ponges
Gauze squares
Probe-pointed curved bistoury.

1. Room should be abundantly ventilated, as free from dust and lint
as possible, and the air should be moistened by steam in winter.
2. Keep mouth clean. Tooth brush. Rinse alcohol 1:10.
3. Sponge away secretion after the cough before drawn in.
4. Remove inner cannula (not outer) as often as needed. Not less
often than every hour. Replace immediately. Never boil a cannula until
you have thoroughly cleaned it.
5. Obstruction of cannula calling for cleaning indicated by:
Blue or ashy color.
Indrawing at clavicles, sternal notch, epigastrium.
Noisy breathing. (Learn sound.)
6. Surgeon (in our cases) will change outer cannula once daily or
oftener.
7. Duplicate cannulae.
8. Be careful in cleaning cannulae not to damage.
9. Watch for loose parts on cannula.
10. Change dressing (in our cases) as often as soiled. Not less
often than every hour. Large squares. Never narrow strips.
11. Watch color of lips and ears and face.
[299] 12. Report at once if food or water leaks through wound.
(Coughing and choking).
13. Never leave a tracheotomized patient unwatched during the first
days or weeks, according to case.
14. Remember Trousseau dilator or hemostat will spread the tracheal
wound or fistula when cannula is out.
15. Remember life depends on a clear cannula if the patient gets no
air through the mouth.
16. Remember it takes very little to clog the small cannula of a
child.
17. Remember a tracheotomized patient cannot call for help.
18. Decannulation. Testing by corking partially. Watch corks
not too small, or broken. Attach them by braided silk
thread. Pure rubber cord ground down makes best cork.

[300] CHAPTER XXXVIII--CHRONIC STENOSIS OF THE LARYNX AND TRACHEA

The various forms of laryngeal stenosis for which tracheotomy or
intubation has been performed, and the difficulties encountered in
restoring the natural breathing, may be classified into the following
types:
1. Panic
2. Spasmodic
3. Paralytic
4. Ankylotic (arytenoid)
5. Neoplastic
6. Hyperplastic
7. Cicatricial
(a) Loss of cartilage
(b) Loss of muscular tissue
(c) Fibrous

_Panic_.--Nothing so terrifies a child as severe dyspnea; and the
memory of previous struggles for air, together with the greater ease
of breathing through the tracheotomic cannula than through even a
normal larynx, incites in some cases so great