rd and bring the occiput down as close as possible beneath
the cervical vertebrae.
3. No gag should be used, because the patient should be sufficiently
anesthetized not to need a gag, and because wide gagging defeats the
exposure of the larynx by jamming down the mandible.
4. The epiglottis must be identified before it is passed.
5. The speculum must pass sufficiently far below the tip of the
epiglottis so that the latter will not slip.
6. Too deep insertion must be avoided, as in this case the speculum
goes posterior to the cricoid, and the cricoid is lifted, exposing the
mouth of the esophagus, which is bewildering until sufficient
education of the eye enables the operator to recognize the landmarks.
7. The patient's head is lifted off the table by the spatular tip of
the laryngoscope. Actual lifting of the head will not be necessary if
the patient is fully relaxed; but the idea of lifting conveys the
proper conception of laryngeal exposure (Fig. 55).

[71] CHAPTER V--BRONCHOSCOPIC OXYGEN INSUFFLATION

Bronchoscopic oxygen insufflation is a life-saving measure equalled by
no other method known to the science of medicine, in all cases of
asphyxia, or apnea, present or impending. Its especial sphere of
usefulness is in severe cases of electric shock, hanging, smoke
asphyxia, strangulation, suffocation, thoracic or abdominal pressure,
apnea, acute traumatic pneumothorax, respiratory arrest from absence
of sufficient oxygen, or apnea from the presence of quantities of
irrespirable or irritant gases. Combined with bronchoscopic aspiration
of secretions it is the best method of treatment for poisoning by
chlorine gas, asphyxiating, and other war gases.

Bronchoscopic oxygen insufflation should be taught to every interne in
every hospital. The emergency or accident ward of every hospital
should have the necessary equipment and an interne familiar with its
use. The method is simple, once the knack is acquired. The patient
being limp and recumbent on a table, the larynx is exposed with the
laryngoscope, and the bronchoscope is inserted as hereinafter
described. The oxygen is turned on at the tank and the flow regulated
before the rubber tube from the wash-bottle of tank is attached to the
side-outlet of the bronchoscope. It is necessary to be certain that
the flow is gentle, so that, with a free return flow the introduced
pressure does not exceed the capillary pressure; otherwise the blood
will be forced out