Methods for removing foreign bodies from the respiratory tract. Foreign body in the airways. Ways to rescue Rules for removing a foreign body from the respiratory tract

Situations in which a foreign body can enter the respiratory tract are not uncommon. Active communication and laughter during meals, hasty absorption of food with poor chewing, alcohol intoxication are the most common causes of such cases in adults.

But even more often cases of foreign objects entering the respiratory tract occur with children (more than 90%). They like to take small objects in their mouths, spin around, talk, laugh and play while eating.

Sometimes it is enough for the victim to cough quickly enough to clear the airways. But if the coughing fits continue, the person begins to grab his throat, cannot breathe, his face, which at first turned red, begins to turn pale, and then turn blue - emergency care is required. Delay threatens his life and health. It is necessary to immediately call an ambulance and take urgent measures to free the airways before the arrival of doctors.

Removal of a foreign body from the respiratory tract using the Heimlich maneuver

In children

Signs: The victim is suffocating, unable to speak, suddenly becomes bluish, may lose consciousness. Often children inhale parts of toys, nuts, sweets.

In adults

In pregnant women or obese victims (it is impossible or impossible to give thrusts to the abdomen).

If the victim has lost consciousness, call an ambulance and proceed with cardiopulmonary resuscitation. It is carried out only on a hard surface.

Continue resuscitation until medical personnel arrive or until spontaneous breathing is restored.

After restoring breathing, give the victim a stable lateral position. Ensure constant breath control until the arrival of an ambulance!

Everyone knows that it is better to prevent injuries or diseases than to be treated later and suffer from their consequences. To avoid getting into the respiratory tract of foreign bodies does not require much effort. It is enough to follow a few simple rules:

• do not rush to eat and chew food thoroughly;
• while eating, do not be distracted by conversations, disputes and showdown - violent emotions, laughter and sudden movements with a full mouth can end with Heimlich techniques;
• do not eat lying down, on the go on the street, in transport, especially while driving;
• to wean children and not to keep foreign objects in their mouths: pen caps, coins, buttons, batteries, and the like.

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They say that the cynicism of a doctor goes beyond all limits. Friends walking into the staff room have their hair on end from our conversations. Illness and death are a common excuse for endless jokes and jokes for us. But even among doctors there are topics that are not customary to be ironic and mention once again. One of them is death from asphyxia. In this article, we will consider the most “everyday” of the causes of suffocation - a foreign body in the respiratory tract, and tell you how to provide first aid.

Death from asphyxia. Nobody is safe

In the vast majority of hospital patients, the process of dying from asphyxia lasts in several stages and most often, before the last cardiac impulse (not breathing, since they are on a ventilator), they are in an unconscious state.

Dying from suffocation in community settings until the last moment of consciousness, they feel their respiratory muscles "torn" as they try to breathe. They feel how a pulse wave beats like a hammer in the head, the blood vessels in the eyes burst from tension. A person recently completely healthy, understands that he is about to die, and this terrifies him. And only at the very last moment he falls into a black void ...

Unfortunately, one of the reasons leading to misfortune is a completely domestic reason - a person choked on food.

Probably, the Creator did not design our body very well, connecting the respiratory and digestive tracts into one tube. Only a thin petal-epiglottis protects the respiratory organs from trouble. On the other hand, it is not known how the process of our development and transmission of information would be transformed if we had a facial skeleton with rigidly separated tracts? Perhaps someone with imagination and artistic talent will depict a viable creature with a similar facial skeleton, but for now we will continue our story.

Today, we are what we were created, whether in the course of evolution or in the design bureau of the divine academy, and this will have to come to terms. But it is curious that in animals the state of “hit in the wrong neck” is extremely rare. No, my dog ​​chokes when he swallows an incredible piece of meat, but he expectorates it on his own and eats calmly. Lions in the pride, when dividing the prey, tear kilogram pieces of meat and swallow without choking. How? After all, in general, the structure of our skeleton is similar?

I come to the conclusion that our ancestors were very, very right when they said: "When I eat, I am deaf and dumb." Indeed, during a conversation, the epiglottis momentarily opens the entrance to the trachea, and this will be enough for you to choke during inhalation.

However, in medical practice there are more exotic cases: for example, a woman ate a barbecue, and a piece of meat got stuck in her upper esophagus. She did not suffer from asphyxia and could easily go to the hospital. But our people are not looking for simple solutions. The woman grabbed a pool cue and pushed the piece down. Have you submitted this process yet? Terribly erotic spectacle. The only problem is that she tore her esophagus, giving herself mediastinitis. Until now, few people survive in this state, but she was lucky.

Children - special attention!

