Management of Foreign body aspiration. Speaker : Dr. Pragati Nanda. Moderator : Dr. Subhash Chawla. www.anaesthesia.co.in [email protected] FOREIGN BODY ASPIRATION. Common ,but a life threatening problem. Cause of morbidity and mortality.
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1. soft palate is pulled up and posteriorly,prevent reflux of food into nasal cavities. 2. palatopharangeal folds move medially to form a slit, allow only chewed food to pass. 3. epiglottis moves down and close to glottis.
vegitable FB are slippery,hard to grip and friable. They usually get swollen, struk at subglottis, may lead to complete obstruction.
PATHOPHISIOLOGY tracheobronchitis and lung infection. Hence, when patient presents, often has fever.
Bronchi – 80-90%
Right mainstem most common
Less divergent angle
Larger objects, irregular edges
Relevant Anatomy tracheobronchitis and lung infection. Hence, when patient presents, often has fever.
Airway foreign bodies can become lodged in the larynx, trachea, and bronchus. The size and shape of the object determine the site of obstruction.
large, round, or expandable objects produce complete obstruction, and irregularly shaped objects allow air passage around the object, resulting in partial obstruction.
TYPES OF OBSTRUCTION. tracheobronchitis and lung infection. Hence, when patient presents, often has fever.
1. check valve: air can be inhaled but not exhaled.[emphysema]. 2. ball valve: air can be exhaled but not inhaled.[broncho pul segment collapse]. 3. bypass valve: FB partially obstructs both in insp. and exp. 4. stop valve: total obstruction, airway collapse and consolidation.
Presentation tracheobronchitis and lung infection. Hence, when patient presents, often has fever.
In general, aspiration of foreign bodies produces the following 3 phases:
Initial phase - Choking and gasping, coughing, or airway obstruction at the time of aspiration
Asymptomatic phase - Subsequent lodging of the object with relaxation of reflexes that often results in a reduction or cessation of symptoms, lasting hours to weeks
Complications phase - Foreign body producing erosion or obstruction leading to pneumonia, atelectasis, or abscess
Indications tracheobronchitis and lung infection. Hence, when patient presents, often has fever.
Perform surgical intervention with rigid bronchoscopy on patients:
who have a witnessed foreign body aspiration.
those with radiographic evidence of an airway foreign body.
those with the previously described classic signs and symptoms of foreign body aspiration. A strong history of suspected foreign body aspiration prompts an endoscopic evaluation, even if the clinical findings are not as conclusive or are not present
Contraindications tracheobronchitis and lung infection. Hence, when patient presents, often has fever.
No contraindications exist to the removal of an airway foreign body from a child.
If necessary, health problems can be optimized before surgical intervention. However, even children who are at high risk due to health reasons still need surgical intervention to remove the foreign body.
SPONTANEOUS VENTILATION. ADV; 1. no dislodgement of FB. 2. unhurried bronchoscopy. 3. relatively safe. DISADV; 1. inc coughing, bucking. 2. inc chances of bronco/ larangospasms and arrythmias.[inadequate depth]. 3. inc resistance bcoz of bronchoscope and suctioning. 4. large FB doesn’t come out because of VC movements and closure.