If a foreign object has entered the lungs. Water or food has entered the respiratory tract: treatment. Forecast and prevention of foreign bodies of the bronchi

Accidentally caught (during eating or playing) in the upper respiratory tract small objects that cause respiratory failure and the formation of an inflammatory process are foreign bodies in the respiratory tract. In this article, you will learn the main signs of a foreign body in the airways, as well as how to help with a foreign body in the airways in a child.

Most often, a foreign body enters the respiratory tract occurs from 1.5 to 3 years. At this age, the child actively begins to learn about the world around him: he pulls everything that is horrible into his mouth. This age is also characterized by the fact that the baby learns to chew and swallow solid food correctly. He learns on his own, based on his own feelings. Learn at the subconscious level. And, of course, it doesn't work out right away. It is at this age that the danger of small objects entering the respiratory tract is maximum. It is also bad that the child cannot always tell what exactly happened to him. Sometimes foreign bodies in the airways are detected too late.

You should know that a foreign body in the airways of a child is a terrible and dangerous pathology. Many children became disabled, many underwent the most difficult manipulations and operations due to the oversight and inattention of their parents. There are also fatal outcomes if a foreign body accidentally enters the respiratory tract.

We advise you to remember an important rule: do not give children under 3-4 years old small toys and foods (nuts, peas, etc.) that they could inhale. Be careful! Do not risk the life and health of your own children!

Bronchoscopy in children with a foreign body

Bronchoscopy is indicated if the child has the following symptoms and signs: acute onset of asphyxia, severe shortness of breath, extensive atelectasis, emergency bronchoscopy is necessary.

Assistance with a foreign body should be carried out in a specialized department where there are doctors who own tracheobronchoscopy. Foreign bodies of the trachea and bronchi are removed using endoscopic forceps. Further treatment (antibiotics, ERT, massage) depends on the nature and severity of the inflammatory process in the bronchi. Sometimes, with long standing foreign bodies with the development of complications (bronchiectasis, fibrosis, bleeding, etc.), one has to resort to surgical treatment.

Help with a foreign body in the airways

Signs of foreign bodies in the respiratory tract are found in babies 2 to 4 years old. This is probably due to the problems of development and care of the child, as well as their inherent curiosity. In this age group, they are often found in children in the nasal cavity and ear. Inhalation is not common in children under 6 months of age, although it can occur at any age.

Removal of a foreign body from the respiratory tract

Foreign bodies are different, and not all operations to remove them are the same. The decision is made in many cases under the influence of local management schemes and accepted practices.

Esophagoscopy is effective for almost all types of foreign bodies entering the child's body, and its complications are rare. An alternative is flexible endoscopy, which can remove some bodies without the need for general anesthesia.

If the foreign body completely blocked the airways, the child has the following symptoms: he begins to gasp for air, suffocate, cannot speak and scream, loses consciousness, the skin turns blue. If a foreign body has entered the respiratory tract, it is urgent to call an ambulance.

• Until she arrives, take the child by the legs, lift upside down, shake and pat your hands on the back between the shoulder blades.
• If help with a foreign body does not help, lay it on your back, kneel next to it, put your hand between the navel and the angle between the costal arches, put the other hand on top of it and 6-10 times push hard on the stomach diagonally up to the diaphragm. If the child is very small, place the index or middle finger on the stomach. Then you can try to lift the child upside down and pat on the back.

Sometimes coins stuck in the esophagus come out on their own (more than 30%). It makes sense to observe the child if the coin is stuck shortly (less than a day) before admission to the hospital and does not cause discomfort. This requires careful dynamic control. In most cases, swallowing small sharp objects does without symptoms and complications (these include nails, pins, buttons, paper clips). Need to be wary of sewing needles, because. they can cause intestinal perforation. Objects longer than 4 - 5 cm can not easily pass the narrow bends of the gastrointestinal tract; in these cases, consultation with a specialist is necessary.

Aspiration of foreign bodies

When an object enters a bronchus or smaller airways, children experience coughing, weakening of respiratory noises, and wheezing for the first time. This classic triad is noted only in 33% of children who aspirated the object. The longer the objects remain in place, the more likely the presence of a triad of symptoms, but even with significantly late diagnosis, it develops in 50% of children.

Aspirated foreign objects are diverse, among them products prevail: nuts (peanuts), apples, carrots, seeds, popcorn. In children who have inhaled an object, there are signs of pronounced stenosis of the upper respiratory tract: attacks of suffocation with an extended breath, with periodically strong cough and cyanosis of the face up to lightning asphyxia, weakening of respiratory noises, stridor, wheezing, sensation of an object, wheezing. In the presence of a mobile body in the trachea, a popping sound can sometimes be heard during screaming and coughing.

First aid for foreign bodies

If objects or toys get into the mouth of the larynx, and growing asphyxia that threatens the life of the child, it is necessary to try to urgently remove it in order to prevent a possible fatal outcome:

• if the child is unconscious and not breathing, try to clear the airways;
• if the child is conscious, calm him down and persuade him, do not hold back the cough;
• call the resuscitation team for treatment as soon as possible.

Active interventions are taken when the cough becomes weak, gets worse, or the child loses consciousness. The following are recommended as first aid measures.

Help with foreign bodies in children under 1 year old

1. Put the child on the stomach on the forearm of the left hand, face down (the forearm is lowered down by 60 °, supporting the chin and back). Apply with the edge of the palm of the right hand up to 5 strokes between the shoulder blades. Check for objects in the oral cavity and remove them.
2. If there are no results, turn the child into a supine position (head down) with the child on your hands or knees. Perform 5 chest thrusts at the level of the lower third of the sternum, one finger below the nipples. Don't press on your belly! If a foreign body is visible, it is removed.
3. If the obstruction persists, try to open the airway again (raising the chin and tilting the child's head back) and administer mechanical ventilation. If help with a foreign body in the airways was unsuccessful, you need to repeat the techniques before the arrival of the ambulance team.

Help with foreign bodies in children older than 1 year

1. To provide first aid, you need to perform the Heimlich maneuver: being behind a sitting or standing child, wrap your arms around his waist, press on his stomach (along the midline of the abdomen between the navel and the xiphoid process) and make a sharp push up to 5 times with an interval of 3 seconds. If the patient is unconscious and lies on his side, the doctor places the palm of his left hand on his epigastric region and with the fist of his right hand inflicts short repeated blows (5-8 times) at an angle of 45 ° towards the diaphragm. When performing this technique, complications are possible: perforation or rupture of the organs of the abdominal and chest cavities, regurgitation of gastric contents.
2. Examine the oral cavity, and if an object or toy is visible, it is removed.
3. If there is no effect, repeat the techniques until the ambulance arrives. Due to the risk of aggravating the obstruction, blind digital removal of a foreign body in children is contraindicated!

If a foreign body in the respiratory tract is not found in a child: the decision to conduct a tracheotomy or tracheal intubation, urgent hospitalization in the otorhinolaryngological or surgical department.

If it enters the bronchi - urgent hospitalization for treatment - bronchoscopy. When transporting the patient, calm down, give an elevated position, carry out oxygen therapy.