Small children. Oh, these creatures that are always in good shape. They are always striving for something, climbing into such cracks where an adult is afraid to even look. They have no fear, they have no sense of self-preservation at all! They constantly learn something, they drag everything into their mouths to try, to hide.

As a student, a teacher in ENT diseases told us: “Guys, buy shirts and blouses with a pocket on your chest for your children. They definitely need to hide their find, and if there is no pocket, then in the mouth. All pediatric endoscopists have a collection of findings from the respiratory tract, including from the trachea, larynx, and nose. And ENT doctors supplement these collections with items taken from the outer ear.

How to be with children? Do not leave them alone, take away small things - that's the only way! And do not let them eat what is not intended for their age, understand - the digestive system, ready to accept liquid milk, is not yet ready to accept sausage.

Sometimes adults surprise with their carelessness. A few years ago, while on a business trip in a small hospital, which is far from always accessible by car, and planes are limited by meteorological conditions, I received a two-year-old baby. He was restless, constantly coughing. It turned out - a grandmother from a year and a half gave him unpeeled seeds to husk! She was still very surprised when we told her everything that we think about it.

So simple carelessness almost led to tragedy. We then observed the baby, waited for the arrival of endoscopists, prepared resuscitation equipment, since it is impossible to predict the reaction of the bronchi. Only twelve hours later, regional specialists managed to reach the village. Under general anesthesia, a large seed was removed from the right bronchus; it floated to the beat of breathing.

The boy was lucky, it often happens that a foreign body cannot be removed, and it remains in the lung. Subsequently, such patients often have pneumonia, bronchitis, and asthma develops.

First aid procedure

So, what to do if you choke, a piece of food got into the larynx and blocked the airways?

Cough if your child is older than one year, ask the child to cough. At the same time, do not shake or pat on the back, do not make the piece fall further.

If it doesn’t help, ask the sufferer to open his mouth, wring out his tongue with your finger, if you are sure that you can get it - get it! If there is no certainty and breathing is relatively unaffected - let the specialists take care of the victims - do not risk it!

If the patient weakens, turns blue, the cough decreases, and the ambulance is still on the way, then you need to act on your own!

Stand behind, grab the patient at waist level, while clenching one hand into a fist, so that the fist is just above the navel, but in the center (otherwise, with a sharp movement, you risk tearing the liver!). With the other hand, firmly grasp the fist of your hand and sharply push yourself up and up, this will create high airway pressure, which should squeeze out the foreign body like a cannon. Do this several times until the piece comes out, until the doctor arrives, or in the worst case until the resuscitator loses consciousness.

If nothing helped, the person lost consciousness and does not respond to a shake - do not panic, there are still chances for salvation! Put the patient on a hard surface, unbutton his shirt, open his mouth, wring out his tongue, see if the foreign body can now be removed. If you see it, be sure to try to extract it, because time is not on your side in such a situation.

Tilt your head back, stretch your jaw up, listen for breath. No breath? Turn the victim's head to one side. Didn't get breath? Put a napkin over his mouth, pinch his nose, slowly inhale a portion of your air into the patient. If the chest rises, gently continue to breathe and wait for the ambulance to arrive.

If in response to your breath the chest does not rise, stand at the knees of the patient, rest your palms in the middle of the abdomen just above the navel and sharply press down and at the same time towards the head, as if pushing out a foreign body, and so ten times in a row. Then look in your mouth to see if a foreign body has come out? If not, then try CPR again. Then press down on your stomach again.

Even if you managed to remove the foreign body, in any case, take the patient to the hospital, because hypoxia could damage the internal organs, you could damage the internal organs, or a piece of the foreign body could remain in the airways. Be sure to bring!

Vladimir Shpinev

Photo 1 - thinkstockphotos.com, 2-3 - by the author

One of the most critical pathologies that anyone can encounter is a foreign body in the airways. Emergency assistance in these situations should be provided instantly - in the first seconds. Certain maneuvers that everyone can master can save the life of an adult and a child if they are applied immediately.

At times more often this pathology develops in patients of childhood. This is due to the peculiarities of the behavior of babies - while eating, they tend to play, talk, laugh or cry, cough. In addition, children very often take various small objects into their mouths, which they can then accidentally inhale. The anatomical features of the oral cavity and the underdevelopment of protective reflexes in children also contribute to an increase in cases of aspiration (inhalation) of foreign bodies (FB) in young patients.

Adults most often suffer from this pathology when greedily absorbing food without chewing it, or when actively talking while eating. Another "aggravating circumstance" is alcohol intoxication, which reduces the activity of the nerve centers responsible for protective reflexes.

