DE   EN   ES   FR   IT   PT Anesthesiology and resuscitation Aspiration by a foreign body

Aspiration by a foreign body


Hit of foreign objects in respiratory bodies is called aspiration of foreign bodys. This dangerous state which can lead to a serious injury of a throat, obstruction of respiratory tracts and asphyxia. Aspiration of small bodies happens in the right, wider bronchial tube more often.
Most often aspiration of foreign matters, organic and inorganic, is observed at children of younger age, but remains possible for people of any age and a floor.

Aspiration symptoms foreign body:

The following symptoms are characteristic of the patients aspirating foreign bodys. The healthy child suddenly has a sharp pristupoobrazny cough, asphyxia, sometimes with a loss of consciousness and cyanosis of face skin. Are characteristic stenotic breath with retraction of compliant places of a thorax, often repeating fits of coughing, hoarseness of a voice. Intensity of cough depends on a form, size, character and localization of a foreign body. When fixing a foreign body cough usually happens less intensive.
At foreign bodys of a tracheobronchial tree the stenosis can be fulminant, acute, subacute and chronic. The fulminant stenosis arises at a vklineniya of a foreign body in a glottis. The acute stenosis is caused by a foreign body of a throat or trachea. The acute stenosis of a trachea more often happens is caused by the large foreign body which is localized in the field of bifurcation of a trachea and closing a gleam of bronchial tubes. The subacute stenosis is observed at partial closing of a bronchial tube, for example by haricot, chronic — at the foreign body which put in a bronchial tube with partial obstruction of its gleam.
The condition of children in whose throat there is a foreign body often happens heavy. At aspiration of a small acute foreign body (a sewing needle, a fish bone) at the first moment of its hit in a throat breath disturbance sometimes is not observed; the stenosis phenomena in such cases arise much later as a result of development of the reactive hypostasis of a mucous membrane of a throat leading to asphyxia. At aspiration of foreign bodys of a sharp-pointed or angular form which the acute end can put in thickness of a mucous membrane of a throat and break its integrity, pharyngalgias and behind a breast, amplifying at cough and the sharp movements are possible. In a phlegm blood impurity appears.
The important symptoms testimonial of a foreign body in a throat, are an asthma and disorder of voice function. The last can be short-term or long. Resistant hoarseness, and also an aphonia indicate localization of a foreign body in a glottis or subdepository space, a rough voice and small hoarseness — on an injury of voice folds when passing a foreign body.
The most frequent symptom of a foreign body of a throat — sharply expressed attacks of a pertussoid which sometimes lasts long, with pauses of different duration. Children of advanced age can feel a foreign body and morbidity when swallowing. At auscultation rigid breath, rough wire rattles in both lungs are listened, it is more in upper parts.
At a chest fluoroscopy the increased transparency of pulmonary fabric without focal and infiltrative changes usually comes to light.

