Laryngeal obstruction
Introduction
Brief Introduction to Laryngeal Block Laryngeal obstruction is a group of syndromes in which the lesion of the larynx or adjacent organs narrows the airway of the throat so that it has difficulty breathing. Because the laryngeal obstruction can cause hypoxia, if the treatment is not timely, it can cause suffocation and endanger the patient's life. Due to the rapid onset of the disease, the laryngeal obstruction is divided into acute and chronic. According to the history, symptoms and signs, the diagnosis of laryngeal obstruction is not difficult. X-ray examination is necessary to differentiate the diagnosis. Indirect laryngoscopy, direct laryngoscopy, fiber laryngoscopy, laryngeal X-ray film, CT throat scan, etc. can be used for diagnosis. Direct laryngoscopy is not easy for patients with acute heaviness because it can accelerate the occurrence of airway obstruction. basic knowledge The proportion of illness: 0.025% Susceptible people: no special people Mode of infection: non-infectious Complications: coma heart failure respiratory failure respiratory infection
Cause
Causes of laryngeal obstruction
Acute laryngeal obstruction
(A) inflammation: such as acute epiglottis, pediatric acute laryngitis, acute laryngotracheal bronchitis, inflammation of the vicinity of the throat, such as post-pharyngeal abscess, pharyngeal infection, submandibular cellulitis.
(2) Throat foreign bodies: especially large indentation foreign bodies, such as plastic bottle caps, glass balls, large Chinese medicine pills, etc.
(3) Laryngeal trauma: such as laryngeal contusion, bruise, crush injury, cut injury, injury, burn, laryngotracheal intubation injury, endoscopic injury.
(d) allergic or neurovascular edema.
(5) bilateral recurrent laryngeal nerve paralysis (more common in thyroidectomy).
Chronic throat obstruction
(1) sequelae of laryngeal trauma: such as scarring laryngeal stenosis, iatrogenic injury (such as tracheotomy, endoscopy, endotracheal intubation, especially laryngeal granulation tissue hyperplasia or cartilage scaffold necrosis caused by long-term balloon intubation Lesion.
(2) Scar hyperplasia caused by surgery of benign and malignant tumors of the larynx (such as a wide range of vocal cord papilloma and various types of half-throatectomy).
(3) Compression of neck lesions: such as neck tumors, giant goiter, metastatic carcinoma of the neck, etc.
Prevention
Laryngeal obstruction prevention
1. Closely observe the vital signs such as breathing, pulse, and whether there is irritability.
2. Take the denture in the exit.
3, the surrounding environment is quiet, the light is suitable, the air is fresh and ventilated, but avoid direct blowing.
4, when heating in winter, the heat source should not be placed close, including air conditioning.
5, the supine position generally takes the head high and low, but it is not appropriate to put the items under the head, can be placed on the side of the head.
6, do not eat foods with high sugar and fat.
7, observe the stool, pay attention to keep open, if there is constipation, take the soup, do not take medicine.
8. Regardless of the liquid or powder, it should be fed slowly in small amounts. After hearing the ingestion of the drug, feed the second spoon.
Complication
Laryngeal obstruction complications Complications, coma, heart failure, respiratory failure, respiratory infection
Due to lack of oxygen, irritability, restlessness, severe hypoxia, cold limbs, pale or cyanosis, cold sweat on the forehead, elevated blood pressure, so that heart failure, coma, death.
Symptom
Laryngeal obstruction symptoms Common symptoms Inspiratory difficulty Difficulty breathing cold sweat purple face pale pale blood pressure drop throat hair tight throat irritability hoarseness hoarseness
(1) Inspiratory dyspnea: The reason is that the vocal cord is tilted in the flat and downward direction. Under normal circumstances, the airflow pushes the slanting door inward and downward when inhaling, but due to the outreach of the vocal cord, the glottis opens and the breathing is smooth. However, when the glottis is narrowed, the inhaled airflow pushes the vocal cords downward, so that the free edges of the vocal cords on both sides are close to each other, so the glottis is narrower and inhalation is difficult.
(2) Inspiratory laryngo: A sound that occurs due to the vibration and eddy current generated by the airflow through the narrow throat. When the mucous membrane under the glottis is swollen, a dog-like croup can be produced.
(3) Inspiratory soft tissue depression: due to the negative pressure generated in the thoracic cavity during inhalation, the soft tissue of the chest wall is invaded and the inspiratory depression of the upper sternal fossa, the supraclavicular fossa, the intercostal space and the upper abdomen appears.
(4) The voice is hoarse: the lesion is at the vocal cords, and the hoarseness is caused by the vocal cord movement disorder.
(5) According to the severity of the disease, the laryngeal obstruction can be divided into four degrees:
Once: Asymptomatic when calm, mild inspiratory difficulty during activity.
Second degree: There is mild inhalation dyspnea in quiet, increased during activities, but does not affect sleep and eating, and the symptoms of hypoxia are not obvious.
Third degree: the breathing difficulty is obvious during the inhalation period, the throat sounds louder, the external soft tissue such as the sternal upper fossa and the supraclavicular fossa are obviously inflated during the inhalation period, and the irritability is caused by lack of oxygen, it is difficult to fall asleep, and the patient is not willing to eat, and the patient's pulse is accelerated. The blood pressure is high and the heartbeat is strong and powerful, that is, the compensation function of the circulatory system is still good.
Four degrees: extremely difficult breathing, due to severe hypoxia and carbon dioxide accumulation in the body, the patient is restless, cold sweating, pale or cyanosis, incontinence, weak pulse, irregular heartbeat, blood pressure drop, if not rescued in time, due to Death of suffocation and heart failure.
Examine
Laryngeal obstruction
According to the history, symptoms and signs, the diagnosis of laryngeal obstruction is not difficult. X-ray examination is necessary to differentiate the diagnosis. Indirect laryngoscopy, direct laryngoscopy, fiber laryngoscopy, laryngeal X-ray film, CT throat scan, etc. can be used for diagnosis. Direct laryngoscopy is not easy for patients with acute heaviness because it can accelerate the occurrence of airway obstruction.
Indirect laryngoscopy and fiberoptic laryngoscopy are common laryngeal mucosal edema, hematoma, hemorrhage, tear, laryngeal cartilage exposure and pseudo-channel. The glottic stenosis is limited, and the vocal cord activity is limited or fixed.
The lateral lateral slice and the body slice can show the location of the laryngeal fracture and tracheal injury. Chest X-rays can show whether there is pneumothorax and emphysema.
CT scan of the neck is extremely valuable for the diagnosis of fracture, displacement and laryngeal structural deformation of the hyoid bone, thyroid cartilage and annular cartilage.
MRI of the neck is of great value in judging the damage of the throat, neck soft tissue and blood vessels.
Diagnosis
Diagnosis of laryngeal obstruction
diagnosis
According to the symptoms, medical history and the above examinations, the disease can be diagnosed.
Differential diagnosis
It should be differentiated from pulmonary, central and cardiogenic dyspnea.
Pulmonary dyspnea
Both inhalation and exhalation are difficult. Obvious expiratory difficulty in bronchial asthma, no hoarseness. The auscultation of the lungs can be heard and wheezing. If the lungs are inflamed, the auscultation of the lungs can have a wet voice. X-ray examination can assist with diagnosis.
2. Central dyspnea
Caused by inhibition of the respiratory center. Slow or irregular breathing, such as tidal breathing, intermittent breathing, nodding breathing, etc. There are many cases of primary disease.
3. Cardiac dyspnea
Breathing gas is difficult, relieved when sitting or standing, aggravated when lying down, patients have symptoms and signs of heart disease.
