What got into the respiratory tract. Foreign body in the airways: what to do? Help for babies

Foreign body in the airways

Foreign body in the respiratory tract is a severe pathology caused by the ingress of foreign bodies into the respiratory tract. At the time of entry and removal of a foreign body, there is a danger to life due to the risk of instant development of asphyxia and other complications.

Causes

Usually, foreign bodies enter the respiratory tract through the mouth in a natural way. Also, foreign bodies can enter from the gastrointestinal tract during regurgitation (moving in the opposite direction) of gastric contents, the creeping of worms, the penetration of leeches when drinking water from reservoirs.

When coughing, a foreign body from the bronchi, which previously got there, can get into the larynx. In this case, a severe attack of asphyxia occurs.

The immediate cause of foreign body entry is a sharp deep breath, with which the foreign body moves into the respiratory tract.

Symptoms

Clinical symptoms depend on the period of the course. At the time of inhalation and passage of a foreign body through the larynx and trachea, acute respiratory disorders develop: an asthma attack, convulsive cough, cyanosis of the skin, dysphonia, rashes in the form of spots on the skin of the face. There is a risk of suffocation. When a large foreign body is inhaled, instant death due to asphyxia can occur. Smaller foreign bodies with the next forced breath move into the lower respiratory tract.

Clinical symptoms become less pronounced after the foreign body moves into the bronchus, then a period of complications begins. The main symptoms of complications: pronounced stenotic breathing, a sharp paroxysmal cough as in whooping cough, dysphonia to the degree of aphonia. If the foreign body in the airways is pointed, pain behind the sternum may appear, which intensifies during coughing and sudden movements. Blood is seen in the sputum.

When large foreign bodies enter, suffocation can develop immediately and increase gradually.

The nature of breathing and coughing depends on the placement of the foreign body in the airways.

Diagnostics

Diagnosis is based on the results of a physical examination, laboratory and instrumental studies. Physical examination includes assessment of the general condition, percussion, auscultation, determination of voice trembling, color of the skin and mucous membranes.

Laboratory studies include generally accepted clinical tests to assess the severity of bronchopulmonary processes. Instrumental examinations: radiography and fluoroscopy of the chest, bronchography.

Types of disease

Depending on the level of localization, foreign bodies of the larynx, trachea and bronchi are isolated.

Patient's actions

Patients with confirmed inhalation of a foreign body or suspected aspiration require urgent hospitalization.

Treatment

Non-drug treatment consists in physiotherapy of developed inflammatory complications of the bronchopulmonary system, inhalation therapy; oxygen therapy in severe stenosis.

Drug treatment: antibacterial, hyposensitizing drugs; symptomatic treatment (antitussive, expectorant, antipyretic); inhalation.

Surgical treatment consists in the extraction of foreign bodies during endoscopic interventions. The method of intervention depends on the location of the foreign object, the age of the patient, the severity of complications (direct laryngoscopy, tracheobronchoscopy with a Friedel system bronchoscope, fibrobronchoscopy, tracheotomy, thoractomy). When removing metal foreign bodies, magnets are used.

The development of complications depends on the nature, size of the foreign body, its location, the timeliness and usefulness of the examination of the patient and the provision of qualified medical care to him, on the age of the patient.

Complications

Perhaps the development of tracheobronchitis, acute and chronic pneumonia, tension bilateral pneumothorax, lung abscess, extensive mediastinal emphysema, bleeding from the main vessels of the mediastinum, sepsis; through damage to the bronchus wall; instant death due to asphyxia.

Prevention

Foreign bodies of the trachea, bronchi and larynx can lead to the most unpleasant consequences, up to death. You need to know the main symptoms of foreign objects entering the respiratory tract in order to help the victim in time. Sometimes a foreign body in the bronchi or trachea can be there for quite a long time if it does not block the lumen and does not lead to suffocation, but this does not mean that it can not be removed.

How do foreign objects enter the respiratory tract?

Most often this happens when you inhale. Such a nuisance happens to both children and adults who have the habit of holding small objects in their mouths. Sometimes a piece of food or a tablet can get stuck in the windpipe.

Inhalation of foreign objects is possible with a strong breath, for example, with fear, laughter, crying, yawning. In children, small parts of toys, peas, sweets, buttons, beads and many other small items get into the bronchi and trachea. Adults often suffer from inhalation of cloves, pins that they hold in their mouths while working.

