Overview.
Respiratory foreign body is one of the common emergencies in life. If there is a history of foreign body inhalation, or suspected foreign body inhalation, although there are no physical signs, or X-ray examination is negative, or there is no obvious cause of bronchial obstruction, as well as untreated acute and chronic pneumonia and pulmonary atelectasis of the patient should be considered for bronchoscopy, to further clarify the diagnosis. If certain foreign bodies are misdiagnosed and untreated, serious complications will arise, even life-threatening.
Causes
1. Children like to play with small objects in their mouths.
Sudden inhalation during crying, laughing or frightening, which can be inhaled into the respiratory tract if they are not careful.
2. The foreign body itself is smooth
If the jelly, dumplings, melon seeds, peanuts, beans, small rubber caps, plastic pipe caps, etc. are easy to inhale the respiratory tract.
3. Bad habits at work
Such as shoemakers will needle, nails, buttons, etc. in between the teeth, occasional inadvertence, or sudden speech will be foreign body inhalation. In addition, in vomiting, anesthesia, poisoning or suffering from neurological diseases, so that the pharyngeal reflex is inhibited can also be caused. Instruments may be dislodged during upper respiratory tract surgery, or the resected tissue may slip off, and instruments may be inhaled during root canal treatment of upper teeth.
4. Bad habits in life
For example, laughing and playing while eating, catching the food thrown out by mouth, etc.
5. Elderly and patients with certain diseases
Elderly people and patients with certain diseases (e.g. cerebrovascular disease, etc.) have weakened physiological regulation, which makes them prone to respiratory foreign body ingestion during eating and drinking.
Symptoms
When the foreign body enters the lower respiratory tract, there is a severe cough, and later there is often a long or short asymptomatic period, so it is easy to misdiagnose. Due to the nature of the foreign body, the different parts and shapes of the foreign body, the symptoms are also different, which are summarized as follows:
1. Foreign body in the throat
Foreign body into the throat, immediately choking, shortness of breath, reflex laryngospasm, and cause inspiratory dyspnea and wheezing, if the foreign body stays in the upper laryngeal orifice, there is hoarseness or difficulty in swallowing. If the foreign body stays in the upper larynx, there will be hoarseness of voice or difficulty in swallowing. If a slightly large foreign body is blocked in the vocal folds, it can be asphyxiated immediately.
2. Foreign body in trachea
When the foreign body is just inhaled, the symptoms are similar to those of laryngeal foreign body, mainly choking and coughing. Later, the active foreign body moves with the airflow, which can cause paroxysmal cough and dyspnea, and at the end of expiration, the foreign body can be heard in the trachea impacting on the tracheal wall and the beat of the subglottic area. And in the thyroid cartilage can be touched in the foreign body impact vibration feeling. As the tracheal lumen is occupied by the foreign body, or the subglottic area is edematous and narrow, resulting in incomplete obstruction of the airway, the patient has severe dyspnea and may cause stridor. With the prolongation of time, due to respiratory secretion and other reasons (such as the expansion of the blockage, etc.), the incomplete blockage of the airway can be developed to complete blockage, the patient manifested as unable to speak, extreme pain in the face and the V-shaped hand, accompanied by severe cyanosis, if the failure to discharge the foreign body, the patient will be comatose or even death.
3. Bronchial foreign body
Early symptoms are similar to tracheal foreign body. Due to different kinds of foreign bodies can appear different symptoms. Plant foreign body, such as peanuts, beans, mucosal irritation, often appear high fever, cough, sputum and other acute bronchitis symptoms. If the metal foreign body, the local stimulation is small, such as does not occur obstruction, can be stored in the bronchial tubes for several months without symptoms. Later, due to the foreign body embedded in the bronchus and cause different degrees of obstruction and different symptoms.
