An American text-book of the diseases of children. Including special chapters on essential surgical subjects; orthopaedics, diseases of the eye, ear, nose, and throat; diseases of the skin; and on the (14756317796)

Position for tracheotomy
Identifier: americantextbook1900star (find matches)
Title: An American text-book of the diseases of children. Including special chapters on essential surgical subjects; orthopaedics, diseases of the eye, ear, nose, and throat; diseases of the skin; and on the diet, hygiene, and general management of children
Year: 1900 (1900s)
Authors: Starr, Louis, 1849-1925 Westcott, Thompson S. (Thompson Seiser), 1862-1933
Subjects: Children Pediatrics Disease
Publisher: Philadelphia, W.B. Saunders
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons



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era-tion is generally selected in children, because at this point the trachea is mostsuperficial, and for this reason is more readily exposed and opened. In the highoperation the cricoid cartilage is frequently divided Avith the upper rings of thetrachea. The low operation cannot be executed so rapidly, and is certainlymuch more difficult in its performance, because of the relatively greater depthof the trachea, the large size and number of veins exposed, and the proximityto the large arterial trunks. In young childi-en the extreme shortness ofthe neck sometimes prevents the satisfactory adjustment of the tracheotomy-tube when the low operation is performed. I call to mind the case of a youngchild in Avhom I did a low operation, where the lower extremity of the tubecame in contact Avith the bifurcation of the trachea, and it was only afterI had the tube shortened that the child could wear it with comfort. Manyoperators prefer the low operation: Cohen expresses himself decidedly in its
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hd TBA CHEO TOMY. 877 favor in case tlie tube is to be worn for a long time or where the operationis done for a foreign body impacted in the bronchus. I am myself decidedlyin favor of the high operation in cases of diphtheritic or membranous laryngitiswhen the tube is to be worn only for a short time, and I would thereforerecommend those who have had little experience with the procedure to employthe high operation, on account of the greater ease and safety of its perform-ance, save in the exceptional conditions referred to by Cohen. Position of the Patient for Tracheotomy.—In the operation of trache-otomy it is a matter of the first importance that the patient be placed in sucha position that the neck shall be brought into the greatest prominence, torender the trachea more superficial and give the greatest amount of spacebetween the sternum and the chin; and it is surprising with how much moreease the operation will be accomplished if the patient be placed in this posi-tion. The mos