Respiratory foreign objects pathology

2021-02-01 12:00 AM

During anesthesia, dentures fall into the airways, VA fragments during curettage, when taking a foreign object from the nose, fall into the throat and fall into the airway.

Outline

All ages can suffer from an abnormal airway, most commonly under 4 years old. Airway foreign bodies are inorganic or organic substances that get caught in the larynx, trachea, or bronchi. The most common are peanuts, then corn seeds, melon seeds, nautical seeds, persimmon seeds ... bones, shrimp shells, crabs, fish bones, plastic pieces, needles, hairpins ...

Foreign objects in the airways are accidents that can be life-threatening and must be treated with the appropriate management. Most common in children than in adults, most common in young children.

Causes

Children often have a habit of putting hand-held objects in their mouths. While working, there are also people who are accustomed to holding a number of small tools into the mouth, which is a condition that easily allows foreign objects to fall into the airway or into the oesophagus.

The foreign matter falls into the airway when it is inhaled strongly or after a laugh, crying, surprise, fear ...

The foreign matter falls into the airway due to throat paralysis, food falls into the airway.

Due to surgical complications: during anaesthesia, dentures fall into the airways, VA fragments during curettage, when taking a foreign object from the nose, fall into the throat and fall into the airway.

Symptoms

Children sucking on or eating (sometimes with respiratory infections) suddenly coughing, purple, choking for a while. It is an intrusion syndrome that occurs when a foreign body passes through the larynx, the mucosa is stimulated, the reflex functions that protect the airway of the larynx are activated to expel the foreign body.

Infiltration syndrome

It is a violent cough that expels the object.

Severe shortness of breath with the sound of hissing, tugging, cyanosis, sweating, sometimes urinating on his pants.

Hoarseness.

The cause is due to two reflexes of the larynx: the laryngospasm reflex and the cough reflex to expel the foreign body.

Then return to normal, easy to skip.

Foreign objects in the larynx

The object is long, loud or irregular, can be plugged into or stuck between two vocal cords, the vocal cords, the Morgagni ventricle, and the lower glottis.

The round foreign object like a pill (about 5-8 mm in diameter) is thrown into the Morgagni chamber of the larynx, suffocating and dying if not handled immediately.

Rough foreign objects such as fish vertebrae: children are hoarse and have difficulty breathing, the degree of difficulty breathing depends on the hidden glottis.

The thin object like an anchovy is located along the anterior and posterior direction of the glottis: the child is hoarse, uneasy, but not really breathless.

Foreign objects in the trachea

Usually, a relatively large foreign body, passing through the larynx, cannot pass through the bronchus. Can be inserted into the wall of the trachea, not moving, but usually moves from bottom to top, or from top to bottom, from the opening separating the main bronchus to the subglottic.

Trouble breathing, placing the stethoscope in the trachea heard the flapping sound.

Foreign objects in the bronchi

Often in the right bronchus more because this bronchus has a larger and narrow aperture than the left bronchus. Rarely encounter mobile bronchial foreign bodies, often the objects are fixed quite firmly on the bronchial lumen because the foreign body absorbs water in the chapter, the bronchial mucosa reacts to swelling and holds the foreign body. The foreign body entered the right bronchus more than the left bronchus.

After the initial infiltration syndrome, there is a period of silence for a few days, the child just coughs, has no fever but only warms up, hears no signs of the lung, even chest X-ray, 70-80 % of cases are almost normal. That's when it's easy to misdiagnose, then comes the symptoms of atelectasis, emphysema, bronchitis, lung abscess ...

Diagnosis

Disease history

Ask carefully the signs of the intrusion syndrome, but pay attention when there is an intrusion syndrome but the foreign body is ejected, or vice versa, there is a foreign body but the intrusion syndrome is not exploited (no one looks at the child. look carefully or when it happens, no one knows).

Clinical symptoms

Persistent laryngeal breathing difficulty, if the foreign body is in the larynx. Occasionally appear choking coughs, difficulty breathing and hearing flags fly: think of a foreign object in the trachea.

