Foreign body aspiration.pptx

ENT

1. Foreign body aspiration

2. Foreign body aspiration can be a life threating emergency requiring immediate intervention. Symptoms can go unnoticed for years with serious sequel. foreign body aspirated into air passage can lodge in the larynx, trachea or bronchi . Site of lodgment depend on the size, shape and nature of the foreign body.

3. Large foreign body , unable to pass through the glottis, will lodge in the supraglottic area while the smaller one will pass down through the larynx into the trachea or bronchi . Foreign bodies with sharp points , e.g. needles, fish bones, etc. can stick anywhere in the larynx or tracheobronchial tree.

4. AETIOLOGY Children are more often affected( 80% of cases ) more than half of them are below 4 years. In children , peanut is the most common vegetable In adults, foreign bodies are aspirated during coma, deep sleep or alcoholic intoxication. Loose teeth may be aspirated during anesthesia.

5. Predisposing factors Age: infants and young children Male gender Immature coordination of swallowing Neurological impairment Seizure disorder Anatomical or functional esophageal disorder Immature laryngeal sphincter control

6. Types of foreign bodies 1. Organic type. Peanut Sunflower seed Almond and popcorn leading to congestion and edema of the tracheobronchial mucosa “ vegetal bronchitis .” 2. Nonorganic type. Buttons Toys parts Pins and needles may remain symptomless for a long time.

7. CLINICAL FEATURES divided into three stages: 1. Initial Period of Choking, Gagging and Wheezing. This lasts for a short time. Foreign body may be coughed out or it may lodge in the larynx or further down in the tracheobronchial tree.

8. 2. Symptomless Interval. The respiratory mucosa adapts to the presence of foreign body and initial symptoms disappear. Symptomless interval will vary with the size and nature of the foreign body. It may last a few hours or a few weeks .

9. 3. Later Symptoms. caused by airway obstruction, inflammation or trauma induced by the foreign body and would depend on the site of its lodgment.

10. A- Laryngeal foreign body . large foreign body may totally obstruct the airway leading to sudden death . partially obstructive foreign body will cause discomfort or pain in the throat, hoarseness of voice, cough, aphonia , dyspnoea , wheezing and haemoptysis .

11. B- Tracheal foreign body. sharp foreign body produce cough and hemoptysis . loose foreign body like seed may move up and down the trachea between the carina and the undersurface of vocal cords causing “audible slap” wheeze may also be present.

12. (c) Bronchial foreign body. Most of them enter the right bronchus because it is wider and more in line with the tracheal lumen. A foreign body may totally obstruct a lobar or segmental bronchus causing atelectasis or it may produce a check valve obstruction, leading to obstructive emphysema . Emphysematous bulla may rupture causing spontaneous Pneumothorax Retained foreign body in the lung may later give rise to pneumonitis, bronchiectasis or lung abscess.

13. DIAGNOSIS 1.history and physical examination History of sudden onset of coughing, wheezing and diminished entry of air into the lungs on auscultation.

14. 2.Radiology 1. Soft tissue posteroanterior and lateral view of the neck in its extended position. 2. Plain X-ray chest in posteroanterior and lateral views It may show the radio-opaque foreign body Lobar or segmental atelectasis Unilateral hyperinflation and mediastinal shift pneumothorax. 3. CT chest.

15. Complication Pneumonia Lung abscess Bronchiectasis Hemoptysis Erosion and perforation

16. MANAGEMENT Laryngeal foreign body. large bolus of food obstructed above the cords may make the patient totally aphonic, unable to cry for help. He may die of asphyxia unless immediate first aid measures are taken. The measures consist of pounding on the back, turning the patient upside down and following Heimlich maneuver. Heimlich maneuver. Stand behind the person and place your arms around his lower chest and give four abdominal thrusts. The residual air in the lungs may dislodge the foreign body providing some airway Cricothyrotomy or emergency tracheostomy should be done if Heimlich maneuver fails .

17. Tracheal and bronchial foreign bodies can be removed by bronchoscopy with full preparation and under general anesthesia.

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