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Foreign bodies :yellow_heart: (:fireworks: Complications (Mortality after…
Foreign bodies
:yellow_heart:
True Emer
if it’s
:star:
Disc battery
regardless of any รู
Film: double lumen sign
Leakage of
Battery
contents ⇨ got Alkali ⇨ toxic effect, pressure necrosis ⇨ electrolytic reaction & mucosal burn
Got NaOH, KOH, Mercury
Timing
1 hr ⇨ Mucosal damage
2 to 4 hrs ⇨ Muscular layers
8 to 12 hrs ⇨ Perforation
Rx
Emergent Bronchoscopy
Observation for gastric location for 4-7 days
if bowel perforate ⇨ Laparotomy
Sharp or Too big
:earth_africa:
Epidemiology
Major cause of accidental death
Majority < 3 y/o (child)
Aspiration in Young children
Lack of molar teeth
Poor mastication
Tendency to put things in mouth
Playing with things in mouth
Immature protective laryngeal reflexes
Male > female
Rx
by Removal of
FB
Don’t หยอดน้ำ cuz it’s not helping
Nose: Right angle hook, Katz extractor, Alligator forceps, Bayomet forceps
Throat:
Heimlich maneuver
inward & upward force at fist on xiphoid
Throat—
Choking
Infant
5 back blows (ตบหลัง) ⇨ 5 chest thrusts (ตบอก)
ทำสลับกันไป
Child
Standing: Quick, upward thrust (just above navel)
or
Lying down: Gently, upward thrust in midline just above navel
Ear: Round FB in ear— uses Hook is better
Role of
Anes
If unstable ⇨ must
secure airway
:airplane:: (Priority over fasting guideline)
Spray cords with
2% topical lidocaine
to avoid laryngeal spasm
Ventilate via bronchoscope
Device/Instrument
Roth Net Retrieval device
ตะกร้อ ballon ลากออกมา [เหมือนของcvtที่ลากclot]
Fiberoptic bronchoscopy
Useful when
FB migrates to Distal bronchi
Introduced via ETT or LMA
:star: Age-appropriate Instrument & Communication with Surgical team are paramount!
Role of
Tracheotomy
:airplane:
If FB
too big or sharp
to pass thru glottic area ⇨ Concomitent tracheotomy
Significant laryngeal edema
Postop care
Clear liquid diet
Admission/Observation
CXR
Chest physiotherapy
ATBs (
if delayed Dx
)
:umbrella_with_rain_drops:
S&S
Cough, Dyspnea, Wheezing, Stridor, Rhonchi, :arrow_down: breath sound, Tachypnea
Cyanosis, Somnolence
Classic Hx
: Choking episode ⇨ then got Coughing spells
:eight_pointed_black_star: High sensitive for
Aspiration
Distribution of FB in airway
As
Rt bronchus
is more straighter ⇨ FB tends to fall into Rt side
:fireworks:
Complications
Mortality after bronchoscophy <1%
Bronchiectasis, Pneumonia, Bronchitis
Subcutaneous emphysema, Pneumothorax, Pneumomediastinum
Granulation tissue & Hemorrhage
Cartilage destruction
Airway compromise
Death
:male-scientist::skin-tone-5:
Inx
CXR
Most are Radiolucent (Food origin)
Inspiratory/Expiratory film
May find
Air trapping (on expiration)
Atelectasis
Inflitration
Consolidation
Film AP, Lateral,
Lateral decu(Rt&Lt)
Double lumen sign ⇨ :!: Disc battery
true emer
Normal in 20-40% of cases
Esophagoscopy
Fluoroscopy
(high spec)
⇨ Mediastinal shift, Paradoxical movement of diaphragm
CT scan
(high sense)
— not role tho
:star:
Bronchoscopy
Perform if 1 of the
following
is :heavy_plus_sign:
Hx
esp Hx Choking event then cough
PE
Radiography
Types
Rigid
Pro: can ventilate while enters
Cons: must be done under GA
Flexible
สีดำๆคนเคี้ยวได้
Pro: no pain (so no need for GA)
Cons: can’t ventilate
:star: Radio. Helps Localize & Identify FB