气管异物课件

Foreign body aspiration can result a spectrum of changes,from minimal symptoms,to respiratory compromise,failure,and even death.Foreign body aspiration can re1EtiologyForeign body aspiration is most common in children aged 6 months to 4 years.They lack molars for proper grinding of food.They tend to be running or playing at the time of aspiration.They tend to put objects in their mouth more frequently.They lack coordination of swallowing and glottic closure.EtiologyForeign body aspiratio2EtiologyAdults who are unable to protect the airway,are also at risk of aspiration due to decreased airway protective mechanisms.Mental retardationAlcoholismPsychosesNeurologic disordersEtiologyAdults who are unable 3A drawing pin in the left main bronchusA peanut in the right main bronchusA drawing pin in the left main4AnatomyMost foreign bodies lodged distal to the larynx and trachea in the right mainstem bronchus.The diameter of the right main bronchus is larger than the left.The angle of divergence from the tracheal axis is smaller on the right.Airflow through the right lung is greater than through the left.The carina is more likely to be located to the left of midline rather than to the right.AnatomyMost foreign bodies lod5PathophysiologyAspirated foreign bodies most commonly are lodged in the right main stem and lower lobe.Peanuts are by far the most commonly aspirated material in children,followed by organic material such as sunflower seeds,pieces of vegetables,and hazelnuts.In adults,vegetable matter,meat,and bones rank highest,followed by dental and medical appliances.Aspiration of teeth after trauma is observed occasionally.Pathophysiology6Clinical FeaturesTracheal foreign bodiesAn audible slap heard at the open mouth during cough.Palpable slap with respirations.Asthmatoid wheeze heard with the ear at the patients mouth.Clinical FeaturesTracheal fore7Clinical FeaturesMediastinal shift.Their progress depends upon their size and shape.Vegetable matter tends to be the most common airway foreign body;peanuts are the most common food item aspirated.A drawing pin in the left main bronchusNon-vegetable foreign bodies.They tend to put objects in their mouth more frequently.Clinical FeaturesAtelectasis.They tend to put objects in their mouth more frequently.Depend upon whether the foreign body is of non-vegetable or of vegetable nature.Vegetable foreign bodiesRemoval of the foreign bodyMediastinal shift.A drawing pin in the left main bronchusAn audible slap heard at the open mouth during cough.Airflow through the right lung is greater than through the left.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.5 days after removalClinical FeaturesClinical FeaturesBronchial foreign bodiesThree distinct stages of a foreign body accident: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.Clinical FeaturesClinical Feat8Clinical FeaturesInitial symptomsCough and dyspnoea occur at the time of accident.Bloodstained expectoration is sometimes present.Clinical FeaturesInitial sympt9Clinical FeaturesGeneral symptomsCough with or without dysponea.Expectoration.Asthmatoid wheeze.Clinical FeaturesGeneral sympt10Clinical FeaturesSpecial symptoms Depend upon whether the foreign body is of non-vegetable or of vegetable nature.Clinical FeaturesSpecial sympt11Clinical FeaturesNon-vegetable foreign bodies.Their progress depends upon their size and shape.Little or no inflammatory reaction occurs in the bronchial mucosa at first.Granulations may form later and cause haemoptysis.Cough,after its initial presentation,disappears but it returns if the object changes position.Clinical FeaturesNon-vegetable12Atelectasis occurs if the lobe of the lung is completely obstructed,with subsequent danger of infection and the formation of a lung abscessClinical FeaturesAtelectasis occurs if the lobe13Clinical FeaturesAn obstructive emphysema occurs if a lobe is only partially obstructed.inspirationexpirationClinical FeaturesAn obstructiv14Clinical FeaturesVegetable foreign bodies Vegetable matter tends to be the most common airway foreign body;peanuts are the most common food item aspirated.There is always an intense inflammatory reaction of the trachea and bronchial mucosa.This-may be a specific allergic reaction to the vegetable oil liberated by the swelling object.Symptoms of acute tracheitis and bronchitis may be present.Clinical FeaturesVegetable for15Clinical FeaturesImaging