Landmarks, medical and surgical / by Luther Holden.

  • Luther Holden
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Landmarks, medical and surgical / by Luther Holden. Source: Wellcome Collection.

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    the omo-hyoid crosses the common carotid. Just above this spot is the most convenient place for tying the artery. Those who have not directed their attention to the subject are hardly aware what a little distance there is between the cricoid cartilage and the upper part of the sternum. In a person of the average height sitting with the neck in an easy position, the distance is barely one inch and a half. When the neck is well stretched, about three-quarters of an inch more is gained. Thus, we have (generally) not more than seven or eight rings of the trachea above the sternum. None of these rings can be felt externally. The second, third, and fourth are covered by the isthmus of the thyroid gland. The trachea, it should be remembered, recedes from the surface more and more as it descends, so that, just above the sternum in a short fat-necked adult, the front of the trachea would be quite one inch and a half from the skin. 39. Trachea.—In the dead subject nothing is more easy than to open the trachea : in the living, this operation may be attended with the greatest difficulties. In urgent dyspnoea you must expect to find the patient with his head bent for- ward, and the chin dropped, so as to relax as much as possible the parts. The head should not be too forcibly drawn back, lest a paroxysm of dyspnoea threaten instant suffocation. The elevator and depressor muscles draw the trachea and larynx up and down with a rapidity and a force which may bring the cricoid cartilage within half an inch of the sternum. The great thyroid veins which descend in front of the trachea are sure to be distended. There may be a middle thyroid artery. In children the lobes of the thymus may extend up in front of the trachea, and the left vena innominata may cross it unusually high. Thus the air-tube may be covered by important parts which ought not to be cut. Considering all these possible complications, the least difficult and the best mode of proceeding is to open the trachea just below the cricoid cartilage ; and if more room be requisite, to pull down the isthmus of the thyroid gland, or in children to divide the cricoid itself. It is important that all the incisions be made strictly in the middle line, the ' line of safety.'