气管异物.ppt

Foreign bodies in the trachea and bronchus,Foreign body aspiration can result a spectrum of changes, from minimal symptoms, to respiratory compromise, failure, and even death.,Etiology,Foreign 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.,Etiology,Adults who are unable to protect the airway, are also at risk of aspiration due to decreased airway protective mechanisms. Mental retardation Alcoholism Psychoses Neurologic disorders,A drawing pin in the left main bronchus,A peanut in the right main bronchus,Anatomy,Most 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.,Pathophysiology,Aspirated 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.,Clinical Features,Tracheal foreign bodies An audible slap heard at the open mouth during cough. Palpable slap with respirations. Asthmatoid wheeze heard with the ear at the patients mouth.,Clinical Features,Bronchial foreign bodies Three 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 Features,Initial symptoms Cough and dyspnoea occur at the time of accident. Bloodstained expectoration is sometimes present.,Clinical Features,General symptoms Cough with or without dysponea. Expectoration. Asthmatoid wheeze.,Clinical Features,Special symptoms Depend upon whether the foreign body is of non-vegetable or of vegetable nature.,Clinical Features,Non-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.,Atelectasis occurs if the lobe of the lung is completely obstructed, with subsequent danger of infection and the formation of a lung abscess,Clinical Features,Clinical Features,An obstructive emphysema occurs if a lobe is only partially obstructed.,inspiration,expiration,Clinical Features,Vegetable 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 Features,Imaging 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 Features,X-ray Radiopaque foreign body. Atelectasis. Obstructive emphysema. Mediastinal shift. A patch of pneumonitis.,Radiopaque foreign body,Atelectasis.,Emphysema,3 days after removal,Mediastinal shift.,Complete atelectasis of the left lung, with a mediastinal shift towards the left lung.,A patch of pneumonitis.,Emphysema,5 days after removal,Treatment,Initial supportive therapy Oxygen administration. Cardiac monitor. Pulse oximetry. Antibiotics and steroids. Removal of the foreign body,Removal of the foreign body Removal through a bronchoscope. Removal by thoracotomy. Tracheostomy.,Treatment,Treatment,Removal through bronchoscope,Tracheostomy Tracheostomy may be nece