What are dangerous foreign objects in the respiratory tract:

• obstruction of the lumen of the trachea or bronchus
• damage that can be caused by an object with sharp edges or edges
• inflammation that develops with prolonged traumatic effects on the walls of the respiratory tract.

Both inorganic and organic objects are equally dangerous. Organics decompose, releasing harmful decay products, in addition, organic objects absorb moisture and swell, which can lead to respiratory arrest.

Symptoms of foreign bodies in the airways

Symptoms of foreign bodies entering the bronchi or trachea can be different, depending on the size of the object and its physical properties. Large bodies can cause rapidly developing asphyxia, in which the victim begins to turn blue, gasp for air and quickly lose consciousness.

Small things may not cause obvious difficulty in breathing for a long time. In children, such objects can move freely through the trachea, from time to time causing sudden attacks of suffocation. This happens when the object takes an uncomfortable position, causing a sharp muscle spasm. The kid at the same time loses consciousness, turns blue, stops breathing and falls. With loss of consciousness, the spasm stops, the stuck object is released, breathing is restored. The child comes to his senses and can continue to play as if nothing had happened. Parents often mistake such attacks for epilepsy.

One of the most characteristic signs of a foreign object getting into the trachea or bronchi becomes a strong coughaccompanied by chest pain.

With a long stay of a foreign object in the bronchi or trachea, inflammation develops, causing the formation of a significant amount of sputum, sometimes purulent or mixed with blood. Inflammation is accompanied by an increase in body temperature and impaired respiratory function.

Diagnosis and treatment

For diagnosis, listening, radiography, bronchoscopy and tracheoscopy are used. During bronchoscopy, the foreign object is removed, if possible. In some cases, this cannot be done due to the developed edema of nearby tissues, and then a surgical operation has to be performed.

Foreign bodies of the trachea and bronchi can cause complications such as bronchitis, lung abscess, pneumonia and other diseases.

The content of the article

Definition

Classification of foreign bodies of the respiratory tract

Etiology of foreign bodies in the respiratory tract

The pathogenesis of foreign bodies in the respiratory tract

Clinic of foreign bodies of the respiratory tract

Foreign bodies of the larynx cause the most severe condition of patients. The main symptoms are pronounced stenotic breathing, a sharp paroxysmal whooping cough, dysphonia to the degree of aphonia. With pointed foreign bodies, pain behind the sternum is possible, aggravated by coughing and sudden movements, and an admixture of blood appears in the sputum. Asphyxiation develops immediately when large foreign bodies enter or increases gradually if pointed foreign bodies get stuck in the larynx, due to the progression of reactive edema.

Foreign bodies of the trachea cause a reflex convulsive cough, aggravated at night and with restless behavior of the child. The voice is restored. Stenosis from permanent localization in the larynx becomes paroxysmal due to the balloting of a foreign body. Balloting of a foreign body is clinically manifested by a “pop” symptom, which is heard at a distance and occurs as a result of blows of a moving foreign body against the walls of the trachea and against closed vocal folds that prevent the removal of a foreign body during forced breathing and coughing. Balloting foreign bodies pose a great danger due to the possibility of infringement in the glottis and the development of severe suffocation. Respiratory failure is not as pronounced as with foreign bodies of the larynx, and is repeated periodically against the background of laryngospasm caused by contact of a foreign body with the vocal folds. Self-removal of a foreign body is hindered by the so-called valve mechanism of the tracheobronchial tree (“piggy bank” phenomenon), which consists in expanding the lumen of the airways during inhalation and narrowing it during exhalation. Negative pressure in the lungs drags the foreign body into the lower airways. The elastic properties of the lung tissue, the strength of the muscles of the diaphragm, the auxiliary respiratory muscles in children are not so developed as to remove the foreign body. The contact of a foreign body with the vocal folds when coughing causes a spasm of the glottis, and the forced breath that follows again drags the foreign body into the lower respiratory tract. With foreign bodies of the trachea, a boxed shade of percussion sound, a weakening of breathing throughout the lung field are determined, and an increased transparency of the lungs is noted during radiography.

When the foreign body moves into the bronchus, all subjective symptoms stop. The voice is restored, breathing stabilizes, becomes free, compensated by the second lung, the bronchus of which is free, coughing fits become rare. A foreign body fixed in the bronchus causes at first meager symptoms, followed by profound changes in the bronchopulmonary system. Large foreign bodies linger in the main bronchi, small ones penetrate into the lobar and segmental bronchi.

