. The practice of pediatrics. Fig. 92.—ODwyer intubation set. dents and to many physicians. It has been variously answered, andmany attempts have been made to formulate a series of clinical manifes-tations the presence of which would render the operation , it has been said to be indicated when there is a pronounced reces- DIPHTHERIA 621 sion of the suprasternal and infrasternal regions, and when, as a resultof stenosis, air enters the bases of the lungs but feebly or not at all. Itmay safely be said that intubation is never done too early, but it is veryapt to be done too late—no
. The practice of pediatrics. Fig. 92.—ODwyer intubation set. dents and to many physicians. It has been variously answered, andmany attempts have been made to formulate a series of clinical manifes-tations the presence of which would render the operation , it has been said to be indicated when there is a pronounced reces- DIPHTHERIA 621 sion of the suprasternal and infrasternal regions, and when, as a resultof stenosis, air enters the bases of the lungs but feebly or not at all. Itmay safely be said that intubation is never done too early, but it is veryapt to be done too late—not too late in a great majority of instances tobe of some service to the patient, but too late to be of the greatest pos-sible service. My rule regarding intubation in laryngeal diphtheriais to intubate when I see that the child is wasting vitality in his efforts tocarry on respiration. Intubation should not be postponed until hebecomes exhausted in the struggle for air. Diphtheria is a disease in. Position for intubation. which every possible strength-unit must be preserved. Energy wastedin supplying air is an unnecessary waste, since ODwyer has shown ushow to introduce a tube into the larynx. Operation.—For the operation of intubation, the patient should bewrapped from his shoulders to his feet in a sheet securely pinned fromtop to bottom. The older and stronger the child, the more this is neces-sary (Fig. 93). The patient is held on the lap of the nurse, who passesher right hand around the childs body. The childs head rests on thenurses right shoulder, firmly held in position by her left hand. If the 622 THE PRACTICE OF PEDIATRICS child be large and strong, a third person maybe required to hold the the gag is in position, the operator, with instruments and handsdisinfected, holds the introductor in his right hand, locates the glottiswith the forefinger of the left, and, using it as a guide, directs the tip ofthe tube into the larynx. He must be certain that t
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Keywords: ., bookcentury1900, bookdecade1910, bookid39002, booksubjectchildren