(1) Incomplete obstruction of bronchial tubes During inhalation, the bronchial tubes are enlarged so that air can enter; during exhalation, the bronchial tubes are narrowed so that less air is exhaled, which eventually leads to increasing gas at the distal end of the obstruction, and obstructive emphysema is formed. Examination can find: ① restriction of chest movement on the affected side when breathing; ② decreased breath sounds on the affected side, weakening of tremor, and tympanic sound on percussion.
(2) Complete obstruction of bronchial tubes If air cannot pass through the bronchial tubes during exhalation and inhalation, the air at the distal end of the obstruction is gradually absorbed by the lungs, resulting in the formation of obstructive pulmonary atelectasis. Examination reveals restricted respiratory movements on the affected side, a flat chest on the affected side, diminished or completely absent breath sounds, diminished palpation, and turbid tones on percussion on the affected side.
Examination
1. Characteristic manifestations of foreign bodies in the respiratory tract
Sudden choking and coughing, dyspnea, cyanosis, V-shaped hand shape, and painful face.
2. X-ray examination
X-ray fluoroscopy shows that the heart and mediastinum are shifted to the affected side, which does not move with respiration, the diaphragm on the affected side rises, the intercostal space is narrowed, and the shadow of the lungs is denser.
3. Bronchoscopy.
Diagnosis
Detailed history is most important. Detailed physical examination and X-ray examination are important means to diagnose foreign body.
If there is a history of foreign body inhalation, or suspected foreign body inhalation history, although there is no physical signs, or X-ray examination is negative, or there is no obvious cause of bronchial obstruction, as well as untreated acute and chronic pneumonia and pulmonary atelectasis of the patient should be considered for bronchoscopy, to further clarify the diagnosis.
Differential diagnosis
As the respiratory foreign body is mostly children, inhalation of foreign body, the family or not witnessed, and the child can not tell their own story. No history of foreign body inhalation can be asked, and children are often misdiagnosed as asthmatic bronchitis due to wheezing, or misdiagnosed as whooping cough due to paroxysmal choking, or misdiagnosed as pneumonia or bronchiectasis due to long-term respiratory tract infection. In all cases, the possibility of foreign body in the respiratory tract should be considered, and should be taken seriously. Detailed physical examination and X-ray examination are important means of diagnosing foreign body.
Treatment
After the diagnosis is confirmed, the foreign body should be removed by surgery. Active foreign bodies in the trachea without obvious respiratory difficulties can be removed by laryngoscopy. Intra-bronchial foreign bodies must be removed by bronchoscopy. If the foreign body is large and the dyspnea is serious, tracheotomy should be performed first, and then bronchoscope should be placed through the incision to remove it.
Respiratory foreign bodies stay for a long time often complicate lung infection, preoperative and postoperative antibiotics (penicillin, vancomycin) are needed to control the infection. If laryngeal edema has been complicated, or surgical operation time is too long, to prevent postoperative complication of laryngeal edema and respiratory difficulties, should be added with hormone therapy.
Prevention
1. Dietary attention
It is best not to give children under five years old to eat jelly, melon seeds, peanuts, beans and other foods. When eating watermelon, remove the seeds first. Eating to avoid talking, laughing, crying or scolding children. To change the bad habit of eating while walking and playing, so as not to cry once fell over and inhale the food in the mouth into the lower respiratory tract.
2. Teach children not to put small toys in their mouths.
When children are found to have something in their mouths, they should try to take it out in time. However, do not take it by force, so as to avoid inhalation after crying.
3. Work habits
Adults should change the habit of biting needles, nails and other things in the mouth when working to prevent accidents. For coma or general anesthesia after the patient is not awake, we must be careful care: remove in advance has shaken the denture, vomiting, the head should be turned to the side, so as not to vomit inhalation of the lower respiratory tract.
4. For the elderly and certain diseases, especially cerebrovascular disease patients
Special attention should be paid to drinking and eating, it is best to take a sitting position or semi-recumbent position, do not feed in a hurry, avoid eating and drinking in large mouths.