nstruments_ required for an orderly tracheotomy are:
Headlight
Scalpels
2 Retractors
Trousseau dilator
6 Hemostats
Scissors (dissecting)
Tracheal cannulae (six sizes)
Curved needles
Needle holder
Hypodermic syringe for local anesthesia
No. 1 plain catgut ligatures
Linen tape
Gauze sponges

These are sterilized and kept in a sterile copper box ready for
instant use. Beside the patient's bed following the tracheotomy the
following sterile materials are placed:
Sterile gloves
1 Hemostat
Sterile new gauze
Trousseau dilator
Scissors
Duplicate tracheotomy tube
Silver probe
Basin of Bichloride of mercury solution, 1 : 10,000

Tracheotomy is one of the oldest operations known to surgery, yet
strange to say, it is probably more often improperly performed today,
and more often followed by needless mortality, than any other
operation. The two chief preventable sequelae are death from improper
routine surgical care and wrongly fitted tube, and stenosis from too
high an operation. The classical descriptions of crico-thyroidotomy
and high and low tracheotomy have been handed down to generations of
medical students without revision. Every medical graduate has been
taught that there are two kinds of tracheotomy, high and low, the low
operation being very difficult, the high operation very easy. When he
is suddenly called upon to do an emergency tracheotomy, this erroneous
teaching is about all that remains in the dim recesses of his memory;
consequently he makes sure of doing the operation high enough, and
goes in through the larynx, usually dividing the cricoid cartilage,
the only complete ring in the trachea. As originally made the
distinction between high and low as applied to tracheotomy referred to
operations above and below the isthmus of the thyroid gland, in a day
when primitive surgery attached too much importance to operations upon
the thyroid gland. The isthmus is entitled to absolutely no
consideration whatever in deciding the location at which to incise so
vital a structure as the trachea. Students are taught different short
skin incisions for these two operations, and it is no wonder that
they, as did their predecessors, find tracheotomy a difficult, bloody,
and often futile operation. The trachea is searched for at the bottom
of a short, deep wound filled with blood, the source of which is
difficult to find and impossible to control.

_Tracheotomic cannulae_ shou