Symptoms of a foreign body in the airways

A feature of this pathology is that most often it occurs during meals. This is important information that suggests that a person loses consciousness precisely due to a foreign body, and not, for example, a heart attack (although this is also possible).

The clinical picture of a foreign body goes through three stages in its development:

• initial stage, in which there is a sudden strong paroxysmal cough, lacrimation, redness of the face;
• development- the cough becomes stronger, there is practically no breathing, although the patient makes respiratory movements, cyanosis appears around the lips;
• final stage, during which breathing stops, the person loses consciousness, after a short time, cardiac arrest is observed, followed by clinical death.

How to recognize a foreign body in the airways by external signs

The moment when a foreign body enters the respiratory tract looks like this:

• suddenly the person stops talking, laughing, screaming or crying, grabs his throat with his hands;
• there is a strong cough, the victim stops answering questions;
• when the victim tries to inhale, either wheezing is heard, or nothing is heard; the victim opens his mouth wide, but cannot inhale;
• the face, initially reddening, quickly becomes pale, and then acquires a bluish color, especially in the region of the upper lip);
• within a few tens of seconds, there is a loss of consciousness due to respiratory arrest;
• in a very short time, the work of the heart stops and clinical death occurs.

First aid for foreign bodies in the respiratory tract

A person who knows how to recognize this pathology will not waste a second. The situation is developing rapidly and delaying first aid can cost the victim his life.

The algorithm of actions for this pathology is as follows:

1. Address the victim with the question “What happened?” You may look stupid, but in reality this question is needed in order to understand whether a person is breathing at least somehow. Your further tactics will depend on this.
2. If a person is somehow breathing, encourage him with the words “Cough, harder, more, come on” - with any words that “break through” to his consciousness. Often this is enough for a small foreign body that has entered the upper respiratory tract to come out on its own.
3. If spontaneous release of IT did not occur within 30 seconds, or if the person did not breathe from the very beginning, then the Heimlich maneuver should be applied.

Heimlich maneuver

The technique for doing it is as follows:

• Stand behind the victim.
• Grasp his torso with both hands, cover the fist of your right hand with the palm of your left hand, and use the knuckle of your right thumb to press five hard pressures on the upper abdomen. The direction is up and towards you. Restoration of breathing is a sign of removal of a foreign body from their airways.

Note: The Heimlich maneuver should be performed until the FB leaves the airway or until the person is unconscious. In the latter case, attempts to remove the foreign body should be stopped, and instead start.

Features of the Heimlich maneuver in children and pregnant women

When removing a foreign body in the respiratory tract in children under 1 year old, the rescuer should sit down, put the child on the left forearm face down, holding the lower jaw of the baby with fingers folded into a “claw”. The head of the child should be below the level of the body. After that, five medium-strength blows should be applied with the base of the palm to the interscapular region of the back. The second stage - the child turns face up on the right forearm, after the forehead, the rescuer makes five jerky movements along the sternum to a point located 1 finger below the inter-nipple line. Don't push too hard to break the ribs.

If a foreign body has appeared in the oropharynx, it is visible and can be removed without the danger of pushing it back - it is removed. If not, the whole cycle is repeated either until IT appears, or until cardiac arrest, after which cardiopulmonary resuscitation should be started.

In children aged 1-8 years, the Heimlich maneuver is performed by placing the child on the rescuer's thigh. The rest of the actions are performed according to the general rules.

You will receive more detailed information about emergency care for a child when a foreign body enters the respiratory tract by watching a video review by a pediatrician, Dr. Komarovsky:

Common Mistakes in Airway Foreign Body Removal

The first thing that comes to mind when a foreign body enters the respiratory tract is to knock on the back. The correct algorithm for how to knock is described above. However, most of us just pound on the back with all our might. The danger of this method is that gravity acts on any foreign body. Incorrect tapping may cause IT to penetrate lower into the tracheobronchial tree and may cause complete airway obstruction. First aid in this case is to carry out a tracheotomy, and even if by some miracle a qualified specialist turns out to be nearby, the chance of saving the victim will become scanty.

Never turn your baby upside down to shake him. Spasm of the larynx reduces your attempts to remove a foreign body to zero. Instead, you can dislocate the baby's cervical vertebrae. The fact is that when a child loses consciousness, the tone of the muscles of the neck drops, while shaking, his head begins to dangle in all directions, which can lead to dislocation of the cervical vertebrae and even their fracture. Saving a baby from death, you risk making him disabled or even killed.

