Tracheobronchial foreign body
Introduction
Brief introduction of tracheobronchial foreign body Foreign body of tracheal bronchus (foreignbody oftracheaandbronchus) is a common clinical emergency, foreign body can remain in the throat, throat, trachea and bronchus, causing hoarseness, difficulty breathing, etc., right bronchus is thick and short, so foreign matter easily falls into the right main bronchus . 75% occur in children under 2 years of age. Severity depends on the nature of the foreign body and the degree of airway obstruction. Lighter can cause lung damage, and severe cases can suffocate and die. Foreign bodies are endogenous and exogenous. Endogenous foreign bodies are pseudomembranes, dryness, blood clots, pus, vomit, etc. due to inflammation of the respiratory tract. Exogenous foreign bodies are various objects that are inhaled by the mouth. basic knowledge The proportion of illness: 0.06% Susceptible people: no specific population Mode of infection: non-infectious Complications: pneumonia, lung abscess, empyema, atelectasis, emphysema
Cause
Tracheobronchial foreign body etiology
Foreign matter caused by mistakes into the airway (30%)
According to the source of foreign matter, there are two types of endogenous foreign bodies and exogenous foreign bodies. The former is a pseudomembrane in the respiratory tract, dryness, and cheese-like necrosis. The foreign body of the tracheobronchial is usually exogenous. All items inhaled by the mouth, foreign matter entering the trachea and bronchi are related to the following situations.
1. Young children like to grab food and inhale the trachea when crying or laughing.
2, children's teeth development is imperfect, chewing function is poor, can not chew hard food, plus the defense of the throat is poor, the protection is not perfect.
3. When you are joking or working, you may have food or articles in your mouth. If you accidentally or when you are laughing, you may inhale the trachea.
4, general anesthesia or coma patients, when the tracheal intubation may also loose teeth or dentures are not found; other vomit removal is not timely, can be inhaled into the trachea.
5. During upper airway surgery, the instrument device is unstable, or the excised tissue suddenly slips off the airway.
6. Psychiatric patients or attempted suicides.
Pathological changes (40%)
Foreign matter enters the trachea, caused by the bronchi, and is related to the nature of the foreign body, the residence time of the foreign body and the shape of the foreign body. In general, botanical foreign bodies such as peanuts are highly irritating to the mucous membrane due to the presence of free fatty acid, after entering the trachea. Inflammatory reaction of bronchial mucosa can occur in 2 to 3 days, manifested as mucosal congestion, edema, increased secretion, and partial obstructive manifestation. With the increase of secretions, and the swelling of foreign body after water absorption, complete obstruction may occur. The secretions gradually turned into purulent, and some showed granulation growth around the foreign body, and surrounded by foreign bodies, when sharp foreign matter entered the trachea, some could damage the mucosa, local mucosal hemorrhage, followed by congestion and swelling, metallic foreign bodies and animals Sex, chemical products are less irritating to the mucous membranes, and less inflammation occurs. However, if the residence time is long, trachea and bronchial inflammation may occur, followed by pneumonia, lung abscess, empyema and the like.
Prevention
Tracheobronchial foreign body prevention
1. First of all, educate children not to develop the habit of mouth inclusions. When children have food in their mouths, don't tease them to laugh, talk or scare. They should patiently persuade them to spit out and not snoring to prevent food from being inhaled into the trachea. If the child is already crying, it can no longer be forced to eat, otherwise it will easily lead to foreign matter entering the respiratory tract. Keep small items that your child can easily inhale where children can't get them. Toys should be safe.
2. When a child vomits, he should turn his head to one side, so that he can easily spit out, so as not to inhale the trachea.
3, if there are foreign bodies in the pharynx, you can never use your fingers to dig, or you can use the method of swallowing large pieces of food to suppress the foreign matter, you should try to induce it to spit out.
4, children under the age of 3 should try to eat less dried fruit, beans, parents and childcare workers should pay attention to children, do not give melon seeds, peanuts and other food to children.
Complication
Tracheobronchial foreign body complications Complications Pneumonia, lung abscess, empyema, atelectasis emphysema
1, lung infection: can be expressed with pneumonia, lung abscess and empyema.
2, respiratory blockage: light can have difficulty breathing, cyanosis, severe atelectasis or emphysema, and even suffocation.
3, heart failure: long-term poor breathing, patients may be due to difficulty breathing, hypoxia and heart failure.
Symptom
Tracheobronchial foreign body symptoms Common symptoms Abscess wheezing sound tracheal carina over the chest pain hemoptysis cyanosis cough dyspnea blisters
1. Clinical staging
(1) Inhalation period of foreign body: When the foreign body enters the trachea through the glottis, it will appear severe coughing. Some of them will have a short-term hernia and cyanosis. If the foreign body is invaded in the glottis, hoarseness and difficulty in breathing may occur. Asphyxia occurs, such as foreign matter entering the trachea or bronchi, except for a slight cough.
(2) Quiet period: foreign matter enters the trachea, and after bronchus, stays in a certain part, the irritation is reduced. At this time, the patient may have a mild cough without other symptoms, which is often neglected. The length of this period is uncertain, such as foreign matter blocking the trachea. Inflammation, this period will soon end and enter the third period.
(3) Inflammatory period: local stimulation of foreign body and secondary inflammation, aggravation of trachea, bronchial blockage, cough, atelectasis and emphysema, patients may have elevated body temperature in this period.
(4) Complications: With the development of inflammation, pneumonia, lung abscess or empyema may occur. Patients have high fever, cough, purulent sputum, chest pain, hemoptysis, difficulty breathing, etc. The length and severity of this period may be due to foreign bodies. Size, nature, patient's physique and treatment vary.