Bronchitis-pulmonary atelectasis: think of a bronchial foreign body.

X-ray

If it is a contrast object, the projection or photoelectric imaging will show the location and its shape. If you have atelectasis you will see typical signs of atelectasis. Sometimes, a contrast bronchoscope can show the shape and position of an object without its own obstructions. X-rays are very important, indispensable if possible.

Bronchoscopy

Both to confirm the diagnosis and to treat.

Prognosis

It is generally dangerous, in children the more dangerous.

The prognosis depends on:

The nature of foreign bodies: foreign bodies are organic matter, plant seeds, enlarged in water, causing infection and exudate stagnation, which is more dangerous than clean, smooth metallic foreign bodies.

The younger the patient's age the more dangerous the danger. Sometimes the foreign body is removed quite quickly and still cannot save the child because of severe acute bronchitis.

Be examined and intervened sooner or later, sooner or later, it is easy to take foreign bodies, later there is a reaction of mucosal oedema, serious complications, difficulty in taking foreign bodies, the body's stamina decreases.

Equipped with endoscopic tools and qualified physicians. The rate of complications is about 20-30%, the death rate is about 5%.

Treatment

Emergency in place

Manipulating J. Heimlich.

There are 2 situations where the victim is awake and the victim is unconscious.

Victim awake: it is possible to put the victim in a standing or sitting position on the chair, the ambulance person stands behind the victim, his arms wrapped around the victim's chest. One hand clasped, the other hand grabbed the wrist of the fist. Hold the first to reach the victim's abdomen above the navel below the sternum.

With a jerky movement that brings the body up from below, in order to push the diaphragm to expel air in the lungs, trachea, bronchi, hopefully, the foreign body will pop into the mouth. One movement needs to be strong, decisive, and repeat 10 times. It is necessary to monitor the victim's mouth, if the foreign body appears, quickly remove it.

Unconsciousness: Put casualty in lying position. The ambulance knelt on the victim. Place the hand on the victim's abdomen, between the navel and sternum, and the other hand on this hand. Do a quick push up and forward, and repeat 10 times. It is necessary to monitor the victim's mouth, if the foreign body appears, quickly remove it.

Emergency at the hospital

An endoscopy to pick up a foreign body is the most positive way to treat a foreign object in the airway. Particularly difficult, sharp and cannot be removed through the natural airway by endoscopy (very rare), sometimes it is necessary to open the chest, open the bronchi to remove the foreign body. It is very important to pay attention if you have severe difficulty breathing, you should open the trachea before scanning. If the patient is very tired, need to be resuscitated, should not be too rushed to perform an examination. In case the patient does not have much difficulty breathing at the time of examination but has unusual episodes of dyspnea and due to certain conditions, the foreign body cannot be removed or must be moved, the tracheostomy can avoid breathing difficulties. suddenly abnormally.

Foreign matter in the larynx: examine the larynx to pick up the foreign object.

Foreign objects in the trachea: tracheotomy to pick up the foreign body.

Foreign objects in bronchoscopy: bronchoscopy to remove foreign bodies.

After scanning and picking the foreign body through the natural way, but the foreign body has been removed, it may cause laryngeal oedema, difficulty breathing should be monitored.

Simultaneously combine antibiotics, anti-oedema, reduce secretion, improve physical condition and support cardiovascular.

Prevention

Propagate to make more people aware of the dangers of foreign bodies.

Children should not be allowed to put objects and toys on the mouth and suck.

Do not let children eat easy foods such as nautical seeds, peanuts, kumquats, persimmon, squash seeds, melon seeds ...

If you see that the child is sucking on or eating things that are easy to cause, do not panic, scream or scold them for doing so, they are afraid of being choked.

Adults should avoid the habit of keeping tools in the mouth while working.

If choking or suspicion of being thrown into the airways seek medical attention immediately.