Help with a foreign body in the bronchi

Signs of a foreign body in a child

At that moment, when a child inadvertently inhales a foreign body, an attack of painful coughing occurs; there may be vomiting at this time. In the event that there is a gap between the wall of the respiratory tract and a foreign body, there is no threat of instant death. The victim should be urgently transported to the hospital.

Emergency care for a foreign body in the bronchi

1. If suffocation occurs, it is necessary to take actions aimed at moving the foreign body from the place it occupied: tilt the child with the body down, hit the hand between the shoulder blades several times, shake the body sharply.
2. A little boy or girl can be turned upside down, shake him by holding his legs; some foreign bodies - like a metal or glass ball - may fall out from these actions.

Even if the foreign body was removed, you should call an ambulance doctor or take the children to the hospital.

Help with a foreign body in the trachea

The condition of patients with foreign bodies fixed in the trachea is very difficult. Breathing is speeded up and difficult, retraction of compliant places of the chest is observed, acrocyanosis is pronounced. The child tries to take a position in which it is easier for him to breathe. The voice is usually clear. On percussion, a box sound is noted over the entire surface of the lungs.

Balloting foreign bodies in the trachea in children

Balloting foreign bodies pose a great danger to life. Most balloting foreign bodies in the respiratory tract have a smooth surface, such as watermelon, sunflower, corn, pea, etc.

Such items when coughing, laughing, anxiety easily move in the tracheobronchial tree. Foreign bodies are thrown to the glottis by the current of air, irritate the true vocal cords, which instantly close. At this moment, the sound of a foreign body clapping against closed ligaments is heard. This sound can be compared to the sound of clapping hands, and it is quite strong and can be heard from a distance. Sometimes a balloting foreign body can become strangulated in the glottis and cause an asthma attack. With prolonged spasm of the vocal cords, a fatal outcome is possible.

Why are balloting foreign bodies in the trachea dangerous?

The insidiousness of balloting foreign bodies lies in the fact that at the time of aspiration the patient experiences, in most cases, a short-term attack of suffocation, and then for some time his condition becomes, as it were, satisfactory.

Despite the vivid symptoms indicating the likelihood of aspiration of a foreign body, diagnosis can be difficult, since with most of the baloting foreign bodies, physical data are minimal.

Balloting foreign bodies are also dangerous because, getting either into the left or into the right bronchus, they can cause reflex spasm of the smallest branchioles. This immediately worsens the patient's condition. Breathing becomes frequent, superficial, without a sharp retraction of the compliant places of the chest, pronounced cyanosis of visible mucous membranes and acrocyanosis.

Foreign bodies fixed in the area of ​​the tracheal bifurcation represent a great danger. When breathing, they can move in one direction or another and close the entrance to the main bronchus, causing its complete obstruction with the development of atelectasis of the entire lung. The patient's condition in this case worsens, shortness of breath and cyanosis increase.

With the formation of valvular stenosis of the trachea or main bronchus, the development of obstructive emphysema, respectively, of the lungs or lung is possible.

Diagnosis of foreign bodies in the trachea

A chest x-ray, which should always precede a bronchoscopic examination, confirms the emphysematous lung fields due to impaired patency of the trachea with a valve mechanism. With the valvular mechanism of violation of the patency of the main bronchus, emphysematous changes are observed in the corresponding lung.

Symptoms of a foreign body in the airways

Cough while eating or playing, wheezing, cyanosis of the skin, shortness of breath, etc. All of these signs in the respiratory tract may be present, as well as each of them individually. Usually, parents clearly associate the appearance of these symptoms with eating or playing with small toys. But sometimes, especially when the child is left unattended, this connection may not be established. Then the diagnosis is especially difficult. Sometimes they don't show up at all.

Signs of a foreign body entering the respiratory tract

The clinical picture depends on the size and location of the body. The very ingress of a foreign object into the respiratory tract is accompanied by such symptoms: a fit of coughing, respiratory failure. When it is localized in the larynx, there are attacks of spasmodic cough, inspiratory dyspnea. Foreign bodies of the trachea usually ballot, i.e. move in the space between the vocal cords and the bifurcation, also causing bouts of coughing and inspiratory dyspnea. If it enters the bronchi, the cough may completely stop.

If it was not possible to cough up or remove the foreign body, an inflammatory process is formed in the underlying sections of the bronchial tree: a wet cough and fever appear.

In the presence of complete obturation and atelectasis, the study determines the local shortening of the percussion sound, and the x-ray examination - the displacement of the mediastinum towards the lesion. With incomplete obturation, the resulting valve mechanism leads to swelling of the lung on the side of the lesion with weakening of breathing and mediastinal displacement towards the healthy lung.

What foreign bodies enter the respiratory tract? The objects that come in are very diverse. They can be organic (seeds, spikelets of various herbs, nut shells, peas, etc.) or inorganic (metal and plastic parts of toys, pens, pieces of foil, pill holders, small coins, etc.). Most often they fall into the right lung (the right main bronchus is wider and departs from the bifurcation of the trachea in a vertical direction).

How to suspect a foreign body in the respiratory tract in a child? Almost all cases of bronchoscopically confirmed aspiration have a history of choking. If a child suddenly develops respiratory signs or wheezing, a question should be asked regarding recent episodes of choking (especially while eating nuts, carrots, popcorn), which will identify almost all cases of aspiration.

Aspiration is facilitated by the peculiarities of the respiratory system in young children: narrowness of the airway lumen, discoordinated muscle work, reduced cough reflex. Granulations grow around the foreign body, leading to bronchial obstruction. Complete obturation of the bronchus leads to the development of atelectasis and atelectatic pneumonia, often with the subsequent formation of a chronic bronchopulmonary process.

Where can foreign bodies be found in the body? Almost everywhere. Children usually take various small objects into their mouths (with further swallowing or inhalation) or put them into their noses and ears. Less frequently, objects end up in the vagina, rectum, or urethra. Often they get into the respiratory tract.

The largest number of objects (60 - 70%) is located in the esophagus at the level of the entrance of the esophagus into the chest cavity, at the location of the crico-pharyngeal muscle. The rest is accounted for by the lower esophageal sphincter at the level of the aortic arch. In babies with a history of congenital anomalies or acquired structures of the esophagus, objects (usually eaten pieces of meat) get stuck at the site of the narrowing.

What foreign bodies most often enter the body of a child? Coins and fish bones most often enter the esophagus. If it enters the stomach, it most often passes safely through the intestines and is excreted in the feces. In this case, it is useful to give the child porridge, bread or mashed potatoes. Then the swallowed object is wrapped in food and, without damaging the walls of the digestive tract, easily comes out. It is necessary to look at the child's bowel movements to make sure that the foreign body has come out. If it is not detected, x-rays must be taken again. Small objects (coins) usually pass the rest of the gastrointestinal tract without complications in the next 3 to 8 days.

How to understand that a child has a foreign body inside? If a child complains of such signs: chest pains, difficulty swallowing, salivation, this indicates that something is stuck in the esophagus. In this case, the child must be urgently sent to the surgical department for treatment.

What are the dangers of foreign bodies in children's respiratory tract?

