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Show 10 or BODlES LODGING 1N run LARYNX. to the The substitution of this simple introduction of a tube y happ this have formidable operation of bronchotomy, would unwrlllngw consequence, that it would be resorted to with less t. patien the save to ness', and frequently early enough, has falL which When the operation is to be done for a body s en into the larynx or trachea, there may be some circumstan ces peculiar in the treatment. 91' BODIES LODGING IN THE LARYNXu {4350i Imam ‘ . r-Wr"! n}- -'.._z.sr'u.- f... 1., Wins}: a body is drawn into and lodges in the larynx, it may be known from the convulsive cough, wheezing and rats tling in the throat, the weakness and hoarseness of the voice. Sometimes when there is a dreadful difliculty of breathing, the symptoms will suddenly remit, and the person become . easy. After several changes from tranquility, to laborious respiration, and from difficult to easy breathing, the patient may be at the end of some days, suifocated suddenly. It happens thus I believe, the body is loose, and is sometimes lodged in the trachea, sometimes near the glottis. When in the trachea, (the sensibility of which is much less than that of the upper part of the larynx), the patient breathes easily, but when the body is moved towards the more sensible glottis, then comes the spasm of the muscles of the glottis, and great difficulty of breathing. Mean time with each successive attack, the parts are inflaming and becoming more irritable, and the violence and difficulty of breathing, is producing a degree of etl‘usion in the lungs which increases the evil. One more severe paroxysm succeeds and the patient is suffocated. It would be easy to furnish many striking cases of children thus suffocated. 1. We have to ascertain the nature of the accident. See that the cause of suffocation, be not in the upper part of the pharynx, and ascertain the nature, and size of the foreign body. 2. Observe, whether posture by throwing down the body into the wind-pipe, does not relieve, and if the sense of suffocation, has been preceded by posture or circumstances, 0F BODIES LODGING IN THE LARYNX. 11 which would favour the shifting of the body, into the rima glottidis. 3. We have to observe, if the breathing become more difficult even in the interval of the spasmodic attack. 4!. If from the greater violence of the paroxysm, the mem- brane of the larynx be inflaming and swelling, then the danger is imminent, and the Operation seems to be the only reme« .dy. 5. If there be any pulfness, or emphysematous tumour of the neck, during the previous stage of suffering, before the operation is determined on, there may have occurred a burst ing of the trachea. 'We bleed frequently, and give an opiate in a mucilaginous mixture, which is to be taken by frequent sipping, rather than as a draught. For this will often give relief of the teazv ing, tickling sensation that precedes the paroxysm. It has been recommended that we should excite vomiting, or sneeze ing, which by the suddenness of the action of the respiratory muscles, may throw out the body from the larynx. ‘ But should the body be removed more directly into the current of air, by this means and yet not altogether discharged, the consequence would be sudden suffocation. There are two operations proposed, the one may be thus conducted. 1. To lay bare that part of the trachea, which is inferior to the isthmus of the thyroid gland. 2. Let the bleeding be entirely stopt. 3. Slit across three of the rings of the trachea, that it may be held open by introducing a small spatula, which will allow the patient to breathe freely, and having established free respiration, will then enable you to introduce a probe, or bougie, upwards through the larynx. So that the foreign body may be pushed forth. But if the body should be fixed as I have seen it, after death, it will be no easy matter to dislodge it, in short we may not find it, and we may not be able to extract it! which makes the operation precarious and dangerous. Before thinking of such an operation, the surgeon will of course provide the complete apparatus for the operation of bronchotomy, lest he should be obliged to introduce the tube, without extract» |