Clinical symptoms associated with the presence of a foreign body in the bronchus depend on the level of localization of this foreign body and the degree of obstruction of the lumen of the bronchus. There are three types of bronchoconstriction: with complete atelectasis, with partial, along with the displacement of the mediastinal organs towards the obstructed bronchus, the unequal intensity of the shadow of both lungs, the slanting of the ribs, the lag or immobility of the dome of the diaphragm during breathing on the side of the obturated bronchus are noted; with valve, emphysema of the corresponding section of the lungs is formed.

Auscultation determines the weakening of breathing and voice trembling, respectively, the localization of the foreign body, wheezing.
The development of bonchopulmonary complications is facilitated by a violation of ventilation with the exclusion of significant areas of the lung parenchyma from breathing; possible damage to the walls of the bronchi, infection. In the early stages after aspiration of a foreign body, asphyxia, laryngeal edema, and atelectasis occur predominantly, respectively, in the area of ​​the obstructed bronchus. Atelectasis in young children causes a sharp deterioration in breathing.
Perhaps the development of trachebronchitis, acute and chronic pneumonia, lung abscess.

Diagnosis of foreign bodies of the respiratory tract

Physical examination

Laboratory research

Differential diagnosis of foreign bodies of the respiratory tract

Treatment of foreign bodies in the respiratory tract

Indications for hospitalization

Non-drug treatment

Medical treatment

Surgery

The laryngeal mask greatly facilitates the passage of the fiberscope into the lower respiratory tract.
Indications for tracheotomy for aspirated foreign bodies:
asphyxia with large foreign bodies fixed in the larynx or trachea;
pronounced subglottic laryngitis, observed when foreign bodies are localized in the subglottic cavity or developed after surgical intervention when removing a foreign body;
inability to remove a large foreign body through the glottis during upper bronchoscopy;
ankylosis or damage to the cervical vertebrae, which does not allow the removal of a foreign body by direct laryngoscopy or upper bronchoscopy.
tracheotomy is indicated in all cases when the patient is threatened with death from suffocation and there is no way to send him to a specialized medical institution.
In some cases, with aspirated foreign bodies, thoracic intervention is performed. Indications for thoracotomy:
movement of a foreign body into the lung tissue;
a foreign body wedged into the bronchus after unsuccessful attempts to remove it with rigid endoscopy and fiberoptic bronchoscopy;
bleeding from the respiratory tract when trying to endoscopic removal of a foreign body;
tension pneumothorax during aspiration of pointed foreign bodies and the failure of their endoscopic removal;
deep destructive irreversible changes in the segment of the lungs in the zone of localization of the foreign body (removal of the affected area of ​​the lungs along with the foreign body in such cases prevents the development of extensive suppurative changes in the lung tissue).
Among the possible complications in the removal of aspirated foreign bodies, there are asphyxia, cardiac and respiratory arrest (vagal reflex), bronchospasm, laryngeal edema, reflex atelectasis of the lung or its segment, airway occlusion with exhaustion of the cough reflex and paresis of the diaphragm.
When extracting pointed foreign bodies, perforation of the bronchial wall, subcutaneous emphysema, mediastinal emphysema, pneumothorax, bleeding, trauma to the mucous membrane of the larynx, trachea and bronchi are possible.

Prognosis of foreign bodies in the respiratory tract

Violations of respiratory activity when a foreign body enters the respiratory organs and pathways has a medical name - aspiration.

Most often with this diagnosis, children of primary preschool age are admitted to the hospital. This is due to the fact that during the games it is interesting for children to taste their favorite toys. The smallest ones pull everything that comes to hand into their mouths, which is why, in order to protect the child from danger, it is necessary to exclude all toys with small details from the children's room.

In childhood, the danger lies in the fact that the child cannot always explain what happened. And in the absence of severe symptoms, the fact that a foreign matter enters the respiratory tract is found out when concomitant diseases develop.

Objects in the lungs completely or partially block the bronchial lumen, disrupting the movement of air, causing inflammation and purulent processes in the pulmonary tract.

The size of the foreign body depends on where it gets: into the trachea, bronchi or lungs. Next, we will consider how dangerous it is for objects to enter the respiratory system and what to do in this case.

Why are foreign bodies in the lungs dangerous and how to recognize the condition?

In most cases, foreign bodies enter the right-sided bronchi and lungs. This is due to the large volume of the right lung and its location. Particles deposited in small bronchial ramifications rarely have severe symptoms.