Studies:Posteroanterior and lateral chest radiographs are an adjunct to the history and physical examination in patients in whom foreign body aspirations are suspected.Chest radiographs(inspiratory and expiratory films)demonstrate atelectasis on inspiration and hyperinflation on expiration with a foreign body obstructing the bronchus.Clinical FeaturesImaging Studi16Clinical FeaturesX-rayRadiopaque foreign body.Atelectasis.Obstructive emphysema.Mediastinal shift.A patch of pneumonitis.Clinical FeaturesX-ray17Radiopaque foreign bodyRadiopaque foreign body18Three distinct stages of a foreign body accident:Initial phase-Choking and gasping,coughing,or airway obstruction at the time of aspirationNeurologic disordersForeign body aspiration is most common in children aged 6 months to 4 years.Most foreign bodies lodged distal to the larynx and trachea in the right mainstem bronchus.Chest radiographs(inspiratory and expiratory films)demonstrate atelectasis on inspiration and hyperinflation on expiration with a foreign body obstructing the bronchus.Non-vegetable foreign bodies.Clinical FeaturesThere is always an intense inflammatory reaction of the trachea and bronchial mucosa.Clinical FeaturesClinical FeaturesMediastinal shift.Clinical FeaturesPulse oximetry.Clinical FeaturesClinical FeaturesA drawing pin in the left main bronchus5 days after removal5 days after removalCough and dyspnoea occur at the time of accident.Pulse oximetry.Atelectasis.Three distinct stages of a for19Emphysema3 days after removalEmphysema3 days after removal20Mediastinal shift.Mediastinal shift.21Complete atelectasis of the left lung,with a mediastinal shift towards the left lung.Complete atelectasis of the le22A patch of pneumonitis.A patch of pneumonitis.23Emphysema5 days after removalEmphysema5 days after removal24TreatmentInitial supportive therapy Oxygen administration.Cardiac monitor.Pulse oximetry.Antibiotics and steroids.Removal of the foreign bodyTreatmentInitial supportive th25Removal of the foreign bodyRemoval through a bronchoscope.Removal by thoracotomy.Tracheostomy.TreatmentRemoval of the foreign bodyTre26TreatmentRemoval through bronchoscopeTreatmentRemoval through bron27TracheostomyTracheostomy may be necessary if oedema of the larynx develops,either before or after bronchoscopy.TreatmentTracheostomyTreatment28They tend to put objects in their mouth more frequently.Aspirated foreign bodies most commonly are lodged in the right main stem and lower lobe.Adults who are unable to protect the airway,are also at risk of aspiration due to decreased airway protective mechanisms.Mediastinal shift.Clinical FeaturesClinical FeaturesThis-may be a specific allergic reaction to the vegetable oil liberated by the swelling object.Aspiration of teeth after trauma is observed occasionally.They lack molars for proper grinding of food.An audible slap heard at the open mouth during cough.Vegetable foreign bodiesVegetable foreign bodiesClinical FeaturesThe diameter of the right main bronchus is larger than the left.Removal through a bronchoscope.Non-vegetable foreign bodies.The foreign body is too large to remove by bronchoscope.The foreign body is too large to remove by bronchoscope.Little or no inflammatory reaction occurs in the bronchial mucosa at first.5 days after removalClinical FeaturesMediastinal shift.Imaging Studies:Removal by thoracotomy.They tend to put objects in their mouth more frequently.Symptoms of acute tracheitis and bronchitis may be present.Vegetable matter tends to be the most common airway foreign body;peanuts are the most common food item aspirated.Cough and dyspnoea occur at the time of accident.Vegetable foreign bodiesNeurologic disordersObstructive emphysema.Most foreign bodies lodged distal to the larynx and trachea in the right mainstem bronchus.Vegetable matter tends to be the most common airway foreign body;peanuts are the most common food item aspirated.Clinical FeaturesComplete atelectasis of the left lung,with a mediastinal shift towards the left lung.Pulse oximetry.Mental retardationClinical FeaturesClinical FeaturesThey tend to put objects in their mouth more frequently.Vegetable foreign bodiesThey tend to put objects in their mouth more frequently.Removal by thoracotomy The foreign body is small and locate in the lower-lobe bronchus.The foreign body is too large to remove by bronchoscope.TreatmentThey tend to put objects in th29