A text-book of diseases of the nose and throat / by D. Braden Kyle.

  • Kyle, D. Braden (David Braden), 1863-1916
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of diseases of the nose and throat / by D. Braden Kyle. Source: Wellcome Collection.

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    tube liaving reached the tip ni' the left forefinger, it is gently guided inter the larvnx, the obturator withdrawn, the tube eare- fullv pushed to its place, the silk loop secured, and the gag removed. This method the author finds in his experience to be easier in actual performance than when introduction is attempted in the upright position. The hard table gives a steady resistance of more utility in restraining the violent struggles of a patient than does the mere clasp of an assistant's arms. The light in the operating field is better and the danger of the tube slipping beyond control into the trachea or esophagus is averted. Further, if intu- bation should be found not practicable, or if any sudden impera- tive necessity arise, the position of the patient is at once available for tracheotomy. When the tube is in place, unless very marked, or at least sufficient, relief for the safety of the patient does not take place, thorough investigation must be made to discover the cause. Complications, Dangers, and Accidents.—Like all other operations upon the respiratory tract, the actual performance is more difficult than a written description would indicate. Strug- gling and gagging are more or less ^•iolent, and in spite of the vise- likc*grasp of the assistants, some sudden movement is almost sure to disarrange the relations of the instruments. Sudden slipping of the gag may occur during some such movement and result in a Avound'of the operator's hand, even if protected against it, which may lead to disastrous results. The operator runs the risk of per- sonal infection in eye, nose, or mouth from bits of material expec- torated during violent coughing. The tube may be found a mis- fit and require a repetition of the process. Or the tube may be dropped in the esophagus, or possibly even passed through the vocal bands into the trachea—complications which the prone posi- tion averts. Glottic spasm may occur sufficiently severe to pre- vent entrance of the tube, and. even so protracted and severe as to demand tracheotomy. Finally, the tube may push ahead of it a mass of membrane and occlude the trachea beyond any hope of relief except through tracheotomy, or it may become packed with shredded membrane and necessitate removal and cleansing. Postoperative Care.—A case of intubation, froni the inser- tion of the tube to its removal, requires careful watching. Sud- den blocking, particularly in membranous cases, may occur and demand immediate removal and cleansing. The nurse in charge nnist therefore be carcfidly instructed as to the danger symptoms to be observed which demand the abstraction of the tyibe, and shown how to withdraw it by means of the silk loop left ini^Hu. Should any hesitancy Ini noted in the tube leaving its position, inversion of the i)atient nuist b(; ])erforjned, and the chest and back smartly jarred to dislodge it. The tube may be ejected dur- ing some pantxysm of coughing, in which case, not inlrequently, it