1. In the respiratory tract, they can be anywhere - in the nasal passages, larynx, trachea, bronchi, in the tissue of the lung itself, in the pleural cavity. By localization, the most dangerous place is the larynx and trachea. Foreign bodies in this area can completely block the access of air. If you do not provide immediate assistance, then death occurs in 1-2 minutes.
2. Foreign bodies in the main and lobar bronchi are dangerous. If they clog the lumen of the bronchus like a “valve”, then intrathoracic tension syndrome develops, leading to very serious respiratory and circulatory disorders.
3. Foreign bodies of small bronchi may not manifest themselves at all at first. They do not cause pronounced respiratory disorders and do not affect the well-being of the child. But after some time (days, weeks, and sometimes months and years), a purulent process develops in this place, leading to the formation of bronchiectasis or the development of pulmonary bleeding.
4. Foreign bodies of the trachea are also dangerous because when they hit the vocal cords from below, a persistent laryngospasm occurs, leading to an almost complete closure of the lumen of the larynx.
5. Prolonged standing causes chronic inflammation leading to bronchiectasis, fibrosis, or pulmonary hemorrhage. All these complications are treated only surgically. Sometimes penetration into the pleural cavity occurs (most often these are spikelets of cereal plants), as a result of which pyothorax and / or pyopneumothorax may occur.

Diagnosis of a foreign body in the respiratory tract

The only decisive diagnostic method is bronchoscopy. In rare (less than 15%) cases, the diagnosis is made by plain radiography.

Foods containing oil or fat are the greatest aspiration hazard because they can contribute to the development of chemical pneumonitis. Sharp objects are rare.

Instrumental studies of a foreign body

Almost all foreign bodies are X-ray negative, the patient can detect atelectasis, mediastinal displacement towards the lesion with complete or in the opposite direction with incomplete bronchial obstruction, emphysema. With bronchoscopy, it is not always possible to visualize. More often, granulations are found, often bleeding, edematous mucous membrane, purulent endobronchitis.

Restoration of airway patency

The child is placed on a rigid base in the supine position. If assistance is provided to the victim lying face down, then when turning his head, it is necessary to keep it in line with the body in order to avoid aggravating a possible injury to the cervical spine. Then the oral cavity and pharynx are cleaned of foreign bodies, mucus, vomit, blood clots, broken teeth.

The leading cause of airway obstruction in terminally ill children is the obstruction of the hypopharyngeal region by the root of the tongue: the muscles of the tongue and neck, deprived of tone, cannot lift the root of the tongue above the pharyngeal wall. If there is no suspicion of an injury in the cervical spine, to eliminate obturation of the hypopharyngeal region with the tongue and restore airway patency, a triple Safar maneuver is performed: the head is hyperextended in the cervical spine (this manipulation alone allows eliminating airway obstruction in about 80% of children), put forward forward lower jaw, open the mouth. There is tissue tension between the lower jaw and the larynx, and the root of the tongue moves back from the back of the pharynx.

The caregiver is located at the patient's head on the right or left, one hand is placed on the child's forehead, the other covers the lower jaw. By mutual efforts of the hands, it hyperextends the head in the neck-occipital joint. With a hand in the area of ​​​​the body of the lower jaw, he brings the jaw up and slightly opens the oral cavity.

How is airway management performed in children?

The caregiver is located at the head of the child from the back of the head, covers the lower jaw with 2-5 fingers of both hands, pushes the lower jaw and hyperextends the head in the cervical spine, with the pressure of the thumbs, which are placed on the chin, slightly opens the mouth. This method is more convenient for patients with preserved spontaneous breathing, but is of little use for the subsequent maintenance of airway patency in case of need for ventilation from mouth to mouth or from mouth to nose.

With a presumptive diagnosis of a fracture or dislocation in the cervical spine, extension in the atlantooccipital joint is unacceptable. Since it is very difficult to establish a diagnosis of trauma in the cervical region in a patient in a terminal state, one has to focus on a situational diagnosis. Injury in the cervical spine is likely with the development of a terminal condition after diving, in an accident, in a fall from a height. In such cases, the person providing assistance only pushes the lower jaw. If there is an assistant, then he places his hands on the parietal tubercles of the affected child and stabilizes the cervical spine.

After restoration of airway patency, the child's ability to breathe independently is assessed.

To do this, leaning towards the body of a small patient in the region of the head end, they visually control the excursion of the chest, and the passage of the air flow through the patient's respiratory tract is recorded with the cheek and ear. This procedure should take no more than 3-5 seconds.

If spontaneous breathing is preserved (after the restoration of airway patency, an excursion of the chest and anterior abdominal wall appears, the movement of air flow through the patient’s airways during inhalation and exhalation is felt) and heart activity, then airway patency is supported by one of the above methods, and children older and adults can be given a stable position on their side. This position is achieved by turning the patient on his side, bending his lower leg and placing his hand behind his back, as well as placing the upper hand under the chin to hold the victim's head in a tilted position.

If there is no spontaneous breathing after the restoration of airway patency, it is necessary to start artificial ventilation of the lungs.

Prevention of a foreign body in the respiratory tract

The child may also choke while eating (peanuts, corn flakes, peas, caramel, nuts, bitten off pieces of an apple or carrot). This can also happen while taking medication, so in no case should you give unground dragees, tablets or capsules. You should not feed the child where he plays, as there is always a risk that fragments of accidentally broken dishes or pieces of food will go unnoticed.

Small objects are dangerous not only because the child can inhale them, but also because he can swallow them. The smallest and smoothest objects usually do not cause much trouble and pass out naturally with the baby's stool. Larger objects can become lodged in the esophagus or stomach or block the intestinal lumen. Sharp objects (pins, paper clips, needles, pins, bones, matches, glass fragments) can stick into the pharynx, tonsils, esophagus, walls of the stomach or intestines, which will require the child to be hospitalized and treated in a hospital up to surgery.

How to prevent child suffocation?

Plastic bags pose a great danger to the child. A child can press this film to his face or put a bag over his head and get scared or even suffocate.

A child can suffocate himself by sticking his head between the bars of a crib, a fence, playing with a rope or a skipping rope. He can hit his head in the loop from a hanging toy, so never hang toys on a double loop, but only on a single one. Do not place the crib next to curtains, cords, curtains. There should be no wall decorations with ribbons or narrow long stripes near the crib and play area.

Dr. Komarovsky about a foreign body in the respiratory tract

Mechanical asphyxia- this is a complete or partial blockage of the respiratory tract, leading to a violation in the vital organs due to oxygen starvation. Asphyxia can lead to death if the cause of its occurrence is not eliminated in time. Frequent victims of asphyxia can be infants, the elderly, patients with epilepsy, persons in a state of intoxication.

Asphyxia is an urgent condition and requires urgent measures to eliminate it. Knowing some general rules, such as examining the oral cavity for the presence of a foreign body, tilting the head to the side to avoid dropping the tongue, mouth-to-mouth artificial respiration can save a person's life.


Interesting Facts

• The most sensitive organ in oxygen starvation is the brain.
• The average time to death in asphyxia is 4-6 minutes.
• Playing with asphyxia is a children's way of getting euphoria as a result of various methods for short-term introduction of the body into a state of oxygen starvation.
• During asphyxia, an involuntary act of urination and defecation is possible.
• The most common symptom of asphyxia is a convulsive agonizing cough.
• Asphyxia is diagnosed in 10% of newborns.