Most often, food (nuts, sweets, chewing gum) and small objects (balls, beads, parts of children's toys) enter the respiratory tract. Natural coughing is the most effective way to remove foreign bodies. But in the case when the airways are completely blocked, the Heimlich maneuver is used to prevent a threat to life. The purpose of this technique is to sharply push air out of the lungs, cause an artificial cough push and free the airways from a foreign body.

What to do

• Call an ambulance immediately.
• If the caregiver is alone with the victim, and the latter is already unconscious, then first, within 2 minutes, resuscitation should be carried out (artificial respiration and closed heart massage), and then call an ambulance.
• Start performing techniques to remove a foreign body from the victim's respiratory tract.

If the victim is a child under 1 year of age

The child is conscious

• Lay the baby face down on your forearm so that his chest is in your palm. Place your child's hand on your hip or knee.
• Lower the child's head below his torso.
• With the palm of your free hand, apply 5 sharp blows between the shoulder blades with an interval of 1 second.

If the foreign body cannot be removed using this technique:

• Lay the child on his back on a hard surface or keep him on his lap facing away from you. Keep the child's head lower than his torso.
• Place the middle and index fingers of both hands on the child's abdomen at a level between the navel and costal arches.
• Press vigorously on the epigastric region upward towards the diaphragm without squeezing the chest. Be very careful.
• Continue this maneuver until the airway is clear or an ambulance arrives.

Unconscious child

• Examine the oral cavity and pharynx, if you see a foreign body, and it is at the exit, remove it.
• If the foreign body could not be removed, proceed with the removal technique (Heimlich maneuver) in the same sequence as for a child under the age of 1 year who is conscious.
• Check the child's mouth and throat after each series of blows. If you see a foreign body in your throat, remove it.
• If the child is not breathing, proceed to artificial respiration, and in the absence of a pulse, to chest compressions.
• Perform resuscitation until the ambulance arrives.

If the victim is a child over 1 year old or an adult

The victim is conscious

• Stand behind the victim, wrap your arms around him. The body of the victim should be slightly tilted forward.
• Squeeze one hand into a fist and place it on the victim's stomach with the side where the thumb is located, at the level between the navel and costal arches (on the epigastric region of the abdomen).
• Grasp the fist with the palm of the other hand, quickly make 6-10 jerky pressures on the epigastric region of the abdomen inward and upward to the diaphragm.
• Continue this maneuver until the airway is clear or an ambulance arrives.

If the victim is unconscious:

• Lay the victim on their back.
• Turn his head to the side.
• Sit astride the victim's thighs, facing the head.
• Place your hands, one on top of the other, on the victim's upper abdomen (epigastric region).
• Using your body weight, forcefully push the victim's abdomen up toward the diaphragm.
• Continue this maneuver until the airway is clear or an ambulance arrives.

If the victim is not breathing, proceed to artificial respiration, and in the absence of a pulse, to chest compressions.

self help

• Clench one hand into a fist and the side where the thumb is, place it on the stomach at a level between the navel and costal arches.
• Place the palm of the other hand on top of the fist, with a quick push inward-upward, the fist is pressed into the stomach.
• Repeat several times until the airways are clear.

You can also lean on a firmly standing horizontal object (table corner, chair, railing) and push upward in the epigastric region.

What not to do

• Do not start taking Heimlich if the victim is coughing heavily.
• Do not try to grab an object stuck in the throat of the victim with your fingers - you can push it even deeper, use tweezers or other improvised tools.
• A poorly performed Heimlich maneuver is not safe because it can lead to regurgitation, damage to the stomach and liver. Therefore, the push must be performed strictly at the specified anatomical point. It is not produced in late pregnancy, in very obese people and in children under one year of age. In these cases, compression of the chest is used, as with a closed heart massage, and blows between the shoulder blades.

Further actions

The victim must be necessarily examined by a doctor - even with a favorable outcome.

The information in the article is provided for informational purposes only.

Check with your doctor before taking any action. Based on materials

In the process of dental treatment, unforeseen situations may occur. Sometimes patients come to the clinic complaining of pain in a previously treated tooth. During the x-ray examination, it may become clear that there is a foreign body in the canal of the tooth. It also happens that up to a certain point the patient is unaware of such a “treasure” hidden in one of the dental units, since it does not reveal itself in any way.

If a foreign body is noticed in the cavity of the tooth or the dental canal, then it is recommended to remove it immediately.

What is a foreign body

Various objects can act as a foreign body. Most often it is:

• fragments of professional instruments that the dentist used during tooth treatment - perhaps these are the most common objects “forgotten” in the tooth canal;
• pins that were previously used for filling dental canals;
• fragments of an incompletely removed root.

