气管异物课件

Foreignbodyaspirationcanresultaspectrumofchanges,fromminimalsymptoms,torespiratorycompromise,failure,andevendeath.Foreignbodyaspirationcanre1EtiologyForeignbodyaspirationismostcommoninchildrenaged6monthsto4years.Theylackmolarsforpropergrindingoffood.Theytendtoberunningorplayingatthetimeofaspiration.Theytendtoputobjectsintheirmouthmorefrequently.Theylackcoordinationofswallowingandglotticclosure.EtiologyForeignbodyaspiratio2EtiologyAdultswhoareunabletoprotecttheairway,arealsoatriskofaspirationduetodecreasedairwayprotectivemechanisms.MentalretardationAlcoholismPsychosesNeurologicdisordersEtiologyAdultswhoareunable3AdrawingpinintheleftmainbronchusApeanutintherightmainbronchusAdrawingpinintheleftmain4AnatomyMostforeignbodieslodgeddistaltothelarynxandtracheaintherightmainstembronchus.Thediameteroftherightmainbronchusislargerthantheleft.Theangleofdivergencefromthetrachealaxisissmallerontheright.Airflowthroughtherightlungisgreaterthanthroughtheleft.Thecarinaismorelikelytobelocatedtotheleftofmidlineratherthantotheright.AnatomyMostforeignbodieslod5PathophysiologyAspiratedforeignbodiesmostcommonlyarelodgedintherightmainstemandlowerlobe.Peanutsarebyfarthemostcommonlyaspiratedmaterialinchildren,followedbyorganicmaterialsuchassunflowerseeds,piecesofvegetables,andhazelnuts.Inadults,vegetablematter,meat,andbonesrankhighest,followedbydentalandmedicalappliances.Aspirationofteethaftertraumaisobservedoccasionally.Pathophysiology6ClinicalFeaturesTrachealforeignbodiesAnaudibleslapheardattheopenmouthduringcough.Palpableslapwithrespirations.Asthmatoidwheezeheardwiththeearatthepatient'smouth.ClinicalFeaturesTrachealfore7ClinicalFeaturesMediastinalshift.Theirprogressdependsupontheirsizeandshape.Vegetablemattertendstobethemostcommonairwayforeignbody;peanutsarethemostcommonfooditemaspirated.AdrawingpinintheleftmainbronchusNon-vegetableforeignbodies.Theytendtoputobjectsintheirmouthmorefrequently.ClinicalFeaturesAtelectasis.Theytendtoputobjectsintheirmouthmorefrequently.Dependuponwhethertheforeignbodyisofnon-vegetableorofvegetablenature.VegetableforeignbodiesRemovaloftheforeignbodyMediastinalshift.AdrawingpinintheleftmainbronchusAnaudibleslapheardattheopenmouthduringcough.Airflowthroughtherightlungisgreaterthanthroughtheleft.Asymptomaticphase-Subsequentlodgingoftheobjectwithrelaxationofreflexesthatoftenresultsinareductionorcessationofsymptoms,lastinghourstoweeks.5daysafterremovalClinicalFeaturesClinicalFeaturesBronchialforeignbodiesThreedistinctstagesofaforeignbodyaccident:Initialphase-Chokingandgasping,coughing,orairwayobstructionatthetimeofaspirationAsymptomaticphase-Subsequentlodgingoftheobjectwithrelaxationofreflexesthatoftenresultsinareductionorcessationofsymptoms,lastinghourstoweeks.Complicationsphase-Foreignbodyproducingerosionorobstructionleadingtopneumonia,atelectasis,orabscess.ClinicalFeaturesClinicalFeat8ClinicalFeaturesInitialsymptomsCoughanddyspnoeaoccuratthetimeofaccident.Bloodstainedexpectorationissometimespresent.ClinicalFeaturesInitialsympt9ClinicalFeaturesGeneralsymptomsCoughwithorwithoutdysponea.Expectoration.Asthmatoidwheeze.ClinicalFeaturesGeneralsympt10ClinicalFeaturesSpecialsymptomsDependuponwhethertheforeignbodyisofnon-vegetableorofvegetablenature.ClinicalFeaturesSpecialsympt11ClinicalFeaturesNon-vegetableforeignbodies.Theirprogressdependsupontheirsizeandshape.Littleornoinflammatoryreactionoccursinthebronchialmucosaatfirst.Granulationsmayformlaterandcausehaemoptysis.Cough,afteritsinitialpresentation,disappearsbutitreturnsiftheobjectchangesposition.ClinicalFeaturesNon-vegetable12Atelectasisoccursifthelobeofthelungiscompletelyobstructed,withsubsequentdangerofinfectionandtheformationofalungabscessClinicalFeaturesAtelectasisoccursifthelobe13ClinicalFeaturesAnobstructiveemphysemaoccursifalobeisonlypartiallyobstructed.inspirationexpirationClinicalFeaturesAnobstructiv14ClinicalFeaturesVegetableforeignbodiesVegetablemattertendstobethemostcommonairwayforeignbody;peanutsarethemostcommonfooditemaspirated.Thereisalwaysanintenseinflammatoryreactionofthetracheaandbronchialmucosa.This-maybeaspecificallergicreactiontothevegetableoilliberatedbytheswellingobject.Symptomsofacutetracheitisandbronchitismaybepresent.ClinicalFeaturesVegetablefor15ClinicalFeaturesImagingStudies:

