Treatment.—The simplest means are sometimes sufficient to dislodge an im pacted body. A violent slap on the back, just as an expulsory effort is being per formed by the patient, often succeeds. At times, the object remains over the aperture and can easily be removed with the finger. As we have seen under the heading of FOREIGN BODIES IN THE PHARYNX, the epiglottis may be held down by the impacted body so as to com pletely close the laryngeal aperture; the finger can also be used in this case.
When the foreign body presents a cer tain degree of weight, such as a piece of coin, a bullet, etc., an effort may be made to cause its fall from the larynx by in verting the body, the patient standing on his hands while his feet are held up; or he may be placed, face downward, on a table, one end of which is then raised as high as possible.
Pins and needles, tacks, and bones i.e., objects having a tendency to pene trate into the tissues when efforts at ex pulsion are made which cause them to increase their hold—can be withdrawn by means of forceps with the assistance of the laryngeal mirror. Before cocaine was introduced, this was an exceedingly difficult procedure. The larynx, through the pressure of the foreign body, became much more sensitive than usual, and the mirror could hardly be borne, let alone the forceps. In the midst of the retching and gagging, which occurred in most cases, the forceps had to be introduced, and advantage taken of an effort at in spiration to seize the object and draw it out. With cocaine, however, the opera tion is greatly simplified; a 10-per-cent. solution applied generously to the laryn geal membrane and all the parts around the larynx, including the epiglottis and the base of the tongue, so aniesthetizes the throat as to render the extraction of the foreign body a comparatively easy task. Any laryngeal forceps may be em ployed to grasp small objects, while .Mackenzie's, or Cuzco's may be used for large ones.
When the foreign body cannot be reached and suffocation is threatened, tracheotomy is the only resort, and should be performed. If the necessary instru ments are not at hand, the trachea may be opened with a penknife and the wound kept patulous with carefully cleansed hair-pins the curved ends of which are bent into hooks. The sharp ends being
also bent into hooks in the opposite di rection, thus forming an S, the pins are secured by means of a piece of tape passed around the patient's neck. Or the thyrocricoid membrane may be divided, thus furnishing a sufficient opening for the admission of air until more decided measures can be adopted. Before doing this, however, it is advisable to ascertain as nearly as possible the location of the foreign body, to avoid making an un necessary opening in case it should have fallen into the trachea. The location of the foreign body may often be ascer tained by auscultation, a whistling noise being audible at the point of impaction; a stethoscope may be used for the neck.
Tracheotomy is occasionally performed to enable a foreign body impacted in the trachea to be coughed out. The opening made in the windpipe should be longer than for the introduction of the cannula: one inch and a quarter for an adult and about one inch for a child. The spon taneous extrusion of the foreign body is thus greatly facilitated.
Cocaine can be used to great advan tage for the mechanical removal of for eign bodies located in the trachea, and especially in either bronchi, through a tracheal opening. For the removal of an object located above the wound, thor ough anaesthesia of the larynx from above, and also from below, by means of a small atomizer with a curved tip, using a 10-per-cent. solution, permits the in troduction of a small mirror into the trachea, through the wound, without provoking cough. A probe, curved up ward, is then passed in, and the foreign body pushed up into and out of the larynx. The operation can thus be con ducted in the safest possible manner, and be accomplished much more rapidly. A foreign body impacted in one of the bronchi can sometimes be seen by intro ducing the mirror with its face down ward; the amesthetic having been care fully applied, its exact location, shape, and surroundings can be ascertained, and a suitable forceps employed for its ex traction.