Foreign bodys of a trachea meet often, they (for example, a water-melon seed) easily move in a tracheobronchial tree and cause a pristupoobrazny pertussoid. Disturbances of breath are expressed not so sharply as at localization of foreign bodys in a throat, and periodically amplify owing to balloting (movement) of a foreign body at the time of its contact with the lower surface of true voice folds. Cough can be non-constant, amplify at night and at concern of the child. Sometimes fits of coughing are expressed sharply, are followed by cyanosis of the person and vomiting, reminding whooping cough that quite often is the reason of diagnostic mistakes, especially when the moment of aspiration of a foreign body "is seen".
Balloting of a foreign body is a characteristic sign of the unstable foreign bodys located in a trachea and is objectively shown by a clap symptom. During concern of the child, crying, laughter or cough the clap — result of balloting of a foreign body and blow about walls of a trachea, throat and about voice folds clearly is listened at the movement during a breath and an exhalation. Vykashlivaniya of a foreign body stir the valve mechanism of a tracheobronchial tree consisting in expansion of a trachea at a breath and its narrowing at an exhalation and also the fact that at cough the foreign body is thrown to a glottis and, adjoining to the lower surface of voice folds, causes short circuit of a glottis and a spasm of a throat. The deep breath following it carries away a foreign body in lower parts of a trachea again.
The mucous membrane in the field of bifurcation of a trachea differs in hypersensitivity to external irritations in comparison with a mucous membrane on other extent of respiratory tracts. Therefore at localization of a foreign body in the field of bifurcation cough is especially sharply expressed and has big duration. When the foreign body substantially closes a gleam of a trachea or bronchial tube and expired air passes through the crack which is formed between a surface of a subject and a wall of a trachea or bronchial tube it is possible to hear the whistle similar to that at bronchial asthma.
At foreign bodys in bronchial tubes distinguish through, valve and their full obstruction. In cases of through obstruction the foreign body closes a bronchial tube gleam not completely. Breath at the same time is not broken. Inflammatory process in pulmonary fabric is expressed moderately.
Valve obstruction is characterized by the fact that the foreign body leaky adjoins to walls of a bronchial tube and at a breath air gets into a lung. At an exhalation it does not leave owing to reduction of muscles of a bronchial tube. Thus, air is late in a lung, causing emphysema. Owing to full bronchial obstruction a foreign body in a lung the obturatsionny atelectasis develops.
When passing a foreign body on a bronchial tube breath becomes free, cough arises less often and has smaller duration, the child calms down. Localization in a bronchial tube of a foreign body depends on its size. Large foreign bodys are late in the main bronchial tubes, small get in share and segmented. At the same time usually it is not possible to establish any characteristic subjective signs. On side of an obturirovanny bronchial tube more forced ventilation as if overcoming an obstacle is listened; in the field of localization of a foreign body shortening of a percussion sound, weakening of breath and voice trembling are noted. But dry and even wet rattles are sometimes listened. If the foreign body is long is in a bronchial tube, expectoration is observed; the quantity and its quality depend on secondary changes in an easy and tracheobronchial tree.
Roentgenoscopic signs of disturbance of bronchial conductivity — a symptom of shift of bodies of a mediastinum towards an obturirovanny bronchial tube, an atelectasis of a segment or a lung lobe according to the level of localization of a foreign body, emphysematous changes of lungs come to light at a valve stenosis of a bronchial tube.
At an atelectasis as well as at emphysema, there can be symptoms of respiratory insufficiency.
If full obturation of one of primary bronchi is observed, then the corresponding lung is switched off from the act of breath. As a rule, the atelectasis of the corresponding lung is accompanied by cardiovascular insufficiency. The atelectasis of a segment of one lung can proceed along with emphysema in other lung with the shift of bodies of a mediastinum in the sick party. Emphysema of a lung is followed by an asthma and pathological disturbances from cardiovascular system.
Later along with an atelectasis bronchitis or pneumonia develops. However at full or valve closing of bronchial tubes and disturbance of their drainage function chronic pneumonia at which inflammatory process on site of fixing of a foreign body is defined can develop.
The foreign body of respiratory tracts is distinguished not only on the basis of carefully collected anamnesis, objective data, on knowledge of the main clinical manifestations at aspiration of foreign bodys, but also by means of X-ray inspection (a tomography, a bronchography etc.). For final diagnosis use also endoscopic methods (a bronkhoskopiya, a direct laringoskopiya).
In a bronchial tube it is necessary to make for detection of a foreign body a suction machine aspiration of purulent contents, and also to reduce hypostasis of a mucous membrane of a bronchial tube of 0,1% adrenaline solution. Foreign bodys of a tracheobronchial tree should be differentiated with a laryngotracheobronchitis, pneumonia, an acute bronchitis, inborn share emphysema of a lung, a foreign body of a gullet, an acute respiratory disease and so forth. Long stay of a foreign body in respiratory tracts is resulted by complications, and is more often at children of early age. It is quite often caused by narrowing of a gleam of respiratory tracts, and also decrease in resilience of pulmonary fabric. Besides, foreign bodys of the organic nature, such as peas, quite often cause bronchial pneumonia. Such bronchial pneumonia proceeds is long and will difficult respond to treatment. One of very rare and heavy complications at foreign bodys of respiratory tracts — lung abscess. Such diseases as the abscessing pneumonia, tracheobronchitis, lung atelectasis, pheumothorax, bronchoectatic disease, bleedings etc. also belong to complications.