Posteroanteriorandlateralchestradiographsareanadjuncttothehistoryandphysicalexaminationinpatientsinwhomforeignbodyaspirationsaresuspected.Chestradiographs(inspiratoryandexpiratoryfilms)demonstrateatelectasisoninspirationandhyperinflationonexpirationwithaforeignbodyobstructingthebronchus.ClinicalFeaturesImagingStudi16ClinicalFeaturesX-rayRadiopaqueforeignbody.Atelectasis.Obstructiveemphysema.Mediastinalshift.Apatchofpneumonitis.ClinicalFeaturesX-ray17RadiopaqueforeignbodyRadiopaqueforeignbody18Threedistinctstagesofaforeignbodyaccident:Initialphase-Chokingandgasping,coughing,orairwayobstructionatthetimeofaspirationNeurologicdisordersForeignbodyaspirationismostcommoninchildrenaged6monthsto4years.Mostforeignbodieslodgeddistaltothelarynxandtracheaintherightmainstembronchus.Chestradiographs(inspiratoryandexpiratoryfilms)demonstrateatelectasisoninspirationandhyperinflationonexpirationwithaforeignbodyobstructingthebronchus.Non-vegetableforeignbodies.ClinicalFeaturesThereisalwaysanintenseinflammatoryreactionofthetracheaandbronchialmucosa.ClinicalFeaturesClinicalFeaturesMediastinalshift.ClinicalFeaturesPulseoximetry.ClinicalFeaturesClinicalFeaturesAdrawingpinintheleftmainbronchus5daysafterremoval5daysafterremovalCoughanddyspnoeaoccuratthetimeofaccident.Pulseoximetry.Atelectasis.Threedistinctstagesofafor19Emphysema3daysafterremovalEmphysema3daysafterremoval20Mediastinalshift.Mediastinalshift.21Completeatelectasisoftheleftlung,withamediastinalshifttowardstheleftlung.Completeatelectasisofthele22Apatchofpneumonitis.Apatchofpneumonitis.23Emphysema5daysafterremovalEmphysema5daysafterremoval24TreatmentInitialsupportivetherapyOxygenadministration.Cardiacmonitor.Pulseoximetry.Antibioticsandsteroids.RemovaloftheforeignbodyTreatmentInitialsupportiveth25RemovaloftheforeignbodyRemovalthroughabronchoscope.Removalbythoracotomy.Tracheostomy.TreatmentRemovaloftheforeignbodyTre26Treatment

