Tracheobronchial foreign bodies are one of the common emergency cases in ENT.
It is most likely to occur in children and the elderly. About 500 children die from foreign bodies in the whistle each year in the United States, and nearly 3,000 children die each year in China due to accidental asphyxiation caused by swallowing foreign bodies or obstruction of tracheal foreign bodies. In Dalian, most of the treatment of tracheobronchial foreign body cases is concentrated in the Department of Otolaryngology of the First Hospital of Dalian Medical University. The analysis of 372 cases of tracheobronchial foreign bodies treated in our hospital in recent years found that 78% occurred in children aged 1-2 years, 11% in those aged 3-4 years, 5% in those aged 9-15 years and 3% in those aged 60 years or older, indicating that tracheobronchial foreign bodies mainly occurred in young children, children and the elderly.
Statistics found that the main types of tracheobronchial foreign bodies are.
(1) plant foreign bodies such as peanuts, melon seeds, hazelnuts, beans, etc.
(2) Mineral foreign bodies such as pins, pins with large heads, screws, root and crown treatment needles, nails, coins, sand grains, etc.
(3) Chemical synthetics such as plastic pen caps, whistles, plastic toys, loose dentures, etc.
(4) Animal foreign bodies such as fish spines, bone fragments, etc.
Young children and children are prone to tracheobronchial foreign bodies mainly because of.
(1) children’s chewing function and cough reflex are not sound, harder food is swallowed without chewing, and accidental aspiration is likely to occur.
(2) Children like to try small toys or food in their mouths, and are prone to inhale the orally contained objects when they are suddenly startled or cry.
(3) Parents or older children feeding young children deliberately teasing, frightening or scolding, resulting in food inhalation into the whistle. The elderly are often prone to tracheobronchial foreign bodies due to reduced chewing ability and cough reflex or combined neurological disorders.
Foreign body inhalation into the airway will immediately occur violent choking and coughing, red face and ears, and breath-holding, severe lip cyanosis, poor inspiration and other symptoms. If the foreign body is large and embedded in the larynx or trachea, death by asphyxiation can occur immediately. Therefore, if there is a clear history of foreign body misaspiration, misaspiration occurs when intense choking and coughing and timely consultation, tracheobronchial foreign body is not difficult to diagnose. Young children do not actively state when they accidentally aspirate peanuts and beans, and children are mostly afraid of parental reprimand and conceal their aspiration history, resulting in many children being misdiagnosed and mistreated with pneumonia for a long time. In the elderly, aspiration is easy to ignore because the cough reflex is reduced and the foreign body enters the vocal cords with only a mild cough, which is not noticed, and the foreign body can remain in the bronchus for a long time causing various complications, such as recurrent infections in the lower whistle, hemoptysis, pulmonary atelectasis and asthma.
Once a foreign body is diagnosed, bronchoscopic removal of the foreign body should be performed as soon as possible.
Depending on the patient’s age, systemic status, type of foreign body, and duration of surgery, the procedure can be performed without anesthesia or under general anesthesia, and most patients under 2 years of age are operated under no anesthesia. Some scholars also propose to operate under general anesthesia as much as possible.
Parents and caregivers of children should be widely informed that children before the age of 3 should not be given peanuts, melons, beans and other foods with nuclei, and small toys should not be given to children orally, nor should they jump and play while eating to avoid inhaling food when they fall down. When eating, do not scare, tease or scold to avoid crying and laughing. Teach children to break bad habits such as holding pen caps, whistles and small toys in their mouths. Any object that a child may inhale or swallow should not be used as a toy.
If a foreign body completely blocks the trachea, it can be life-threatening for more than four minutes, and even if it is successfully resuscitated, it often leaves serious sequelae such as aphasia and paralysis. Therefore, it is very important for parents to know how to save themselves in an emergency.
Pharyngeal stimulation method
Once a foreign body occurs in a child’s trachea, you can immediately put something like an index finger or toothbrush handle into the child’s mouth to reach the pharynx and stimulate him to cough and vomit to facilitate the discharge of foreign bodies.
Abdominal pushing method.
The child will lie on his back on the table, the rescuer put his hand on his abdomen between the umbilicus and the raphe, press upward against the abdomen and press upward appropriately, and the other hand gently on the chest wall, press upward and into the chest cavity appropriately to increase the pressure in the abdominal and thoracic cavities, repeatedly for many times, so that the foreign body can be coughing out. For older children, let them sit or stand, the rescuer stands behind them, holds the child with both arms, makes a fist with one hand, puts the thumb inward on the midpoint of the umbilicus and the fenestra of the child, presses the fist with the palm of the other hand, rhythmically pushes upward and inward to cause the diaphragm to lift and compress the bottom of the lungs, so that a strong airflow is generated in the lungs, so that it rushes outward from the trachea, forcing the foreign body to go straight to the mouth with the airflow and expelling it. The foreign body should be expelled, but care should be taken not to press on both sides of the midline.
Back tapping method.
In standing first aid, the rescuer stands behind the child’s side, places one arm on the child’s chest, surrounds the child, and gives continuous, sharp and strong tapping on the crest of the interscapular region with the palm of the other hand, in order to facilitate the discharge of foreign bodies. For a lying child, let the child bend his knees and curl up, facing the rescuer, while the rescuer holds his knees and thighs against the child’s chest and gives continuous, strong tapping with his palm root on the interscapularis ridge to make the foreign body expel.
Inverted back patting method.
For infants and young children, lift their legs upside down, so that the head drops down, while patting their backs, so that through the gravity of foreign bodies and choking gas impulse in the chest cavity, forcing foreign bodies to cough out; or let the child lying prone between the legs, head low feet high, and then use the palm of the hand forcefully in the child’s two interscapular crest continuous pat 4 times, if not effective, the child turned into a supine position, the back against the rescuer’s legs, and then the rescuer with index finger and middle finger to squeeze the child’s upper abdomen upward and backward, relax after pressure, repeatedly, to help the foreign body discharge. If the above methods do not work or the situation is urgent, while taking resuscitation measures, send to a nearby hospital as soon as possible, and do not stop resuscitation on the way. If cardiac arrest occurs, perform cardiopulmonary resuscitation. The doctor will perform laryngoscopy or tracheoscopy to remove the foreign body according to the condition, so do not delay.