Most often there is a rare cough, which is attributed to a cold.

This condition is difficult to diagnose, and is dangerous because foreign particles can completely block the bronchial lumen.

Even if a person feels relatively normal immediately after a foreign body enters the lungs, the following symptoms develop over time:

The worst sign is the absence of cough, which means that the foreign body has completely blocked the airways.

When the particles are large enough, they can completely block the air supply to the lungs, which can be fatal. Symptoms of a life-threatening condition:

1. The complexion changes, acquiring a red or blue tint.
2. Inability to take a breath.
3. Sudden onset of paroxysmal cough.
4. The patient is holding his throat.
5. Hoarseness, complete loss of voice.
6. Whistling breath.
7. Dyspnea.
8. Loss of consciousness.

Objects with an uneven surface, when swallowed, contribute more than others to the inflammatory process, since mucus lingers on them, bacteria settle, and they can injure the bronchial tract. Foreign proteins cause allergic reactions and local inflammatory processes.

The biggest danger is food particles that can decompose into smaller grains. Only a doctor will tell you what to do if food enters the respiratory system. Its extraction is more difficult, and the particles decompose very quickly, causing purulent inflammation.

When a foreign body enters the bronchial tract, the following diseases develop:

1. Emphysema of the lungs.
2. Obstructive bronchitis.
3. Pulmonary edema.
4. Pneumonia.
5. Purulent pleurisy.
6. Bronchiectostasis.

If foreign objects are in the small bronchial tracts, mechanical damage, infection and growth of the lung tissue are possible.

To avoid this, if aspiration is suspected, it is necessary to contact a pulmonologist, who, after diagnosing, will determine whether there is a foreign body in the airways or not.

Diagnosis and treatment

First of all, the diagnosis is based on the complaints of the victim. If it concerns a child, then on the stories of adults about what happened. If the fact of aspiration was not noticed, then without the presence of external symptoms, diagnosis can be difficult.

First, the patient's breathing is listened to, the doctor can hear: wheezing, whistling, weakened or hard breathing. With complete blockage of the bronchial lumen, the specialist will not hear anything. Further, the following diagnostic methods are assigned:

1. Radiography.
2. X-ray.
3. Endoscopy.

Inhaled objects and food are not always visible on x-rays. This may be due to the permeability of x-rays or the formation of severe edema in the lungs that covers the foreign body.

The most accurate method of diagnosis is endoscopy. Depending on the condition and age of the patient, the procedure can be performed under local or general anesthesia.

Children endoscopy is performed only under general anesthesia. Another diagnostic method is, but it is used extremely rarely due to the high cost of the procedure.

Urgent Action

What is the first thing to do when aspirating? If a foreign body enters the respiratory tract, the patient's condition should be assessed. If he is conscious and not choking, he needs to cough well. If you suspect that the particles could remain in the respiratory system, you must call an ambulance or go to the emergency room of the hospital yourself.

If the cough after aspiration is accompanied by shortness of breath, cyanosis on the face, the following assistance should be provided:

It is forbidden to hit the back in a vertical position, so the particles will fall even lower! Children should be especially careful. If round, even objects hit, the child can be turned upside down and tapped on the back, perhaps the object will fall out by itself.

Health care

In any case, the entry of a foreign body into the lungs and bronchi requires medical intervention. Therefore, at the first signs of aspiration, it is necessary to call an ambulance, and, while waiting for it, help the patient remove the object from the respiratory tract.

Treatment of aspiration means removing foreign particles from the airways. If foreign particles enter the larynx, then it is possible to remove the foreign body manually or using laryngoscopy. If a foreign body is found in the trachea, a tracheoscopy procedure is performed.

The biggest difficulty in removing a foreign body is bronchoscopy - the extraction of small particles from the bronchi and bronchial tract. Often this procedure has to be repeated several times, especially if the object crumbles heavily, for example, if food has entered the respiratory tract.

To avoid the negative consequences of aspiration, you should consult a doctor immediately after suspecting that particles have entered the lungs.

During endoscopic intervention, in addition to extracting a foreign body, pus and mucus accumulated in the bronchial lumen are sucked off. In some cases, a piece of lung tissue is taken for a biopsy, since the development of benign and malignant tumors is possible. After removing the object from the respiratory tract, further treatment is based on the elimination of the consequences of aspiration - anti-inflammatory treatment.