RemovalthroughbronchoscopeTreatment

Removalthroughbron27TracheostomyTracheostomymaybenecessaryifoedemaofthelarynxdevelops,eitherbeforeorafterbronchoscopy.TreatmentTracheostomyTreatment28Theytendtoputobjectsintheirmouthmorefrequently.Aspiratedforeignbodiesmostcommonlyarelodgedintherightmainstemandlowerlobe.Adultswhoareunabletoprotecttheairway,arealsoatriskofaspirationduetodecreasedairwayprotectivemechanisms.Mediastinalshift.ClinicalFeaturesClinicalFeaturesThis-maybeaspecificallergicreactiontothevegetableoilliberatedbytheswellingobject.Aspirationofteethaftertraumaisobservedoccasionally.Theylackmolarsforpropergrindingoffood.Anaudibleslapheardattheopenmouthduringcough.VegetableforeignbodiesVegetableforeignbodiesClinicalFeaturesThediameteroftherightmainbronchusislargerthantheleft.Removalthroughabronchoscope.Non-vegetableforeignbodies.Theforeignbodyistoolargetoremovebybronchoscope.Theforeignbodyistoolargetoremovebybronchoscope.Littleornoinflammatoryreactionoccursinthebronchialmucosaatfirst.5daysafterremovalClinicalFeaturesMediastinalshift.ImagingStudies:Removalbythoracotomy.Theytendtoputobjectsintheirmouthmorefrequently.Symptomsofacutetracheitisandbronchitismaybepresent.Vegetablemattertendstobethemostcommonairwayforeignbody;peanutsarethemostcommonfooditemaspirated.Coughanddyspnoeaoccuratthetimeofaccident.VegetableforeignbodiesNeurologicdisordersObstructiveemphysema.Mostforeignbodieslodgeddistaltothelarynxandtracheaintherightmainstembronchus.Vegetablemattertendstobethemostcommonairwayforeignbody;peanutsarethemostcommonfooditemaspirated.ClinicalFeaturesCompleteatelectasisoftheleftlung,withamediastinalshifttowardstheleftlung.Pulseoximetry.MentalretardationClinicalFeaturesClinicalFeaturesTheytendtoputobjectsintheirmouthmorefrequently.VegetableforeignbodiesTheytendtoputobjectsintheirmouthmorefrequently.RemovalbythoracotomyTheforeignbodyissmallandlocateinthelower-lobebronchus.Theforeignbodyistoolargetoremovebybronchoscope.TreatmentTheytendtoputobjectsinth29EtiologyAdultswhoareunabletoprotecttheairway,arealsoatriskofaspirationduetodecreasedairwayprotectivemechanisms.MentalretardationAlcoholismPsychosesNeurologicdisordersEtiologyAdultswhoareunable30ClinicalFeaturesNon-vegetableforeignbodies.Theirprogressdependsupontheirsizeandshape.Littleornoinflammatoryreactionoccursinthebronchialmucosaatfirst.Granulationsmayformlaterandcausehaemoptysis.Cough,afteritsinitialpresentation,disappearsbutitreturnsiftheobjectchangesposition.ClinicalFeaturesNon-vegetable31ClinicalFeaturesVegetableforeignbodiesVegetablemattertendstobethemostcommonairwayforeignbody;peanutsarethemostcommonfooditemaspirated.Thereisalwaysanintenseinflammatoryreactionofthetracheaandbronchialmucosa.This-maybeaspecificallergicreactiontothevegetableoilliberatedbytheswellingobject.Symptomsofacutetracheitisandbronchitismaybepresent.ClinicalFeaturesVegetablefor32ClinicalFeaturesImagingStudies:

Posteroanteriorandlateralchestradiographsareanadjuncttothehistoryandphysicalexaminationinpatientsinwhomforeignbodyaspirationsaresuspected.Chestradiographs(inspiratoryandexpiratoryfilms)demonstrateatelectasisoninspirationandhyperinflationonexpirationwithaforeignbodyobstructingthebronchus.ClinicalFeaturesImagingStudi33Mediastinalshift.Mediastinalshift.34Littleornoinflammatoryreactionoccursinthebronchialmucosaatfirst.Initialphase-Chokingandgasping,coughing,orairwayobstructionatthetimeofaspirationClinicalFeaturesTheirprogressdependsupontheirsizeandshape.Littleornoinflammatoryreactionoccursinthebronchialmucosaatfirst.Palpableslapwithrespirations.Theirprogressdependsupontheirsizeandshape.Anaudibleslapheardattheopenmouthduringcough.5daysafterremoval3daysafterremovalTracheostomymaybenecessaryifoedemaofthelarynx