What are the mechanisms of asphyxia?

Breathing is a physiological process necessary for normal human life. During breathing, when you inhale, oxygen enters the body, and when you exhale, carbon dioxide is released. This process is called gas exchange. The respiratory system provides all organs and tissues with oxygen, which is necessary for the work of absolutely all cells of the body.

The structure of the respiratory tract:

• upper respiratory tract;
• lower respiratory tract.

upper respiratory tract

Thus, passing through the nasal cavity, the air is cleaned and prepared for further entry into the lower respiratory tract.

From the nasal and oral cavities, air enters the pharynx. The pharynx is simultaneously part of the digestive and respiratory systems, being a connecting link. It is from here that food can enter not into the esophagus, but into the respiratory tract and, as a result, become the cause of asphyxia.

lower respiratory tract

The lower respiratory tract includes:

• Larynx. The larynx is a continuation of the pharynx. Below the larynx borders on the trachea. The hard skeleton of the larynx is the cartilaginous framework. There are paired and unpaired cartilages, which are interconnected by ligaments and membranes. The thyroid cartilage is the largest cartilage in the larynx. It consists of two plates, articulated at different angles. So, in men, this angle is 90 degrees and is clearly visible on the neck, while in women this angle is 120 degrees and it is extremely difficult to notice the thyroid cartilage. The epiglottic cartilage plays an important role. It is a kind of valve that prevents food from entering the lower respiratory tract from the pharynx. The larynx also includes the vocal apparatus. The formation of sounds occurs due to a change in the shape of the glottis, as well as when stretching the vocal cords.
• Trachea. The trachea, or windpipe, is made up of arcuate tracheal cartilages. The number of cartilages is 16 - 20 pieces. The length of the trachea varies from 9 to 15 cm. The mucous membrane of the trachea contains many glands that produce a secret that can destroy harmful microorganisms. The trachea divides and passes below into the two main bronchi.
• Bronchi. The bronchi are a continuation of the trachea. The right main bronchus is larger than the left, thicker and more vertical. Like the trachea, the bronchi are made up of arcuate cartilage. The place where the main bronchi enter the lungs is called the hilum of the lungs. After that, the bronchi repeatedly branch into smaller ones. The smallest of them are called bronchioles. The entire network of bronchi of various calibers is called the bronchial tree.
• Lungs. The lungs are a paired respiratory organ. Each lung consists of lobes, with 3 lobes in the right lung and 2 in the left. Each lung is pierced by a branched network of the bronchial tree. Each bronchiole ends the smallest bronchus) transition to the alveolus ( hemispherical sac surrounded by vessels). It is here that the process of gas exchange takes place - oxygen from the inhaled air enters the circulatory system, and carbon dioxide, one of the end products of metabolism, is released with exhalation.

Asphyxiation process

In the process of asphyxia, 5 phases are distinguished:

• preasphyxic phase. This phase is characterized by a short-term cessation of breathing for 10-15 seconds. Often there is erratic activity.
• Breathlessness phase. At the beginning of this phase, there is an increase in breathing, the depth of breathing increases. After a minute, expiratory movements come to the fore. At the end of this phase, convulsions, involuntary defecation and urination occur.
• Brief cessation of breathing. During this period, breathing is absent, as well as pain sensitivity. The duration of the phase does not exceed one minute. During a short-term stoppage of breathing, you can only determine the work of the heart by feeling the pulse.
• Terminal breath. Attempt to take one last deep breath. The victim opens his mouth wide and tries to catch air. In this phase, all reflexes are weakened. If by the end of the phase the foreign object has not left the respiratory tract, then complete cessation of breathing occurs.
• The phase of complete cessation of breathing. The phase is characterized by the complete failure of the respiratory center to support the act of breathing. Persistent paralysis of the respiratory center develops.

oxygen starvation
As a result of complete closure of the airway lumen, mechanical asphyxia leads to respiratory arrest. As a result, oxygen starvation occurs in the body. The blood, which is enriched with oxygen in the alveoli at the level of the lungs, contains extremely small reserves of oxygen due to the cessation of breathing. Oxygen is essential for most enzymatic reactions in the body. In its absence, metabolic products accumulate in the cells, which can damage the cell wall. In case of hypoxia ( oxygen starvation), the energy reserves of the cell are also sharply reduced. Without energy, the cell is not able to perform its functions for a long time. Different tissues react differently to oxygen starvation. So, the brain is the most sensitive, and the bone marrow is the least sensitive to hypoxia.

Violation of the cardiovascular system
After a few minutes, hypoxemia ( decreased oxygen in the blood) leads to significant disturbances in the cardiovascular system. The heart rate decreases, blood pressure drops sharply. There are disturbances in the heart rhythm. In this case, there is an overflow of venous blood, rich in carbon dioxide, of all organs and tissues. There is a bluish complexion - cyanosis. The cyanotic shade occurs due to the accumulation in the tissues of a large amount of protein that carries carbon dioxide. In the case of serious vascular diseases, cardiac arrest can occur at any phase of the asphyxial state.

Damage to the nervous system
The next link in the mechanism of asphyxia is the defeat of the central nervous system ( central nervous system). Consciousness is lost at the beginning of the second minute. If within 4 - 6 minutes the flow of oxygen-rich blood is not renewed, then the nerve cells begin to die. For normal functioning, the brain must consume approximately 20 - 25% of all oxygen received during breathing. Hypoxia will lead to death in case of extensive damage to the nerve cells of the brain. In this case, there is a rapid inhibition of all vital functions of the body. That is why changes in the central nervous system are so destructive. If asphyxia develops gradually, then the following manifestations are possible: impaired hearing, vision, spatial perception.

Involuntary acts of urination and defecation are often found in mechanical asphyxia. In connection with oxygen starvation, the excitability of the soft muscles of the intestinal wall and bladder increases, and the sphincters ( circular muscles that act as valves) relax.

The following types of mechanical asphyxia are distinguished:

• Dislocation. Occurs as a result of the closure of the lumen of the respiratory tract by displaced damaged organs ( tongue, mandible, epiglottis, submaxillary bone).
• Strangulation. Occurs as a result of strangulation by hands or a loop. This type of asphyxia is characterized by extremely strong compression of the trachea, nerves and vessels of the neck.
• Compression. Compression of the chest with various heavy objects. In this case, due to the weight of the object, squeezing the chest and abdomen, it is impossible to make respiratory movements.
• Aspiration. Penetration into the respiratory system during inhalation of various foreign bodies. Common causes of aspiration are vomit, blood, and stomach contents. As a rule, this process occurs when a person is unconscious.
• Obstructive. There are two types of obstructive asphyxia. First type - asphyxia of closing the lumen of the respiratory tract, when foreign objects can enter the respiratory tract ( food, dentures, small objects). Second type - asphyxia from closing the mouth and nose with various soft objects.

The following types of obstructive asphyxia are distinguished:

• closing of the mouth and nose;
• closure of the airway.

Closure of the mouth and nose

Closure of the airway

Obstruction by small objects occurs, as a rule, in small children. Therefore, you need to carefully monitor that the child does not have access to them. Elderly people are characterized by asphyxia caused by the ingress of a denture into the lumen of the respiratory tract. Also, the absence of teeth and, as a result, poorly chewed food can lead to obstructive asphyxia. Alcohol intoxication is also one of the most common causes of asphyxia.