Aspiration reasons foreign body:

Foreign bodys of respiratory tracts — quite widespread pathology of children's age. They share on inorganic (a baby's dummy, sewing needles, safety pins, coins, details from toys, nails, etc.) and organic (peas, beans, haricot, stones from peaches, apricots, cherries, water-melon sunflower seeds etc.). Ascarids, bloodsuckers can also be foreign bodys. Depending on a form, size and character of aspirirovanny foreign bodys they are localized in various departments of upper respiratory tracts. In a trachea they usually are not late and to 80% of cases get into the right bronchial tube.
Aspiration of a foreign body is always unexpected and happens under the most various conditions. Foreign bodys usually get to an organism in the natural way, is more rare — at surgical interventions (tracheotomy, an adenotomy, removal of a foreign body from a nasal cavity, dental interventions), and also at the getting wounds of a thorax, neck, a throat injury. Except a usual way (through a mouth), foreign bodys can get into airways from a gullet and a stomach at the time of vomiting.
Hit of foreign bodys in respiratory tracts happens during food; it is promoted by laughter, a conversation, crying, a sudden fright, cough, falling, and also aspiration of most of children to take all objects in a mouth. The foreign bodys which are in a mouth at the time of a sharp breath are fond of a strong inspiratory current of air inside. Foreign bodys of respiratory tracts are more often noted at children of early age because of poor development at them protective reflexes — a spasm of an entrance to a throat and a laryngospasm with the subsequent reflex cough. At small children the throat is located very highly, distance from teeth to an entrance to a throat small. Besides, the underdevelopment of reflexogenic zones in the field of true and false voice folds, in subdepository space, in the field of an epiglottis takes place. The stated above reasons also promote penetration of foreign bodys into a throat. Pathoanatomical changes in respiratory tracts depend by nature and the size of a foreign body, and also on time of its stay in respiratory tracts. At implementation of an acute metal foreign body the hyperemia, swelling of a mucous membrane, the exudation phenomenon are locally noted. To late local signs of a foreign body formation around it of the capsule, its sklerozirovaniye, growth of granulations treat with the subsequent their scarring.

Aspiration treatment by a foreign body:

Any foreign body is subject to removal. The child with a foreign body of respiratory tracts should be hospitalized immediately in a hospital. If the child is in a condition of acute asphyxia, then according to vital indications immediate tracheotomy is necessary (operation the doctor does).
Parents, the immediate family of the child, having suspected at him aspiration of a foreign body, have to ask for the help in any medical institution, in particular on medical and obstetrical center. In all cases if there is no suffocation, the paramedic at suspicion on a foreign body of respiratory tracts is obliged to send the child to laryngologic department. The paramedic has to be able to assist the doctor at extraction of a foreign body from respiratory tracts.
The child with a foreign body of respiratory tracts is brought in a hospital by the ambulance car. Along the line children with the balloting foreign bodys of a trachea need to give a sitting position in order to avoid movement of a foreign body and asphyxia. If necessary carry out a hardware artificial respiration, enter cardiovascular means and Cytitonum, allow to breathe oxygen.
Children have a foreign body of a trachea or bronchial tubes delete by means of an upper bronkhoskopiya (under an endotracheal anesthesia using muscle relaxants).
At strongly put foreign bodys it is necessary to make tracheotomy or the lower bronkhoskopiya. At the wedged foreign body of a bronchial tube (share or segmented) at children of early age the rupture of a bronchial tube with infection of a mediastinum is possible. Sometimes in such cases resort to a thoracotomy.
For prevention of hypostasis of subdepository space at once after an upper bronkhoskopiya intravenously enter 50 — 100 mg of a hydrocortisone, isopromethazine in an age dosage.

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