A. Ensuring the patency of the airways 1. Lay the patient on a firm surface on his back. 2. Bend your head sharply backward. With a suspected fracture or dislocation in cervical spine spine (when struck in the back of the neck, whiplash) -

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Foreign bodies of the larynx, trachea and bronchi are most often found in children. They enter the respiratory tract if a child eats carelessly and adults do not control the behavior of children. Among foreign bodies, the most common are sunflower seeds, watermelon, pumpkin, carrot pieces, coins, pins, parts of a fountain pen, toys, etc.

In adults, foreign bodies enter the respiratory tract with careless and inattentive handling of certain objects (needles, pins, hairpins, etc.) - In a state of intoxication, vomit, blood, food pieces, dentures, etc. may enter the bronchi. Another category is made up of foreign bodies that enter the respiratory tract as a result of gunshot wounds, shrapnel wounds and injuries with cold weapons.

Foreign bodies trapped in the airways, as a rule, do not cough up. This is due to the fact that at the time of exit, a foreign body is pinched between the walls of the bronchus (at the time of entry, the bronchus expands, narrows when exiting). However, in some cases, a foreign body can either invade the wall or run in the trachea. The ballot mechanism is that at the moment of a cough push, a smooth foreign body rises and hits the lower surface of the vocal folds. At this time, a spasm of the glottis instantly occurs and the foreign body does not pass outside, a squelching noise occurs. When a foreign body is lowered, due to its severity, it may enter one of the bronchi (usually the right one).

Clinical picture... Signs of the presence of a foreign body in the respiratory tract depend on both the foreign body itself and the reaction of the body. When a foreign body enters the larynx, a convulsive cough occurs. With complete closure of the lumen of the glottis, instant asphyxia and death occur, with partial closure - hoarseness, cough, swelling of the mucous membrane.

It is known that foreign bodies can be of various sizes and nature. Small smooth objects quite often penetrate the small bronchi, obstructing the lumen and thereby causing atelectasis of a part of the lung. Blockage of the main, lobar or segmental bronchus leads to atelectasis of the entire lung or most of it. As a result, emphysema occurs in the other lung, the mediastinal organs are displaced to the diseased side. Healthy lung volume and function are reduced. The patient develops shortness of breath and symptoms of cardiovascular failure.

Sharp thin foreign bodies can wedge into the wall of the trachea or bronchus without disrupting the act of breathing. In the future, a focus of inflammation occurs at this place; when a foreign body moves deep into the wall of the bronchus or trachea, the integrity of the wall may be disturbed and large blood vessels may be injured.

Long-term lung atelectasis, supported by a foreign body, leads to the development of pneumonia and abscess. The local reaction of tissues to the presence of a foreign body is characterized by the growth of easily bleeding granulations, the appearance of a trophic ulcer at the place of pressure by a foreign body on the wall of the respiratory tube. In rare cases, at the site of introduction of a foreign body, sclerosis is observed, followed by encapsulation of a foreign body. When examining the lungs of a patient with a foreign body that does not obstruct the bronchus, dullness of the percussion sound on the affected side is determined, with auscultation - weakening of breathing. With atelectasis, a boxed sound is heard percussion on the healthy side (due to emphysema) and a dull sound on the patient.

Fluoroscopy and radiography of the respiratory tract allow not only to clarify the nature and localization of a foreign body, but also to determine the nature of complications that arise.

Diagnosis is based on data from anamnesis, physical and X-ray examination of the lungs, laryngoscopy. For small children, only direct laryngoscopy is performed. At this point, a foreign body floating in the trachea can be removed. Adults are diagnosed at the time of bronchoscopy.

Treatment. A foreign body trapped in the respiratory tract must be removed. Sometimes removal is performed under X-ray control. For children, elderly and debilitated patients, a foreign body is removed under anesthesia. In case of sharply stenotic breathing or asphyxia, an urgent tracheostomy, artificial respiration, and then lower tracheobronchoscopy with an optical device of the Friedel system are indicated.

Prevention of foreign bodies in the respiratory tract includes measures to clarify the severity and possible complications of this pathology.

Penetration of foreign objects into the upper respiratory tract is extremely dangerous for human life. Blocking the free access of air, they do not allow a person to breathe, causing. If a foreign body enters the bronchi, it causes a strong inflammatory process that leads to the formation purulent focus... Therefore, when hit foreign object in the respiratory tract, first aid should be provided immediately, in the first minutes of the onset of symptoms.

Causes and their consequences

Most cases of damage to the respiratory tract by a foreign body are recorded in babies under 5 years old.

