Foreign body aspiration

Foreign body aspiration

    * Introduction
    * Diagnosis
    * Treatment
Foreign body aspiration can be a life-threatening emergency. A solid or semi-solid object can block the intake in the larynx or trachea. If the object is big enough to completely block the airway, asphyxia can cause rapid death. Grades of incomplete obstruction or obstructive lower carina passing object can cause signs and symptoms less severe.
Debilitating symptoms of chronic recurrent infections occur late in the extraction of the object or the patient may remain asymptomatic. Object identification can get sucked in some cases. The most frequently aspirated objects include seeds, bone fragments, small toys, nails, coins, fragments of medical instruments and dental equipment.
Unfortunately mortality occurs due to acute aspiration, and morbidity can occur due to acute hypoxia during episodes of acute or chronic lung destruction through a long drawn body.
Pathogenesis The human body has many defense mechanisms to keep the airway open. These include physical action of the epiglottis and arytenoid cartilages in blocking the airway, intense spasm of the vocal cords when they approach an object and a potent cough reflex. Yet none of these mechanisms is not perfect and often hangs in foreign corpora airways.
Almost complete obstruction of the larynx or trachea can cause immediate suffocation and death. The location will depend on the patient's age and physical position at the time of suction. Since the angles between the trachea and main bronchi are similar up to 15 years old, are found in both Foreign corpus bronchi with equal frequency in people in this age group. once with normal growth and development, right and left main bronchi at different angles starting from the trachea, right bronchus having a sharp angle. Objects that fall below the trachea are often found in the right than the left endobronchial tree.
Local inflammation, edema, local infiltration, ulceration and granulation tissue form may contribute to airway obstruction and remove the object by making it more difficult bronchoscopy. The airways will bleed to manipulation, the object will be hidden and difficult to identify the displaced. Traheoesofagiene mediastinitis or fistula may occur. Distal obstruction, emphysema cause trapped air local atelectazii, hypoxic vasoconstriction, pneumonia and possible loss of volume postobstructiva, initiation necrotizing pneumonia or abscess, suppurative pneumonia or bronchiectasis.
Bronchoscopy object can appear as a tumor. Even if it is removed inflammatory changes can not be completely reversible. It is believed that in these local changes may develop carcinoma. The incidence of complications increased to 24-48 hours, making foreign body removal imperative. Causes and risk factors: Children are at risk of aspiration toys, candies and seeds. The 1-3 years before chewing incomplete incisors and molars erupt objects can be propelled back waging inhalation reflex.
Among adults these conditions, actions and procedures to facilitate the extraction of foreign bodies: -Diminished swallowing reflex, diminished cough reflex -Mental retardation, alcohol or sedative use -General anesthesia, poor dentition -Dental devices, oral or throat procedures -Sensitivity of impaired unconsciousness -Seizures, maxillofacial trauma.
Signs and symptoms Children, especially those between 1-3 years are at risk of aspiration of foreign bodies due intrioduce tendency to mouth everything and because of the way of chewing. Young children with incompletely chewed food iainte incisors to the molars erupt. Objects or fragments may be driven back, waging an inhalation reflex.
Adults who suffer from oropharyngeal procedures have different oral devices are intoxicated, received sedatives or neurological and psychiatric problems, are exposed to risk of aspiration objects. Because young children and older people with neurological, cognitive or psychiatric-care and present his own case, the diagnosis is delayed. Coffee coronary syndrome: In this syndrome a large object (perhaps a piece of chewed meat) gets stuck in the larynx or trachea forcing complete airway obstruction. Respiratory distress, aphonia, cyanosis, unconsciousness and death occurring in rapid succession if the object is not displaced. When the degree of obstruction is less severe or when the subject ingested carina down lower, the presentation is less dramatic. Sudden onset of the triad of fever (coughing, wheezing, respiratory noise reduction) is not frequently observed. Early symptoms other than cough include fever, haemoptysis, dyspnoea and chest pain. History of choking episodes are not always obtained and can be ignored or misdiagnosed initially. Most patients or parents can identify a specific episode of drowning, though the presentation is delayed by more than a week. Latent period before onset of symptoms may be several months or years if the foreign body is a bone or inert inorganic material.
Patients can be treated empirically for other medical conditions, even though the episode was seen choking and drowning. Patients with chronic symptoms may be mistakenly diagnosed as having asthma or chronic bronchitis. Young children and patients with neurological or psychiatric disorders are at risk of aspiration but may not be able to describe symptoms or to report episodes of drowning.
Other risk factors include institutionalization, old age, poor dentition and the use of alcohol and drugs. Presentation with cyanosis, cough, breath hissing, pneumonia not remitted or localized bronchiectasis should raise the suspicion of foreign body aspiration, especially in people at risk of foreign body aspiration. Physical Exam: A small number of cases are discovered incidentally by chest radiography and bronchoscopic inspection. Patients may be asymptomatic or may be tested for other diagnoses. If obstruction is severe cyanosis may occur. Signs of consolidation may accompany pneumonia postobstructiva.
Many objects are discovered incidentally sucked or remain undiscovered. Asphyxiation fatal syndrome of acute upper airway obstruction associated with feeding, known as coffee and coronary aspiration of stomach contents are not associated with exhaustion of other objects.
Sunken objects in developed countries remains the fourth leading cause of death from unintentional injury. The incidence is 0. 5 deaths per 100. 000 people between 0-4 years old. is lower for adolescents and young adults. Then the incidence increases with age in the sixth decade. Morbidity increases if the object extraction is delayed beyond 24 hours.