The following individual characteristics of the body can affect the course of asphyxia:

• Floor. To determine the reserve capacity of the respiratory system, the concept of VC is used ( lung capacity). VC includes the following indicators: tidal volume, inspiratory reserve volume and expiratory reserve volume. It has been proven that women have VC by 20-25% less than men. From this it follows that the male body better tolerates the state of oxygen starvation.
• Age. The VC parameter is not a constant value. This figure varies throughout life. It reaches its maximum by the age of 18, and after 40 years it gradually begins to decline.
• Susceptibility to oxygen starvation. Regular exercise helps to increase the vital capacity of the lungs. Such sports include swimming, athletics, boxing, cycling, mountaineering, and rowing. In some cases, the VC of athletes exceeds the average of untrained people by 30% or more.
• Presence of comorbidities. Some diseases can lead to a decrease in the number of functioning alveoli ( bronchiectasis, lung atelectasis, pneumosclerosis). Another group of diseases can restrict respiratory movements, affect the respiratory muscles or nerves of the respiratory system ( traumatic rupture of the phrenic nerve, injury of the dome of the diaphragm, intercostal neuralgia).

Causes of asphyxia

Causes of asphyxia:

• diseases of the nervous system;
• diseases of the respiratory system;
• diseases of the digestive system;
• aspiration of food or vomit in children;
• weakened infants;
• psycho-emotional states;
• alcohol intoxication;
• talking while eating;
• haste in eating;
• lack of teeth;
• dentures;
• entry of small objects into the respiratory tract.

Diseases of the nervous system

Another type of disease of the nervous system leading to asphyxia is the defeat of the respiratory center. The respiratory center is understood as a limited area of ​​the medulla oblongata responsible for the formation of the respiratory impulse. This impulse coordinates all respiratory movements. As a result of traumatic brain injury or swelling of the brain, the nerve cells of the respiratory center may be damaged, which can lead to apnea ( cessation of breathing). If during a meal paralysis of the respiratory center occurs, this inevitably leads to asphyxia.

Vagus neuritis can lead to impaired swallowing and possible blockage of the airways. This pathology is characterized by hoarseness of the voice and a violation of the swallowing process. Due to unilateral damage to the vagus nerve, vocal cord paresis can occur ( weakening of voluntary movements). Also, the soft palate cannot be held in its original position, and it descends. With a bilateral lesion, the act of swallowing is sharply disturbed, and the pharyngeal reflex is absent ( swallowing, coughing or gagging reflexes with irritation of the pharynx are impossible).

Respiratory system diseases

Asphyxia can be caused by the following diseases:

• Abscess of the epiglottis. This pathology leads to swelling of the epiglottic cartilage, an increase in its size and a decrease in its mobility. During a meal, the epiglottis is not able to perform its functions as a valve that closes the lumen of the larynx during the act of swallowing. This inevitably leads to food entering the respiratory tract.
• Quinsy. Phlegmonous tonsillitis or acute paratonsillitis is a purulent-inflammatory disease of the tonsils. Occurs as a complication of lacunar tonsillitis. This pathology leads to swelling of the soft palate and the formation of a cavity containing pus. Depending on the location of the purulent cavity, blockage of the airways is possible.
• Diphtheria. Diphtheria is an infectious disease that usually affects the oral part of the pharynx. In this case, the occurrence of croup, a condition in which there is a blockage of the respiratory tract with a diphtheria film, is of particular danger. The lumen of the airways can also be blocked in case of extensive edema of the pharynx.
• Tumor of the larynx. A malignant tumor of the larynx leads to the destruction of surrounding tissues. The degree of destruction depends on the size of food that can penetrate from the pharynx into the larynx. Also, the tumor itself can cause asphyxia if it partially or completely blocks the lumen of the larynx.
• Tumor of the trachea. Depending on the shape, the tumor is able to protrude into the lumen of the trachea itself. At the same time, stenosis is observed ( constriction) lumen of the larynx. This will greatly complicate breathing and further lead to mechanical asphyxia.

Diseases of the digestive system

The following diseases can cause asphyxia:

• Cancer of the upper esophagus. A tumor of the esophagus, growing, is able to exert significant pressure on adjacent organs - the larynx and trachea. Increasing in size, it can partially or completely compress the respiratory organs and, thereby, lead to mechanical asphyxia.
• Gastroesophageal reflux. This pathology is characterized by the ingestion of the contents of the stomach into the esophagus. In some cases, the contents of the stomach can enter the oral cavity, and when inhaled, enter the respiratory tract ( aspiration process).
• Tongue abscess. An abscess is a purulent-inflammatory disease with the formation of a cavity containing pus. The following picture is characteristic of an abscess of the tongue: the tongue is enlarged in volume, inactive and does not fit in the mouth. The voice is hoarse, breathing is difficult, there is profuse salivation. With an abscess of the tongue, the purulent cavity can be located in the root zone and prevent air from entering the larynx. Also, the increased size of the tongue can cause asphyxia.

Aspiration of food or vomit in children

Among newborns, aspiration is quite common. It can occur if the mammary gland fits snugly into the baby's nasal passages and makes breathing difficult. The child, trying to breathe, inhales the contents of his mouth. Another reason may be the wrong position of the child during feeding. If the child's head is in a tilted state, the epiglottis is not able to completely block the lumen of the larynx from milk entering it.

Aspiration of regurgitated masses during vomiting is also possible. The cause may be malformations of the digestive tract ( esophageal atresia, esophageal-tracheal fistula).

Birth trauma, toxicosis during pregnancy ( complication of pregnancy, manifested by edema, high blood pressure and loss of protein in the urine), various malformations of the esophagus significantly increase the chance of asphyxia due to aspiration.

Weakened babies

Psycho-emotional states

Alcohol intoxication

Talking while eating

Haste while eating

Absence of teeth

The absence of teeth can be the cause of asphyxia. Once in the mouth, food is not crushed enough. Poorly chewed food can get stuck in the mouth of the pharynx and turn into a foreign object. Large and small molars are responsible for grinding food. The absence of several of them can cause mechanical asphyxia.

Dentures

Inhalation of small objects

Symptoms of asphyxia

Symptom	Manifestation	A photo
Cough	When a foreign object enters the larynx, a person will reflexively begin to cough. At the same time, the cough is convulsive, painful, not bringing relief.
Excitation	The person instinctively grabs his throat, coughs, screams and tries to call for help. Small children are characterized by stifled crying, frightened eyes, wheezing and wheezing ( stridor). Less often weeping is stifled and muffled.
forced posture	Tilt the head and torso forward allows you to increase the depth of inspiration.
Bluish complexion	As a result of oxygen starvation, a large amount of blood containing carbon dioxide is concentrated in the tissues. A protein that binds to carbon dioxide and gives the skin a bluish tint.
Loss of consciousness	The blood flowing to the brain contains insufficient oxygen. With hypoxia, the nerve cells of the brain cannot function normally, which leads to fainting.
Respiratory arrest	Respiratory arrest occurs within a few minutes. If the cause of asphyxia is not eliminated and the foreign body is not removed from the lumen of the respiratory tract, then in 4-6 minutes the person will die.
Adynamia	Decrease in motor activity up to its complete cessation. Adynamia occurs due to loss of consciousness.
Involuntary urination and defecation	Oxygen starvation leads to an increase in the excitability of the soft muscles of the walls of the intestines and bladder, while the sphincters relax.