Small children are inquisitive, because they are just beginning to learn the world around them. They strive to study it by any available means: touch, smell, taste. Inhalation of a foreign object often occurs during the game. The kid is frightened, because of this, a reflex spasm of the tracheal and bronchial muscles occurs, which further worsens the child's condition.

Read everything about how first aid is provided for the penetration of a foreign body into the respiratory tract of children.

In adults, this dangerous condition occurs most often in the process of eating. For example, a person who is keen on talking may inhale air when a piece of food is already in his mouth. Reflex swallowing will occur, and unchewed food will become stuck in the airways. The rush to eat, when a person "swallows" large chunks, is also often the cause of a life-threatening condition.

Neurological pathologies or the state of alcoholic intoxication significantly reduce self-preservation reflexes. When vomiting occurs, patients can choke or choke on their masses, which can cause a dangerous disease - aspiration pneumonia.

Depending on what foreign bodies are in the upper respiratory tract, they are usually classified into 3 groups:

1. Endogenous. This is the name for accidentally swallowed pieces of organic tissue,
2. Exogenous items of organic origin. This includes any food.
3. Exogenous objects of inorganic origin. These are parts of toys, paper clips, beads, coins.

Note!

Stuck food and synthetic fabrics are especially dangerous. Their location cannot be determined using x-rays. In addition, in the process of being in organs, they crumble, swell, increase in size, or decompose. Getting into the distal bronchi, they cause purulent accumulation in the lungs.

The resulting obstruction (impaired bronchial patency) depends on several factors:

• The quantities and structural features object alien to the body;
• The depth of its passage into the respiratory tract;
• The presence or absence of fixation in the visibility zone;
• The degree of disturbance caused by the foreign body.

Symptomatic manifestations

Emergency care is needed for a patient if he has the following symptoms:

• It is difficult for a person to inhale;
• He is sorely lacking in air;
• The skin of the face first turns red, then turns pale, around the nose and mouth begins to turn blue;
• Reflex urge to cough appears;
• The child begins vomiting and severe lacrimation;
• The voice is hoarse, it can disappear completely;
• Possible short stop breathing.

Note!

This symptomatology may pass for a while and then return.

If first aid will not be provided on time, due to obstruction of air in the airways, the developing suffocation will pass 3 stages, the symptoms of which are presented in the table.

The symptomatology is also different from which part of the respiratory tract the foreign object has got.

The attack has an acute onset. It manifests itself in a strong, pronounced labored breathing and cough, similar to that which is fixed with whooping cough. Blue skin of the face.

Note!

If the swallowed object has sharp edges, the cough is accompanied by a discharge of blood.

• Trachea.

When the trachea is blocked, the cough is prolonged, barking. It is often accompanied by vomiting. The patient feels dull pain behind the breastbone. With a sharp movement of a foreign body, a flapping symptom is observed.

• Bronchi.

If a foreign body has passed into the bronchi, the symptomatology develops in three consecutive periods:

1. Acute respiratory disorders. A coughing fit is accompanied by blue skin and a feeling of suffocation. Doesn't have a long course.
2. Hidden period. At this time, there is no symptomatology, since the object is fixed in one of the sections of the bronchi. The period lasts from 2 hours to 3-5 days.
3. Complications. A foreign body fixed in the bronchi causes many dangerous diseases: pneumonia, lung destruction, peritonitis and others.

Note!

If adults do not notice the ingress of a foreign body into the child's respiratory tract, the baby will begin to develop inflammatory processes in the bronchi that cannot be cured.

Principles for immediate assistance

If foreign bodies enter the respiratory tract, competent first aid can save human life. In this case, not a single minute should be lost, since the development of suffocation can occur rapidly.

Help with a foreign body stuck in the respiratory system is provided in this order:

1. Ask the victim any question. So you can determine how much the person's respiratory function is preserved. After all, the specifics of further actions will depend on this factor.
2. If the person is able to breathe a little, encourage them to cough. A deliberate cough is capable of "pushing out" a foreign object.
3. If, despite coughing, the subject does not leave the respiratory tract, they begin special techniques.

• Technique No. 1

The person is placed with his stomach on the bent knee of the one who is providing assistance. The victim's head should be lowered as low as possible.

They make strong, sharp blows on the back so that the knee exerts pressure on the chest. Do not forget to look into the patient's mouth in order to remove the foreign body that appears in time.

• Technique No. 2

This technique is named after its creator, Heimlich (see video after article). It is carried out in the following sequence:

• You need to stand behind the back of a choked person;
• With two hands "hug" his torso, clenching his working hand into a fist;
• Cover the fist with the palm of the other hand and make strong sharp pressure up the abdomen;
• Observe the correct direction of pressing: first up, and then inward.

If the patient's respiratory function is restored, it means that the foreign object is no longer in the respiratory system.

Note!

It is impossible to use the Heimlich technique for patients who are unconscious. In this case, urgent resuscitation actions will be required.

If there is a foreign body in the airway in pregnant women, first aid is provided in a slightly different way.

Reception is carried out according to the same principle, however, given that it is impossible to press on the pregnant woman's belly, pressing is done in the lower sternum.

If a person develops suffocation, and none of the techniques helps to remove the stuck object, an urgent health care: in a hospital, an emergency tracheotomy is performed.

Very often, a foreign body enters the respiratory tract by inhalation (aspiration). This usually happens with young children who use small objects during play or inhale food while feeding. A variety of small objects can get into the respiratory tract of children. A foreign body in the upper respiratory tract in children can threaten their lives, so an urgent need to consult a specialist. ENT doctors very often take all kinds of small objects, toy parts and food parts from the nose, lungs, bronchi, larynx and trachea of \u200b\u200bchildren.

When a foreign body enters the bronchus or smaller airways, children have a cough, weakening of respiratory noises and first-ever wheezing. This classic triad occurs in only 33% of children who have aspirated a foreign body. The longer the foreign objects remain in place, the more likely the triad of symptoms is, but even with significantly late diagnosis, it develops in 50% of children. Aspiration of a foreign body in children is common, objects are diverse, but prevail among them food products: nuts (peanuts), apples, carrots, seeds, popcorn. In children who inhaled a foreign body, there are signs of pronounced stenosis of the upper respiratory tract: asthma attacks with prolonged inhalation, with periodically strong cough and cyanosis of the face up to lightning asphyxia, weakening of respiratory noises, stridor, wheezing, foreign body sensation, wheezing. In the presence of a mobile body in the trachea, a popping sound can sometimes be heard during screaming and coughing.

Foreign body aspiration.

General information.

The entry of foreign objects into the respiratory organs is called foreign body aspiration. It is a dangerous condition that can lead to serious injury to the larynx, blockage of the airways, and asphyxiation. Aspiration of small bodies more often occurs into the right, wider bronchus.

Most often, the aspiration of foreign bodies, organic and inorganic, is observed in young children, but remains possible for people of any age and gender.

Causes of the disease.

The first and main cause of pathology is the abandonment of babies 2-7 years old without adult supervision. A curious child pulls small objects into his mouth, accidentally inhales, and a foreign body ends up in the respiratory organs.

There are frequent cases of aspiration of food particles during the meal, both in children and in adults. The habit of holding small objects (screws, buttons) in your teeth, rolling toothpicks in your mouth, etc. is dangerous.

Symptoms of the disease.

Aspiration of a foreign body is manifested by difficulty in the respiratory process, a sharp unexpected attack of coughing (if a foreign object gets into the trachea, the cough resembles whooping cough symptoms), blue skin, in severe cases - asphyxiation with loss of consciousness, in extremely severe cases - death from suffocation with complete overlap by strangers the body of the respiratory tract.

If the aspirated foreign body remains in the respiratory system, this is characterized by attacks of suffocation with paroxysmal cough, persistence of manifestations of stenosis, pain in the larynx, sometimes radiating to the ear region. Exacerbations of the condition are replaced by quieter periods. In almost all cases, hoarseness is noted, the patient feels the presence of a foreign body in the larynx. More specific signs depend on the location of the foreign object and its movements. If foreign bodies are in the bronchi, trachea or larynx for a long time, inflammatory processes with suppuration develop.

Possible complications.

Due to the presence of aspirated bodies in the respiratory organs, chronic forms of bronchitis and pneumonia can occur, an abscess of the lung, and purulent pleurisy can develop.

Health care.

The task of doctors is to quickly remove the aspirated foreign body; treatment tactics are developed after determining the localization of the object that has entered the respiratory organs and its characteristics. If the situation permits, the extraction of foreign bodies should be carried out in a specialized (otolaryngological) department of the hospital.

A foreign body of the respiratory tract occurs, as a rule, in children aged 1 to 3 years, but it also happens in adults, especially in old age and at neurological diseases, violating the acts of swallowing, closure of the glottis. Usually in children, these are small nuts, grains, beads, toys or their fragments; in adults - small dentures, food leftovers (brushes).

Symptoms

Most of the inhaled objects cause a coughing fit, sometimes immediate respiratory failure, but some go unnoticed and appear after many days or even weeks with pneumonia, atelectasis, and other complications.

A sudden onset of cough and history data suggest the presence of a foreign body in the respiratory tract. In addition to a paroxysmal cough, there may be shortness of breath, stridor breathing, cyanosis, wheezing, or, conversely, complete "silence" over a lobe or whole lung (more often the right one). Hemoptysis may occur when sharp or cutting objects are inhaled.

