23. Acute and chronic foreign bodies in the respiratory tract. Flashcards
etiology of traccheobronchial foreign bodies ?
In children:1-3 years of age because
Natural urge to explore the objects by mouth
Lack of molar teeth to crush nuts
Crying and playing while eating
Lack of parental supervision
Immature glottis reflex
Other causes
Dental, pharyngeal and airway procedure
what’re the site of lodgement ?
lodge into 3 anatomical sites
The larynx
Trachea
Bronchus - mainly right main bronchus and lower lobe
why does aspiration usually get stuck in the right main bronchus ?
Diameter of Right Bronchus is larger
Angle of divergence from the tracheal axis is smaller on the right
Airflow through the right lung is greater
what are the endogenous foreign bodies ?
inhilation of vomit or broken tooth
what is the most common foriegn body to get dislodged ?
peanuts - irritating
sunflower seeds , beads
older children - vegetable , meat and bone
what is the pathophysiology of tracheobronchal foriegn body ?
beans and seeds absorb water - causing there to be complete bronchial obstruction
chronic obstruction - causes inflammation and edema - leading to full obstruction
what is the clinical; symptoms of tracheobronchal obstruction ?
sudden onset of paroxysmal coughing
sudden choking
children undergoinging new onset asthma or bronchitis or pneumonia not responding to treatmnet
UNILATERAL WHEEZING - possibility of foriegn body
some may have inspiratory stridor expiratory wheeze prolonged expiratory phase medium to care rhonchi
tachypnea
nasal flaring
suprasternal retractions
tripping
use of accessory muscles
what are the three phases of aspiration of foreign body ?
initial period of choking , gagging , coughing or airway obstruction
asymptomatic phase - lasting hours to weeks
complication phase
what is the clinical manifestation of laryngeal foriegn body ?
initial cough
then hoarseness , aphonia , choking , sypnea and death
LIFE THREATENING
what is the clinical manifestation of tracheal foriegn body ?
cough
hemoptysis
audible slap and placatory thud
presenting with WHEEZE SIMILAR TO ASTHMA
LIFE THREATENING
what is the clinical manifestation of bronchial foriegn body ?
CLINICAL TRIAD
paroxysmal cough
unilateral wheeze
unilateral diminished breath sounds
what are the respiratory distress signs in in foriegn body obstruction ?
blueness of the lips and mucous membranes
muscle retractions around ribs and neck
decrease mental status or unresponsive
nasal flaring
grunting
resp >60 in infants
>40 in children
how do we diagnose foriegn body obstructions ?
chest x ray - PA and lateral (organi material no radiopaque ) - atelectasis tracheal and mediastinal shift obstructive pneumonia?
chest CT
bronchoscopy
what are the complication of tracheobroncho foriegn body invasion
obstructive emphysema atelectasis bronchiectasis pneumonia hemoptysis pneumomediastium pneumothorax lung abcess
what is the emergency treatmnet of aspirated foriegn body in infants ?
back blows - support the head and neck with your hand in your pronated arm and give black bows down and towards the head between the shoulder blades
HEAD DOWN POSITION
give 5
if the object does not come out - face the baby now towards you
place two fingers below the mid nipple line and give five chest thrust
HEAD DOWN
give 5
until the object comes out , the baby cries or begins to breath , or the baby becomes floppy and unconscious in you arm
if the baby becomes unconscious on your arm or floppy
give 5 cycles of cpr
2 fingers chest below the mid nipple line - 30 compressions
if infan = 1-5inch down
if child use hand - 2 inches
and 2 breaths
DO not place hand in the mouth of the baby to get the object out
========
best treatment - endoscopical removal
emergency bronchospocy if respiratory distress
if larygngeal - laryngoscopy
tracheal or bronchial
rigid bronchoscopy
tracheostomy
when laryngeal foriegn body causes respiratory distress
too large and to sharp object
subglottic edema postoperatively after bronchoscopy
