76. Incision for elective tracheostomy and laryngotomy.

the lower border of the thyroid cartilage. In the notch between the two is the
cricothyroid membrane and with the head extended this lies just underneath
the skin. The space is stabbed horizontally with the blade of a knife of at least
No. 10 size and the incision is lengthened. The blade is then withdrawn and the
handle of the knife inserted and turned at rigftt angles to open an airway.
Special 'all in one* instruments exist to do this procedure, but it is normally
such an emergency that a knife is usually the most readily available instrument.

POSTOPERATIVE CARE

1. Nursing. A nurse who understands the care of tracheostomy patients should
be in attendance for the first 48 hours and should carry out the care with