First aid for mechanical asphyxia

First aid in case of mechanical asphyxia:

• self-help;
• providing first aid to an adult;
• giving first aid to a child.

self help

Types of self-help for asphyxia:

• Perform 4 - 5 strong coughing movements. When a foreign body enters the lumen of the respiratory tract, it is necessary to make 4-5 forced cough movements, while avoiding deep breaths. If a foreign object has freed the lumen of the respiratory tract, then a deep breath can again lead to asphyxia or even aggravate it. If a foreign object is located in the pharynx or larynx, then this method may be effective.
• Make 3 - 4 pressure in the upper abdomen. The method is as follows: put the fist of the right hand in the epigastric region ( the upper part of the abdomen, which is bounded from above by the xiphoid process of the sternum, and to the right and left by the costal arches), press the fist with the open palm of the left hand and make 3-4 pushes with a quick sharp movement towards you and up. In this case, the fist, making a movement towards the internal organs, increases the pressure inside the abdominal and chest cavities. Thus, the air from the respiratory system tends to the outside and is able to push out the foreign body.
• Lean your upper abdomen against the back of a chair or armchair. As in the second method, the method increases intra-abdominal and intra-thoracic pressure.

Providing first aid to an adult

The first thing to do in such cases is to call an ambulance. Next, you should use special first aid techniques for asphyxia.

Ways to provide first aid to an adult with asphyxia:

• Heimlich maneuver. It is necessary to stand behind and wrap your arms around the torso of the victim just below the ribs. Place one hand in the epigastric region, clenching it into a fist. Put the palm of the second hand perpendicular to the first hand. With a quick jerky movement, press the fist into the stomach. In this case, all the force is concentrated at the point of contact of the abdomen with the thumb of the hand clenched into a fist. The Heimlich maneuver should be repeated 4-5 times until breathing normalizes. This method is the most effective and most likely will help push the foreign object out of the respiratory system.
• Make 4 - 5 blows with the palm of your hand on the back. Approach the victim from behind, with the open side of the palm, make 4-5 medium-strength blows on the back between the shoulder blades. Impacts must be directed along a tangent path.
• A method of helping if the person cannot be approached from behind or is unconscious. It is necessary to change the position of the person and turn him on his back. Next, position yourself on the hips of the victim and place the open base of one hand in the epigastric region. With the second hand, press on the first and move inward and upward. It is worth noting that the head of the victim should not be turned. You should repeat this manipulation 4-5 times.

Method for providing artificial respiration:

• "Mouth to mouth". It is necessary to use any rag material ( handkerchief, gauze, piece of shirt) as a spacer. This will avoid contact with saliva or blood. Next, you need to take a position to the right of the victim and sit on your knees. Inspect the oral cavity for the presence of a foreign body. To do this, use the index and middle fingers of the left hand. If it was not possible to find a foreign object, proceed to the next steps. Cover the victim's mouth with cloth. The head of the victim is thrown back with the left hand, and his nose is clamped with the right hand. Produce 10 - 15 breaths of air per minute or one exhalation every 4 - 6 seconds. It should be in close contact with the victim's mouth, otherwise all the inhaled air will not reach the victim's lungs. If the manipulation is performed correctly, then it will be possible to notice the movements of the chest.
• "Mouth to nose". The procedure is similar to the previous one, but has some differences. Exhalation is made into the nose, which is previously covered with material. The number of breaths remains the same - 10 - 15 breaths per minute. It is worth noting that with each exhalation, you need to close the victim's mouth, and in the intervals between blowing air, open the mouth slightly ( this action imitates passive exhalation of the victim).

Providing first aid to a child

Ways to provide first aid to a child with asphyxia:

• Heimlich maneuver for children under 1 year old. Position the child on your arm so that the face rests on the palm. It is good to fix the baby's head with your fingers. The legs should be on opposite sides of the forearm of the hand. It is necessary to slightly tilt the child's body down. Make 5 - 6 tangent pats on the back of the child. Pats are made with a palm in the area between the shoulder blades.
• Heimlich maneuver for children older than 1 year. You should put the child on his back and sit on his knees at his feet. In the epigastric region, place the index and middle fingers of both hands. Apply moderate pressure in this area until the foreign body clears the airways. The reception must be performed on the floor or on any other hard surface.

For children under the age of 1, artificial respiration is performed using the “mouth to mouth and nose” method, and for children older than 1 year - “mouth to mouth”. First you need to put the child on his back. The surface on which the child is to lie must be firm ( floor, board, table, ground). It is worth checking the oral cavity for the presence of foreign objects or vomit. Further, if a foreign object was not found, put a roller from improvised means under the head and proceed to perform air injections into the child's lungs. It is necessary to use rag material as a gasket. It should be remembered that exhalation is carried out only by the air that is in the mouth. The lung capacity of a child is many times smaller than that of an adult. Forced inhalation can simply rupture the alveoli in the lungs. The number of exhalations for children under one year old should be 30 per 1 minute or one exhalation every 2 seconds, and for children over one year old - 20 per 1 minute. The correctness of this manipulation can be easily checked by the movement of the child's chest during air blowing. It is necessary to use this method until the ambulance team arrives or until the child's breathing is restored.

Do I need to call an ambulance?

It must be remembered that only an ambulance team will be able to provide high-quality and qualified assistance. If necessary, all necessary resuscitation measures will be performed - indirect heart massage, artificial respiration, oxygen therapy. Also, emergency doctors may resort to an emergency measure - cricoconicotomy ( opening of the wall of the larynx at the level of the cricoid cartilage and the conical ligament). This procedure will allow you to insert a special tube into the hole made, and through it to resume the act of breathing.

Prevention of mechanical asphyxia

(applicable to children under the age of one year):

• Protection against aspiration during feeding. It should be remembered that during feeding the baby's head should be raised. After feeding, it is necessary to provide the child with an upright position.
• Use of a probe in case of feeding problems. It is not uncommon for a baby to have trouble breathing when bottle-feeding. If holding your breath during feeding occurs frequently, then the way out may be to use a special feeding probe.
• The appointment of special treatment for children predisposed to asphyxia. In case of repeated repetition of mechanical asphyxia, the following treatment regimen is recommended: injections of cordiamine, etimizol and caffeine. This scheme can be used only after consultation with your doctor.

• Restriction of the child in access to products of solid consistency. Any solid product in the kitchen can cause asphyxia. It is necessary to try to protect such products as seeds, beans, nuts, peas, candies, hard meat from falling into the hands of the child. It is worth avoiding such products for up to four years.
• Choosing and buying safe toys. The purchase of toys should be made based on the age of the child. Each toy should be carefully inspected for removable hard parts. You should not buy designers for children under 3 - 4 years old.
• The right choice of food. Nutrition for a child should strictly correspond to his age. Well-chopped and processed food is a must for children up to three years of age.
• Store small items in a safe place. It is worth keeping various office supplies such as pins, buttons, erasers, caps in a safe place.
• Teaching children to chew food thoroughly. Solid food should be chewed at least 30-40 times, and soft foods ( porridge, puree) - 10 - 20 times.