Absolutely any material that was used in the course of restorative or therapeutic manipulations with a damaged tooth is a foreign body. Over time, it wears out, undergoes corrosive processes and becomes dangerous for the health of the tooth. Anchor and fiberglass pins, old inlays, fragments of instruments can cause a crack in the canal, which threatens to lose the tooth in the future. To avoid such an outcome, the foreign body must be removed from the dental canal in a timely manner.

Quite often, an anchor pin has to be removed, which is a rod made of titanium or other metal alloys, and used in cases where it is necessary to restore a destroyed dental crown. Violations of the rules of operation usually lead to the destruction and wear of the structure.

The reasons why foreign bodies are in the canal of the tooth

Foreign particles may remain in the root canal during complex endodontic treatment due to the following situations:

1. The channels are quite narrow and have a sinuous shape. The dental instrument cannot withstand pressure and breaks off.
2. During manipulations to clean the dental canal from the dead nerve or blood vessels.
3. If work is carried out using hand tools, when there is a possibility of breakage of parts due to thinning of the metal or the presence of defects.

Of course, the bummer of dental instruments is not the norm of the treatment process, but such a risk exists.

Signs indicating the presence of foreign particles in the dental cavity

Immediately at the moment when a piece of a foreign object was in the canal of the tooth, the patient is not able to feel any changes, initially the symptoms are completely absent. However, after a while, the process of metal corrosion starts, accompanied by inflammation. That's when the first signs appear.

Constant irritation of the tooth cavity provokes the destruction of the root. In such conditions, it is not always possible to save a tooth.

Symptoms to pay attention to and respond to in a timely manner

Typical symptoms include the following:

• pain when biting or chewing food - indicate the beginning of the internal periodontal process, that is, purulent contents put pressure on the dental unit;
• there is swelling of the gum tissue;
• a fistula appears through which pus enters the oral cavity; this process reduces the soreness of the tooth for some time, but it is a mistake to believe that an improvement occurs.

During a visual examination, the dentist is interested in the patient's nature of pain, and thanks to an x-ray, he finds out which foreign object and where exactly it is located.

Particles of broken tools are foreign bodies that are subject to mandatory removal. Moreover, the occurrence of corrosion, which provokes cracking of the root and further loss of the tooth, is not the only unpleasant complication.

Due to the presence of a fragment in the root canal, it is impossible to carry out a full filling. The main consequence is associated with the resumption of the inflammatory process, which invariably accompanies the current situation. If a part of the inflamed pulp remains under a foreign object, rotting occurs. This phenomenon requires immediate professional intervention.

Simple extraction

Before proceeding with the direct removal of the debris, the doctor tries to provide easy access to the foreign body. After the successful completion of the preliminary stage, a part of the instrument stuck in the cavity of the dental canal is loosened and an attempt is made to move it away from the dentin. At this stage, the use of ultrasonic dental equipment is optimal. After that, the specialist grabs the tip of the object using a special device and removes it from the cavity. The opened wound is subject to further therapeutic treatment.

Whether the extraction will be simple or difficult - depends on what kind of item is to be removed from the channel.

Simple extraction is used when it comes to broken pins. They are removed quite easily. To this end, the dentist releases the cavity from the previously used filling material with ultrasonic action, loosens the foreign object with a large amplitude for some time. This happens with the help of ultrasound and with the obligatory use of cool water pressure, which avoids overheating of the tooth tissues. After achieving sufficient mobility of the fragment, the doctor easily removes the foreign body.

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What signals the possible presence of fragments of endodontic instruments inside the tooth

Immediately after the completion of the dental treatment process, patients do not feel a foreign object stuck in the root canal. The first symptomatology begins to appear when the process of metal corrosion starts.

At this time, patients begin to worry about:

• soreness of the dental unit caused by mechanical action on it (including biting off solid foods and chewing food);
• swelling of the mucous membrane directly around the treated tooth;
• the formation of a fistula, accompanied by the release of purulent contents.

To assess the condition of the tooth and confirm suspicions of the presence of a foreign object inside, the dentist prescribes an x-ray examination. If a fragment of the instrument is found on the image, the installed seal should be opened, the foreign body removed, high-quality cleaning and re-sealing.

Complex extraction

Technological features of the process of extracting broken pieces of instruments depend on the parameters of the stuck element and the degree of neglect of the pathological process. In the case of sufficiently small fragments, extraction is not easy. Therefore, it is called "complex extraction". In such a situation, the doctor is forced to use a special dental microscope. This "jewelry" work should be entrusted to a professional. It will take care of creating access to the stuck piece of metal. To achieve this goal, the tooth canal is prepared in such a way as to prevent damage to the root. When using high-frequency ultrasound at medium or low amplitude, the instrument is cleaned and loosened in the canal cavity.