Would you describe, in a general way and in lay terms, the purpose for the tracheotomy at that time?
Dr. PERRY. Dr. Carrico had very judicially placed an endotracheal but unfortunately due to the injury to the trachea, the cuff which is an inflatable balloon on the endotracheal tube was not below the tracheal injury and thus he could not secure the adequate airway that you would require to maintain respiration.
(At this point, Mr. McCloy entered the hearing room.)

Mr. Specter.

Dr. Perry, you mentioned an injury to the trachea.
Will you describe that as precisely as you can, please?
Dr. PERRY. Yes. Once the transverse incision through the skin and subcutaneous tissues was made, it was necessary to separate the strap muscles covering the anterior muscles of the windpipe and thyroid. At that point the trachea was noted to be deviated slightly to the left and I found it necessary to sever the exterior strap muscles on the other side to reach the trachea.
I noticed a small ragged laceration of the trachea on the anterior lateral right side. I could see the endotracheal tube which had been placed by Dr. Carrico in the wound, but there was evidence of air and blood around the tube because I noted the cuff was just above the injury to the trachea.

Mr. Specter.

Will you now proceed to describe what efforts you made to save the President's life?
Dr. PERRY. At this point, I had entered the neck, and Dr. Baxter and Dr. McClelland arrived shortly thereafter. I cannot describe with accuracy their exact arrival. I only know I looked up and saw Dr. Baxter as I began the tracheotomy and he took a pair of gloves to assist me.
Dr. McClelland's presence was known to me at the time he picked up an instrument and said, "Here, I will hand it to you."
At that point I was down in the trachea. Once the trachea had been exposed I took the knife and incised the windpipe at the point of the bullet injury. And asked that the endotracheal tube previously placed by Dr. Carrico be withdrawn slightly so I could insert a tracheotomy tube at this level. This was effected and attached to an anesthesia machine which had been brought down by Dr. Jenkins and Dr. Giesecke for better control of circulation.
I noticed there was free air and blood in the right mediastinum and although I could not see any evidence, myself any evidence, of it in the pleura of the lung the presence of this blood in this area could be indicative of the underlying condition.
I asked someone to put in a chest tube to allow sealed drainage of any blood or air which might be accumulated in the right hemothorax.
This occurred while I was doing the tracheotomy. I did not know at the time when I inserted the tube but I was informed subsequently that Dr. Paul Peters, assistant professor of urology, and Dr. Charles Baxter, previously noted in this record, inserted the chest tube and attached it to underwater seal or drainage of the right pneumothorax.

Mr. Dulles.

How long did this tracheotomy take, approximately?
Dr. PERRY. I don't know that for sure, Mr. Dulles. However, I have--a matter of 3 to 5 minutes, perhaps even less. This was very--I didn't look at the watch, I have done them at those speeds and faster when I have had to. So I would estimate that. At this point also Dr. Carrico, having previously attached and assisting with the attaching of the anesthesia machine was doing another cut down on the right leg; Dr. Ronald Jones was doing an additional cut down, venous section on the left arm for the insertion of plastic cannula into veins so one may rapidly and effectively infuse blood and fluids. These were being done.
It is to Dr. Carrico's credit, I think he ordered the hydrocortisone for the President having known he suffered from adrenal insufficiency and in this particular instance being quite busy he had the presence of mind to recall this and order what could have been a lifesaving measure, I think.

Mr. Specter.

Would you identify who Dr. Baxter is?
Dr. PERRY. Yes. Dr. Charles Baxter is, when I noted when I asked for the call, is an assistant professor of surgery also and Dr. McClelland.

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