2, clinical manifestations of different parts of the foreign body, can have different symptoms.
(1) Throat foreign body: When foreign matter enters the larynx, a reflexive throat occurs and causes inspiratory dyspnea and severe irritating cough. If the foreign body stays at the throat, there is difficulty in swallowing or swallowing, such as foreign body lying. The glottic fissure, the suffocation of the larger one, the cough and hoarseness of the small person, difficulty in breathing, throat sounds, etc. If the foreign body is attached to the glottis in a small diaphragm, there may be only hoarseness and no other symptoms, sharp foreign objects. Hemoptysis and subcutaneous emphysema can occur in the stab wound.
(2) Tracheal foreign body: foreign matter enters the airway immediately, severe cough, red face, redness, suffocation, poor breathing and other symptoms. As the foreign body sticks to the tracheal wall, the symptoms can be temporarily relieved; if the foreign body is light and smooth and with breathing The airflow moves up and down between the glottis and the bronchi, and can cause irritating cough, smelling and slamming sounds; tracheal foreign bodies can smell and wheezing sounds, and the lungs have similar breath sounds. If the foreign body is large, the trachea is blocked, and the suffocation can be caused. This kind of situation is dangerous. Foreign bodies may come to the glottis at any time to cause difficulty in breathing or suffocation. Qingdao Medical College had a case of a 3-year-old child with a foreign body of watermelon, with a course of 10 months, during 10 months. Three times of suffocation occurred, all of which eased on the way to the hospital. This caused the watermelon to move up and down in the trachea and suddenly suffocated under the glottis to close the glottis.
3, bronchial foreign body early symptoms and tracheal foreign body similar, cough symptoms are mild, plant-like foreign body, bronchial inflammation is more obvious that is cough, phlegm, dyspnea degree is related to the location of foreign body and obstruction, when the bronchiole is completely obstructed, auscultation Side breathing sounds disappear; when not completely blocked, breath sounds may decrease.
Examine
Trachea bronchial foreign body examination
X-ray examination: Radioactive foreign matter can appear immediately. Transmitted foreign bodies can be diagnosed based on clinical manifestations, such as unexplained atelectasis, emphysema, bronchial pneumonia, and mediastinal shift. Chest penetration also has advantages over chest radiographs, which can dynamically observe changes in mediastinum. Total airway or main bronchial foreign body, the mediastinum becomes wider when inhaling. A bronchial foreign body on one side shows that the mediastinum swings with the breath. Small foreign bodies can sometimes be found in the chest and lateral faults. If necessary, CT or ultrasound can be performed to help diagnose.
If the foreign body stays for a long time and it is difficult to confirm the diagnosis, in addition to the need to discuss with the pulmonary surgeon, a bronchoscopy is necessary for a definitive diagnosis.
Diagnosis
Diagnosis and identification of tracheobronchial foreign body
diagnosis
1. History: Most patients have a clear history of foreign body inhalation, typical symptoms, combined with lung auscultation and X-ray examination, more can be clearly diagnosed.
2, clinical manifestations
(1) Symptoms: If there is no obvious history of foreign body inhalation, the patient should be recalled whether there is sudden and severe coughing, short-term suffocation, etc.; especially when children are laughing or crying when eating, the above symptoms should be considered, and the foreign body of the trachea should be considered. may.
(2) Signs: The signs of trachea and bronchial foreign bodies are another important aspect of diagnosis. Large and active foreign bodies in the trachea can sometimes be heard in the trachea of the neck. Individual cases can be heard without a stethoscope. At the time of palpation, there may be a slight vibration caused by foreign matter colliding with the tracheal wall. The lesion caused by the foreign body in the main bronchus is biased to one side, and the respiratory sound of the affected side is reduced or disappeared during auscultation, and the blisters may be heard when the lung is inflamed. In most cases, wheezing sounds can be heard, and signs such as emphysema and atelectasis can be found.
3, auxiliary examination diagnosis: clinical diagnosis should be in the first place in the history of foreign body inhalation, in the case of clear foreign body inhalation, even if the clinical manifestations and auxiliary examination are negative, should also be bronchoscopy; on the contrary, long-term treatment of lung inflammation , or X-ray examination and signs are in line with foreign bodies, even if there is no obvious history of foreign bodies, bronchoscopy should be performed.
Trachea, bronchial foreign body disease complex, changeable, must be carefully analyzed, comprehensive judgment can make a diagnosis, of the 411 cases of Qingdao Medical College, 60 cases of pathological signs are obvious, but no foreign body found during surgery, accounting for this group of cases 15% of patients with no foreign body found during surgery, anti-inflammatory treatment still has cough and asthma, can not completely rule out the diagnosis of foreign bodies, if necessary, need to perform bronchoscopy, because when performing bronchoscopy, enter the mirror When the wall was not seen, the foreign matter was not seen between the tracheal wall and the outer wall of the mirror tube, causing it to leak.
Differential diagnosis
It needs to be differentiated from foreign body of esophagus. When the flat foreign body such as coin is identified with the foreign body of the esophagus, the glottic fissure is in the longitudinal direction, and the direction of the narrow surface of the foreign body on the posterior anterior piece is more consistent with it, showing a longitudinal strip shadow on the lateral slice. The wide surface of the foreign body is displayed, and the esophagus has a narrow anteroposterior diameter and a wide transverse diameter. On the posterior anterior slice, a wide surface of the foreign body can be displayed, and the lateral slice has a narrow strip shadow.
Pay attention to the identification of general bronchitis, pneumonia, emphysema, asthma, empyema.