• Restriction in the use of alcohol. Drinking alcohol in large quantities can lead to a violation of the chewing and swallowing act and, as a result, increase the risk of mechanical asphyxia.
• Refusal to talk while eating. During a conversation, involuntary combination of swallowing and respiratory act is possible.
• Be careful when eating fish products. Fish bones often enter the lumen of the respiratory tract, causing partial closure of the lumen of the respiratory tract. Also, the sharp part of the fish bone can pierce the mucous membrane of one of the organs of the upper respiratory tract and lead to its inflammation and swelling.
• The use of pins, needles and hairpins for their intended purpose. Hairpins and pins can be placed in the mouth for quick access. During a conversation, these small objects are able to freely enter the respiratory tract and cause asphyxia.

- foreign objects accidentally aspirated or caught in the airways through the wound channels and fixed at the level of the bronchi. The foreign body of the bronchus makes itself felt with a paroxysmal whooping cough, asphyxia, cyanosis of the face, stenotic breathing, hemoptysis, vomiting, impaired phonation. A foreign body in the bronchi is recognized on the basis of the collected history, radiography of the lungs, tomography, bronchography, bronchoscopy. Removal of a foreign body from the bronchus is carried out endoscopically; with wedged foreign bodies resort to bronchotomy.

ICD-10

T17.5 Foreign body in bronchi

General information

Foreign bodies of the respiratory tract are an urgent and very serious problem in otolaryngology and pulmonology. According to clinical data, among all cases of foreign bodies of the airways, foreign bodies of the larynx occur in 12%, foreign bodies of the trachea - in 18%, foreign bodies of the bronchus - in 70% of cases. Foreign bodies of the airways are especially common in childhood. The foreign bodies of the bronchi in children account for 36%; at the same time, in a third of observations, the age of children is from 2 to 4 years. In 70% of cases, foreign bodies enter the right bronchus, since it is wider and straighter.

Foreign bodies of the bronchus can pose a threat to life, so they require urgent specialized intervention. Untimely recognized and not removed in time foreign bodies of the bronchi lead to the development of secondary complications: atelectasis, aspiration pneumonia, bronchiectasis, pneumothorax, purulent pleurisy, lung abscess.

Causes of penetration of a foreign body into the bronchus

A foreign body can enter the bronchus by aspiration (when it is inhaled through the mouth, thrown from the esophagus and stomach with gastroesophageal reflux or vomiting), as well as through the wound channel in case of damage to the chest and lung. The penetration of foreign bodies is possible during surgical interventions: tracheotomy, adenotomy, removal of a foreign body from the nose, dental procedures. Among these mechanisms, the most common is the aspiration route of foreign bodies entering the bronchi.

Aspiration of foreign bodies into the bronchi contributes to the habit of children and adults to hold small objects in their mouths. The ingress of objects from the oral cavity into the bronchi occurs during the game, laughing, crying, talking, coughing, sudden fright, falling, etc. Often, the background for the aspiration of foreign bodies into the bronchi is concomitant rhinitis and adenoid growths, the state of anesthesia.

By their nature, foreign bodies of the bronchi are divided into endogenous and exogenous, organic and inorganic. Endogenous foreign bodies include non-extracted pieces of tissue during tonsillectomy and adenotomy, endoscopic removal of benign tumors of the bronchi, extracted teeth, roundworms.

The most diverse group of findings are exogenous foreign bodies of the bronchi: these can be small objects made of metal, synthetic materials, objects of plant origin. Among the exogenous foreign bodies of the bronchus, there are both organic (food particles, seeds and grains of plants, nuts, etc.) and inorganic (coins, paper clips, screws, beads, buttons, toy parts, etc.) objects. The greatest aggressiveness and difficulty in diagnosis are objects of organic origin, synthetic materials and tissues. They are not contrasted with x-rays, they can stay in the lumen of the bronchus for a long time, where they swell, crumble, and decompose; penetrate into the distal parts of the bronchial tree, causing chronic suppuration of the lungs.

Foreign bodies of the bronchi, having a smooth surface, are capable of moving, translational movement to the periphery. Objects of plant origin (spikelets of cereals and herbs), on the contrary, wedged into the wall of the bronchus and remain fixed. There are cases of single and multiple foreign bodies of the bronchus.

Pathological changes in foreign bodies of the bronchus

Pathological changes in the bronchi depend on the size, nature of the foreign body and the time it has been in the airways. In the initial period, generalized bronchospasm, local hyperemia, swelling and ulceration of the bronchial mucosa, and exudation occur. In later periods, a capsule is formed around the foreign body, granulations grow with their subsequent scarring.

Foreign bodies in the bronchi can occupy different positions, as a result of which various secondary changes in the lung tissue are observed. When balloting foreign bodies, the lumen of the bronchus is not completely blocked, external respiration is not critically disturbed, secondary inflammatory changes in the lung tissue are moderate.

With valve obstruction of the bronchus, there is a loose contact of the foreign body with the walls of the bronchus, therefore, on inspiration, air enters the lung, and on expiration, due to bronchospasm, it cannot exit back. Thus, air is retained in the lung tissue with the development of lung emphysema below the site of bronchial obstruction. With complete blockage of the bronchus by a foreign body in the underlying unventilated sections of the lung, obstructive atelectasis and atelectatic pneumonia occur.

A foreign body in the bronchus always brings an infection with it, which is accompanied by a local inflammatory reaction. Therefore, with long-term foreign bodies of the bronchi, non-resolving bronchitis, bronchopneumonia, deforming bronchitis, bronchiectasis, lung abscesses, broncho-pleuro-thoracic fistulas develop.

Symptoms of a foreign body in the bronchus

In the clinical symptoms of foreign bodies of the bronchi, three periods are distinguished: the debut phase, the phase of relative compensation of respiratory functions and the phase of secondary complications.

In the debut phase after aspiration of a foreign body, a sudden paroxysmal cough develops; aphonia, respiratory failure up to asphyxia. A similar picture is sometimes observed with diphtheria, however, in this case there is no suddenness factor, and pathological symptoms (sore throat, fever, etc.) precede the appearance of a cough. With false croup, catarrhal phenomena of the upper respiratory tract also precede an attack of coughing and suffocation. With benign tumors of the larynx, aphonia increases gradually. Cough attacks are often accompanied by vomiting and cyanosis of the face, reminiscent of whooping cough: this can cause diagnostic errors, especially in cases where the fact of aspiration is "viewed".

Shortly after the penetration of a foreign body into the main, lobar or segmental bronchus, a phase of relative compensation of the respiratory function begins. During this period, due to partial obstruction of the bronchus and bronchospasm, wheezing is heard at a distance - inspiratory stridor. There is moderate shortness of breath, pain in the corresponding half of the chest.

Further dynamics of the pathological process with foreign bodies of the bronchus depends on the severity of inflammatory changes that develop in the area of ​​the lung that is switched off from breathing. In the phase of complications, a productive cough with mucopurulent sputum, fever, hemoptysis, and dyspnea occur. The clinical picture is determined by the developed secondary complication. In some cases, foreign bodies of the bronchi go unnoticed and are an accidental finding during surgical interventions on the lungs.

