TECHNIC OF INTUBAT1ON An intubation outfit comprises six or seven tubes of varying length made of metal, hard rubber or elastic material; an instrument for serting the tube, one for extracting it and a mouth-gag. Fig. 98 shows an ebonite set. The tubes are introduced through the mouth into the larynx and left there until t h e diphtheritic inflammation has ed, usually about three days. The patient should be wrapped from the neck to the feet in a blanket, and he may he intubated while lying in bed or held on the lap of an assistant, who holds the child's legs firmly between the knees, with one hand steadying the mouth-gag and with the other holding the head firmly in moderate tension (see Fig. 9U). The tube is introduced along the left index finger as a guide, which reaches deep in the pharynx and opens the trance of the larynx by holding the epiglottis up against the root of the tongue, so that this is pushed up and forward. Points to be observed
in the operation are: (1) The instrument must be introduced exactly in the middle line in order that it may not catch in any of the different lateral folds of the pharyngeal mucous membrane. (2) As the epiglottis is passed, the handle of the introductor must be raised in order that the tube does not glide into the (esophagus over the root of the tongue which half over hangs the entrance to the larynx. (3) The handle is again to be lowered after the entrance of the tube into the larynx in order to prevent traumatism of the anterior wall of the larynx by the end of the tube (see Figs. 100, 101, 102).
Extubation is accomplished by means of a thread tied to the head of the tube and carried over to one side of the mouth, or if this is bitten through, the tube may be drawn out by the extubator, a special instru ment for the purpose.