Foreign Body of Air Passage

7/29/2019 Foreign Body of Air Passage

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P R E P A R E D B Y : N U R U L S Y A Z W A N I R A M L I

Foreign Bodies of Air Passages



Foreign Bodies of Air Passages

A foreign body (FB) aspirated into air passage canlodge in the larynx, trachea, or bronchi (depend onsize and nature of FB).

Large FB = can’t pass thru glottis lodge insupraglottic area.

Smaller FB = pass down thru larynx into trachea or bronchi.



Aetiology

Vegetable

Peanut (most common)

Almond seed

Peas

Beans

Wheat seed

Water melon seed

Piece of carrot or apple, etc

Nonvegetable

Plastic whistle

Plastic toys

Safety pins

Nails / Screws

Coins

Bones

Buttons

Hair clips

Marble, etc



Nature of Foreign Body

Non-irritating type

Eg: plastic, glass, metallic FB

Relatively non- irritating

May remain symptomless for a long time

Irritating type

Eg: vegetable (peanuts, beans, seeds, etc)

Set up diffuse violent reaction congestion and oedema of tracheobronchial mucosa ( vegetal bronchitis)

swell up with time causing airway obstruction and latersuppuration in the lung.



Clinical Features

Symptomatology of FB is divided into 3 stages:1) Initial period of choking, gagging and wheezing

Last for a short time

FB may be coughed out or it may lodged in the larynx or further

down in tracheobronchial tree

2) Symptomless interval

Resp. mucosa adapts initial symptoms dissappear

3) Later symptoms

Caused by obstruction to the airway, inflammation or traumainduced by FB and would depend on site of its lodgement.



Cont. Clinical Features

Sites of its lodgement:a) Laryngeal FB

Large FB totally obstruct airway sudden death (unless resuscitativemeasures urgently).

Partial obstructive discomfort, pain in throat, hoarseness of voice,croupy cough, aphonia, dyspnoea, wheezing and haemoptysis.

b) Tracheal FB Sharp FB cough, haemoptysis Loose FB move up and down the trachea btwn carina and undersurface

of vocal cords ‘audible slap’, ‘palpatory thud’ and asthmatoid wheeze.

c) Bronchial FB Right Bronchus (most) becoz wider and more in line with tracheal lumen

Totally obstruct lobar or segmental bronchus atelectasis Produce check valve obstruction obstructive emphysema Emphysematous bulla rupture spontaneous pneumothorax Retained FB in lung pneumonitis, bronchiectasis or lung abscess.



Types of bronchial obstruction



Diagnosis

Detailed Hx (FB ingestion)

PE of neck and chest Classical triad

Sudden onset of coughing

Wheezing Diminished air entry

Radiology: Plain X-Ray

CXR at end of inspiration and expiration Fluoroscopy/videofluoroscopy

CT chest



Inspiratory film on left, expiratory film on right ; Foreign body in left mainstem

bronchus



Inspiratory film on left ; expiratory film on right ; foreign body in right

bronchus



Management

Laryngeal FB

First aid measures:

1) Pounding on the back shud not be done

2) Turning the patient upside down if pt. partially

3) Heimlich’s manoeuvre obstructed

4) Cricothyrotomy or emergency tracheostomy (if Heimlich’s manoeuvre fails)

5) Once emergency over, FB can be removed by direct laryngoscopy or laryngofissure (if found impacted)











Chest thrusts for

pregnant victims



Cont. Management

Tracheal and Bronchial FBs Can be removed by bronchoscopy with full preparation and

under GA

Emergency removal not indicated unless there’s airway

obstruction or vegetable nature and likely to swell up. Methods to remove tracheobronchial FB:

1) Conventional rigid bronchoscopy

2) Rigid bronchoscopy with telescopic aid

3) Bronchoscopy with C-arm fluoroscopy

4) Use of Dormia basket or Fogarty’s balloon for rounded objects 5) Tracheostomy 1st and then bronchoscopy thru the tracheostome

6) Thoracotomy and bronchotomy for peripheral FBs

7) Flexible fibre optic bronchoscopy in selected adult pt.



Thank You

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Foreign Body of Air Passage