Diagnosis of a foreign body in the bronchus

The difficulty of recognizing foreign bodies in the bronchi is due to the fact that the fact of aspiration cannot always be noticed. The non-specificity of symptoms often leads to the fact that persons with foreign bodies in the bronchi are treated for a long time by a pulmonologist for various broncho-pulmonary diseases. The reason to suspect the presence of a foreign body in the bronchi is ineffective therapy for asthmatic bronchitis, chronic bronchitis and pneumonia, whooping cough, bronchial asthma, etc.

Physical data with foreign bodies of the bronchus indicate the presence of atelectasis (a sharp weakening or absence of breathing, dullness of percussion sound) or emphysema (percussion tone with a box shade, weakened breathing). On examination, attention is drawn to the lagging of the affected side of the chest during breathing, participation in the act of breathing of auxiliary muscles, retraction of the jugular fossae and intercostal spaces, etc.

In all cases, if a foreign body of the bronchus is suspected, chest X-ray is indicated. In this case, narrowing of the bronchus, local emphysema, atelectasis, focal infiltration of the lung tissue, etc. can be detected. Clarification of the location of the foreign body and the nature of local changes in the lungs is performed using X-ray or computed tomography, NMR, bronchography.

The most reliable diagnostic method for visualizing foreign bodies in the bronchi is bronchoscopy. Often, due to the severity of local changes, a foreign body cannot be detected immediately. In such cases, granulations are removed, a thorough sanitation of the bronchial tree (bronchoalveolar lavage), a course of antibiotic therapy, and then an endoscopic examination of the bronchi is repeated.

Treatment of a foreign body in the bronchus

The presence of a foreign body in the bronchus is an indication for its extraction. In most cases, it is possible to perform endoscopic removal of a foreign body in the bronchus during repeated bronchoscopy. If a foreign body is detected in the lumen of the bronchus, the tube of the bronchoscope is carefully brought to it, the object is grasped with forceps and removed.

Metal objects can be removed with a magnet; small foreign bodies of the bronchi - using an electric suction. Then the bronchoscope is re-introduced to revise the bronchi for leaving "fragments", wounding the walls of the bronchus, etc. In some cases, the removal of foreign bodies from the bronchi is performed through a tracheostomy.

Foreign bodies that are tightly wedged into the wall of the bronchus are subject to surgical removal in the process of thoracotomy and bronchotomy. Indications for bronchotomy are fixed or impacted foreign bodies that cannot be removed without significant damage to the walls of the bronchi. They also switch to surgical tactics in case of complications when trying to endoscopically remove foreign bodies (rupture of the bronchus, bleeding).

Forecast and prevention of foreign bodies of the bronchi

With timely extraction of a foreign body in the bronchus, the prognosis is good. Complications of foreign bodies of the bronchus can be disabling and life-threatening diseases - pleural empyema, fistulas (thoracobronchial, esophageal-bronchial, broncho-pleural), pneumothorax, pulmonary hemorrhage, rupture of the bronchus, purulent mediastinitis, etc. In some cases, death of children from sudden asphyxia.

Preventive measures should include adult control over the quality of toys and their age-appropriateness; weaning children from the habit of taking foreign objects into their mouths; explanatory and educational work among the population; exercise caution in medical procedures.

This can happen to anyone. Everyone experienced that unpleasant moment when a lot of people are sitting at the table, and food or drink got “in the wrong throat”. Most often, to stop this incident, it is enough to clear your throat.
But what to do if within a few minutes it does not get better, neither inhalation nor exhalation is possible, the face changes color? Surrounding people rush to help with the desire to pat on the back.

Now let's imagine: the victim is sitting at the table, the position of the torso is almost vertical, the foreign body is stuck in the airways. Where does it go with pats on the back? That's right - down the airways. Such actions are dangerous, can aggravate the situation and even lead to death.
What is the right way to act in such situations? Opinions are contradictory. Let's turn to the textbook on first aid.

In the section on the ingress of a foreign body into the respiratory tract, recommendations are given: put the victim on the stomach through the knee of the person providing first aid, strike on the back.

And not a word about the Heimlich method, which is described in many articles as the only effective one when food has entered the respiratory tract. Western cinematography also actively advertises this technique to us.

The question arises, what method should a first aid person turn to when every lost second can lead the victim to death?

For help with clarification, go to emergency doctor .

- If a person chokes, in what cases do they use blows to the back, and in what cases do they use the Heimlich maneuver?

- In some cases, taking a tap on the back can provoke the dislocation of the foreign body even lower into the airways. The lower it is from the vocal cords, the more pronounced the degree of asphyxia (suffocation). Ambulance workers are invited in such a situation to act in accordance with the normative act, which clearly regulates the manipulations with the victim.

1. We start with tapping (patting, hitting between the shoulder blades). Only you need to perform it correctly so as not to harm: give the body of the victim a position with an inclination forward and inflict 5 blows between the shoulder blades. The mechanism of this technique is due to the fact that we cause stimulation and enhancement of the cough reflex, which increases the expiratory pressure in the airways. This is necessary for self-removal of a foreign body from the respiratory tract.

2. The second stage, if the pat is ineffective, is the execution Heimlich maneuver. The victim must be tilted forward, stand behind him, put his hand folded into a fist in the area between the navel and the sternum, grab it with the other hand and make 5 sharp pushes inward and upward.

3. If it doesn’t help, start all over again: 5 blows to the back in the correct position of the body, then the Heimlich maneuver.
The Heimlich maneuver is different for pregnant women, children, and unconscious people.

Pregnant produce shocks in the chest area.

If the person has lost consciousness , you need to put it on your back, make sure that your head is not turned to the side. It is more convenient to sit on top of him and in the area between the navel and the xiphoid process of the sternum, make the same shocks as if the rescuer was standing behind, in this case, use your weight.

If a child is choking, do not hesitate. In children, the mucosa is very tender, and edema quickly increases. In a matter of minutes, edema from 1 degree turns into 4 and hypoxic coma. You need to immediately call an ambulance or go to the nearest hospital on your own. While waiting for an ambulance, you can not do nothing. Provide maximum air flow, clean the oral cavity and nasal passages from mucus with a rubber can (syringe) or a syringe with a dropper tube. Since there may be reflex vomiting, it is necessary to give a stable lateral position. In children's practice, it is not always advised to start with tapping. If you do it incorrectly, it can lead to a rupture of the lungs or to the dislocation of a foreign body.
However, it is no coincidence that the order for ambulance workers prescribes a sequence of actions, starting with blows to the back. This is due to high efficiency when done correctly. I can say that if you decide to strike a child in the interscapular region, you need to be careful.

The child is given the following position:

If these actions are ineffective, turn the child on his back, head below the body. Make 5 pushes inward and towards the chest in the area below the nipples by one finger. You can do this with one or two hands.

If there was no one around who would help, you can independently help yourself with a modified Heimlich technique. The point is that the victim independently reproduces the above-described tremors in the epigastric region (a). Or he uses improvised means: the back of a chair, the corner of a table, etc. (b)

Be careful, try not to rush and not be distracted by conversations at the table. Stay calm and follow the steps clearly if you or someone close to you is choking.