Foreign bodies enter the respiratory system through the oral cavity when inhaled. They are very dangerous, as they can block the access of air to the respiratory tract. In this case, it is necessary to provide first aid and call a doctor. With a delay of a small object in the bronchi, an inflammatory process and a focus of suppuration will occur around it.

The reasons

Foreign bodies in the larynx, trachea or bronchi are observed mainly in babies who take small objects into their mouths and can inhale them. In this case, a reflex spasm of the muscles of the trachea and bronchi may occur, which significantly worsens the condition. The ingress of foreign objects into the bronchi of a child requires the help of a doctor.

In adults, cases of the disease are associated with talking or laughing while eating, as well as with the ingestion of vomit into the bronchi during poisoning, for example, when intoxicated. In the latter case, development is possible - severe inflammation of the lungs.

Symptoms

Stopping a foreign object in the larynx is accompanied by the following symptoms:

• difficult breathing;
• lack of air;
• blueness around the nose and mouth;
• strong coughing shocks;
• in children - vomiting, lacrimation;
• brief cessation of breathing.

These signs may disappear and return again. Often the voice becomes hoarse or completely disappears. If the foreign body is small, during exercise, shortness of breath appears with a noisy breath, retraction of the areas under the collarbones and above them, and the spaces between the ribs. In infants, these symptoms are aggravated by feeding or crying.

If a large object enters the larynx, signs of narrowing of the airways occur in a calm state, accompanied by cyanosis, agitation of the victim. If the bluish coloration of the skin during movements extends to the trunk and limbs, there is frequent breathing in a calm state, lethargy or motor excitation appears, this indicates a danger to life. Without help, a person loses consciousness, he has convulsions, breathing stops.

Signs of narrowing of the lumen of the trachea: paroxysmal cough, vomiting and cyanosis of the face. When coughing, clapping sounds are often heard that occur when a foreign object is displaced. With complete obstruction of the trachea or a foreign object stuck in the vocal cords, suffocation appears.

Small foreign bodies can quickly get into one of the bronchi with inhaled air. Often, at the same time, the victim does not present any complaints at first. Then a purulent process develops in the bronchi. If the parents did not notice that the child inhaled a small object, he develops chronic inflammation of the bronchi, which cannot be treated.

Urgent care

The victim must be urgently hospitalized. An examination, including a chest x-ray, should be performed in the hospital. Often, fiberoptic bronchoscopy is needed - an examination of the trachea and bronchi using a flexible thin tube equipped with a video camera and miniature instruments. With this procedure, the foreign object is removed.

Before help arrives, an adult may try to expel a foreign object when coughing. First you need to take a deep breath, which happens when the vocal cords are closed. On exhalation, a powerful air stream can push out a foreign object. If you can’t take a deep breath, you need to cough up the air remaining in the lungs.

With the ineffectiveness of coughing with fists, they sharply press on the area under the sternum. Another way is to quickly hang over the back of a chair.

In more severe cases, with severe shortness of breath, retraction of the subclavian fossae, increasing cyanosis, another person should help the victim. You can do the following:

1. Approach the victim from the back and with the lower part of the palm, make several sharp pushes along the back at the level of the upper edge of the shoulder blades.
2. If this does not help, clasp the victim with your hands, put your fist on the upper abdomen, cover the fist with the other hand and quickly press from the bottom up.

If life-threatening signs appear in a child, first aid is as follows:

1. The baby is turned upside down for a short time, tapping him on the back.
2. They put the child with his stomach on the left thigh of an adult, press the legs with one hand, and slap the back with the other hand.
3. The baby can be put on the left forearm, holding it by the shoulders, and pat on the back.

If there is no threat to life, the victim can breathe, all of the above methods are not recommended, as this can lead to the movement of a foreign object and getting it stuck in the vocal cords.

If the patient is unconscious and not breathing, it is necessary to do artificial respiration. The chest should begin to expand. If this did not happen, it means that the foreign body completely blocked the access of air. In this case, the patient must be turned on his side with his chest to himself, hold him in this position and inflict several blows in the interscapular region. Then it should be turned on its back and examine the oral cavity.

If the foreign object is not removed, both hands are placed on the upper abdomen and make sharp jerks in the direction from the bottom up. The foreign body caught in the mouth is removed and artificial respiration is continued until consciousness is restored. If there is no pulse, begin an indirect heart massage, which should last at least 30 minutes or until the victim's condition improves.

Pediatrician Komarovsky E. O. talks about a foreign body in the respiratory tract:

Help the patient with aspiration of a foreign body into the respiratory tract: