Foreign Body in Airway
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Transcript of Foreign Body in Airway
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HOLY FAMILY HOSPITALRAWALPINDI
Foreign Bodies in Air Way
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Introduction
Common problem in otolaryngology
It is one of the most common cause of sudden death in
children
Most common foreign bodies are food products(peanuts)
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Introduction
Right main bronchus is most common site of impaction
Rigid bronchoscopy is the best and safe method of foreign
body removal in expert hands
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Classification of Foreign Bodies
Exogenous
Endogenous
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Exogenous foreign bodies
Organic
(vegetable)
Inorganic
(non-vegetable)
Peanuts Whistle
Betel Nut Stone
Popcorn Screws
Seeds Pins
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Organic foreign bodies are dangerous because theseproduce severe chemical bronchitis
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Endogenous Foreign Bodies
Saliva and mucopus inhalations in neuromusculardisorders
During surgery aspiration of blood and debris into
lungs
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Percentage Age Incidence of Foreign Bodies
%Age Age
76% Less than 4 years
18% 4 to 14 years
6% More than 14 years
(HOLINGER AND HOLINGER)
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Clinical Features
Depend on:
Nature
Location of foreign body Degree of bronchial obstruction
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Symptoms
Young child h/o choking with eating or
Slipping of object into the mouth
Severe coughing
Patient may become dyspnoeic or apnoiec
Sharp object may cause pain or haemorrhage
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Signs
Large foreign bodies in trachea: signs are bilateral
Unilateral wheeze is the usual presentation accompanied
with chest crepitations Presentation can be of complete or incomplete bronchial
obstruction
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Two main presentations
Obstructive emphysema
Lung collapse(atelectasis)
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Signs
Incomplete bronchialobstruction:(emphysema)
Wheeze
Hyper resonant chest
Decreased breath sounds
Complete bronchialobstruction(atelectasis)
Dull chest
No breath sounds
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Differential Diagnosis
Pneumoniae
Laryngotracheobronchitis
Atelectasis
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Investigations
X-ray neck lateral view
Chest x-ray on expiration
Fluoroscopy
Ct scan Bronchography
Radio nuclide lung scan
Diagnostic bronchoscopy
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Pre-requisite for Bronchoscopy
Informed written consent from patients attendats Senior available anaesthetist surgical staff should
performAvoidance of sub optimal conditions of night timeWith long history of inhalation it should be done
under antibiotics cover Correct size of bronchoscope should be used
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Bronchoscope Size Used
Age Size of bronchoscope
Infants 3-5 mm
1-3 years 4 mm
3-7 years 5 mm
8-12 years 6 mm
Over 12 years 7 mm
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Indications of Bronchoscopy
Diagnostic
HAEMOPTYSIS OF UNKNOWN CAUSE SUSPECTED BRONCHIAL OBSTRUCTION
OBSECURE CHESTSYMPTOMS
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Indications
Therapeutic
Foreign Bodies Bronchial Toilet
Paliation
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Bronchoscopy
Procedure
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Complications of Anaesthesia
Vocal Cord Damage
Tracheaomucosal Abrasions
Lung Collapse
Respiratory Arrest Cerebral Anoxia
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Complications of Bronchoscopy
Massive bleeding
Laryngospasm
Bronchial rupture
Pneumothorax Cardiac arythmias
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Conclusion
The aspiration of foreign body in tracheobroncheal tree is aserious matter
We must have a high index of suspicion in a child whopresents with sudden respiratory distress or paroxysmal
cough without fever
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Conclusion
Absence of classical history & signs & symptoms does notrule out suspicion of foreign body inhalation
History of repeated chest infections especiallyfailure ofmedical treatment to relieve recurrent pneumonia should
raise the suspicion of f.B. Small objects with danger of inhalation should be kept
away from children
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Case No.1This four year old girlpresented with severestrider. She gave historyof aspirating piece of
beetle nut. On
examination she hadstrider, accessory musclesof respiration were active
with trachial tug..Breathsounds were reduced onright side,Chest X-rayshowed expiratoryemphysema on right side
with mediastinum shiftedto left.Bronchoscopy wasdone under generalanesthesia and foreign
body was retrieved fromright lobe bronchus.
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Case No. 2This little girl wasalone in the room andsuddenly developed achoking spell and thensettled. She was
brought to hospital.On examination shewascomfortable.Auscultation revealed reduced
breath sounds on rightside with ronchi. X-ray chest showed
expiratoryemphysema on rightside. A piece of peanut
was removed onbronchoscopy
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Case 3
This twenty year oldboy was having threeyear history ofcough.Recently he
started withhemoptysis . Chest x-ray revealed metalicforeign body in rightbronchus which wasremoved by rigid
bronchoscopy.Foreign body
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Role of Tracheostomy
To reduce dead space and work of breathing
To prevent postoperative airway obstruction due tosubglottic edema
As an approach
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How To Scope
Check the equipment before starting the anesthesia
Locate the foreign body
Make a plan for removal
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Tips
Scope on suspicion
Scope in case of acute wheeze of unknown cause in infantsand children
Scope in case of chronic wheeze in children which does not
settle with all possible medical treatment