Cutting of the trachea. (See also tracheostomy.)
Reasons for operation The cause of laryngeal obstruction should be treated but, if obstruction is acute and endangering the patient’s life, urgent intervention is necessary. In most cases the insertion of an endotracheal tube either through the nose or mouth and down the pharynx through the larynx to bypass the obstruction is e?ective (see ENDOTRACHEAL INTUBATION). If not, tracheostomy is performed. The majority of tracheostomies performed nowadays are for patients in intensive-therapy-unit situations. These patients require airway intervention for prolonged periods to facilitate arti?cial ventilation which is performed by means of a mechanical ventilator. The presence of a tube passing through the larynx for a prolonged period of time is associated with long-term damage to the larynx, and therefore any patients requiring prolonged intubation usually undergo a tracheostomy to prevent further damage. Endotracheal intubation is also the preferred method of airway-intervention for acute in?ammatory disorders of the upper airway (as opposed to tracheostomy); tracheostomy in these cases is performed only in the emergency situation if facilities for endotracheal intubation are not available or if they are unsuccessful. Tracheostomy may also be performed for large tumours which obstruct the larynx until some form of treatment is instituted. Similarly it may be needed in conditions whereby the nerve supply to the larynx has been jeopardised, impairing its protective function of the upper airway and its respiratory function.
Tracheostomy tubes When the trachea has been opened – by an incision through the skin between the Adam’s apple and the clavicles; another through the THYROID GLAND followed by a small vertical incision in the trachea
– a metal or plastic tube is inserted to maintain the opening. There is always an outer tube which is ?xed in position by tapes passing round the neck, and an inner tube which slides freely out of and into the other, so that it may be removed at any time for cleansing, and is readily coughed-out should it happen to become blocked by mucus.
After-treatment When the operation has been performed for some permanent obstruction, the tube must be worn permanently; and the double metal tube is in such cases replaced after a short time by a soft plastic single one. When the operation has relieved some obstruction caused, say, by diphtheria, the tube is left out now and then for a few hours, and ?nally, at the end of a week or so, is removed altogether, after which the wound quickly heals up.... tracheostomy
Symptoms: low grade fever, malaise, sore throat, massive swelling of cervical lymph glands, thick white exudate from tonsils, false membrane forms from soft palate to larynx with brassy cough and difficult breathing leading to cyanosis and coma. Toxaemia, prostration, thin rapid pulse. Throat swabs taken for laboratory examination. See: NOTIFIABLE DISEASES.
Treatment. Bedrest. Encourage sweating.
Recommendations are for those parts of the world where medical help is not readily available and may save lives. Alternatives:–
1. Combine: Tincture Echinacea 3; Tincture Goldenseal 2; Tincture Myrrh 1. Dose: 30-60 drops in water, two-hourly.
2. Combine equal parts: Tincture Lobelia; Tincture Echinacea. Dose: 30-60 drops in water, two-hourly.
3. Combine Tincture Poke root 2; Tincture Echinacea 3. Dose: 30-60 drops in water, two hourly.
4. G.L.B. Rounseville, MD, Ill., USA. I have treated diphtheria since 1883. I have treated diphtheria until I am sure the number of cases treated run into four digits. I have never given a hypodermic of antitoxin on my own initiative, nor have I ever lost a case early enough to inhibit conditions. I have depended upon Echinacea not only prophylactic but also as an antiseptic . . . In the line of medication the remedies are: Aconite, Belladonna, Poke root and Cactus grand, according to indications. But remember, if you are to have success, Echinacea must be given internally, externally and eternally! Do not fear any case of diphtheria with properly selected remedies as the symptoms occur. Echinacea will also be your stimulant, diaphoretic, diuretic, sialogogue, cathartic and antipyretic. (Ellingwood’s Physiomedicalist, Vol 13, No 6, June, 1919, 202)
5. Alexander M. Stern MD, Palatka, Florida, USA. Combine: tinctures Echinacea 1oz, Belladonna 10 drops, Aconite 10 drops. Water to 4oz. 1 teaspoon 2-hourly.
6. F.H. Williams, MD, Bristol, Conn., USA. I took a case which had been given up to die with tracheal diphtheritic croup. I gave him old-fashioned Lobelia (2) seed and Capsicum (1) internally and externally and secured expulsion of a perfect cast of the trachea without a tracheotomy.
7. Gargle, and frequent drink. To loosen false membrane. Raw lemon juice 1, water 2. Pineapple juice. Teas: Red Sage, fresh Poke root. Cold packs – saturated with Echinacea (Tincture, Liquid Extract or decoction) to throat.
Note: Capsicum and Lobelia open up the surface blood flow of the body thus releasing congestion on the inner mucous membranes.
Diet. Complete lemon-juice and herb tea fast with no solid foods as long as crisis lasts.
To be treated by a general medical practitioner or hospital specialist. ... diphtheria
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