Emergency diagnosis and clinical physiology

The clinical and radiological picture has some peculiarities, depending on the level of the foreign body. So, when located at the larynx level, paroxysmal cough, loss of voice and periodic shortness of breath, reaching asphyxia, are characteristic. With the localization of a foreign body in the trachea, almost the only symptom is a strong persistent cough.

With a bronchial location, radiological signs of an asymmetric lesion may occur - atelectasis on the side of bronchial obstruction and overexpansion on the healthy side.

Since the right main bronchus is wider than the left bronchus and departs at an obtuse angle, then more often foreign bodies of the respiratory tract enter the right bronchus. At first, it can move with the flow of air with each inhalation and exhalation, but then it lingers in the mouth of the lobar (segmental) bronchus of a suitable diameter and clogs it.

If the nature of the foreign body allows it to absorb water (grain, fruit), then it swells and tightly closes the bronchus.

Often there is pneumonia (and not only in the affected lobe), often atelectasis, abscess with a corresponding clinical picture.

When x-ray examination The diagnosis of a contrasting foreign body is easy to establish, but if the foreign body is non-contrasting, an accurate diagnosis can be made only with the help of bronchoscopy.

When X-ray examination, one should pay attention to signs of inflammation, atelectasis, mixing of the mediastinum (when inhaling towards the affected lung - the so-called Holzknecht-Jakobson symptom).

Emergency therapy

On initial stages you can try to apply the Heimlich trick. Standing behind the patient, wrap your arms around him upper section belly and lower part difficult cage and at the height of the patient's deep breath, sharply squeeze the covered areas with your hands; the assistant standing in front can simultaneously push his fist into the epigastrium in the direction of the diaphragm. This technique is designed to push out a foreign body with an exhaled air stream.

The most reliable method of emergency care for a foreign body of the respiratory tract is considered to be its removal using bronchoscopy. Direct bronchoscopy with a Friedel bronchoscope is preferred.

Manipulation is performed under general anesthesia with propofol or another anesthetic, sometimes with the use of muscle relaxants and mechanical ventilation.

Having found a foreign body in the respiratory tract, it must be grasped with forceps included in the bronchoscope kit. If the size of the foreign body does not allow pulling it out through the lumen of the bronchoscope, then, securely clamping the foreign body with forceps, remove the bronchoscope together with the foreign body pressed against its distal end.

In practice, there was a case when a 9-year-old girl was admitted in an extremely serious condition with total atelectasis of the left lung, mediastinal mixing to the left after two weeks of "bronchopneumonia", which was treated in the central regional hospital.

A foreign body of the left main bronchus was suspected, although there was no direct X-ray evidence. During bronchoscopy with Friedel's bronchoscope, a plastic elephant 13x8x5 mm in size was found in the mouth of the left main bronchus, which was grasped with a clamp, brought to the distal end of the bronchoscope in order to extract it together with the bronchoscope. When passing through the glottis, the elephant slipped out of the clamp and fell and the right main bronchus (the only breathing lung). A second bronchoscopy was immediately performed, which resulted in the successful removal of a foreign body. After two weeks of respiratory rehabilitation, the girl was discharged healthy with complete clinical and functional recovery of the left lung.

Not every atelectasis of the whole (and even lobe) of the lung can be quickly straightened. Even a lung straightened according to X-ray data long time remains functionally defective: either ventilation (respiratory dead space) or blood flow (venous blood shunting) can sharply prevail in it.

For straightening of lobar atelectasis, injection is used under increased intraalveolar pressure. In this case, the pressure of 30 cm H2O must not be exceeded, otherwise healthy alveoli may be damaged and extra-alveolar gas may appear. To avoid this dangerous complication, two approaches can be taken.

Inflate atelectasis through a Fogarty catheter blocker - then high pressure will only apply to the atelectasized lobe or lung. It is possible to block a lobe only using a fiberoptic bronchoscope, and such a complication of the procedure is justified.

It is easier and more effective to straighten atelectasized zones by increasing pleural rarefaction. This can be accomplished with inspiratory resistance spirometry.

First aid - algorithm

• It is necessary to confirm the presence of a foreign body and clarify its localization. With X-ray negative results, it is necessary to perform fiberoptic bronchoscopy under local anesthesia.
• First of all, you should apply the Heimlich technique (compression of the lower section chest at inspiratory height).
• Study with a Friedel bronchoscope not only clarifies the diagnosis, but also allows you to remove a foreign body, even if its size exceeds the diameter of the bronchoscope.
• After removal, it is necessary to carry out respiratory rehabilitation, including the normalization of the drainage capacity of the lungs and the straightening of atelectasis.