What's on hit. What to do if a foreign body enters the respiratory tract, esophagus, ear or nose? Which burns should not be washed with water
The pharynx, esophagus and respiratory tract often get food fish and meat bones during meals, as well as pins, buttons, small nails and other objects that are taken into the mouth during work. This can cause pain, difficulty breathing, coughing, and even suffocation.
Attempts to cause the passage of a foreign body through the esophagus into the stomach by eating crusts of bread, porridge, potatoes in most cases do not give success, so in any case it is necessary to contact a medical institution.
In those cases when, during mechanical ventilation, when trying to inflate the lungs under positive pressure, an obstacle is encountered, despite the fact that the patient's head is thrown back, the lower jaw is pushed forward, and the mouth is open, a foreign body in the upper respiratory tract can be suspected. If there is no effect, the victim is laid on the table, the head is sharply bent back and the larynx area is examined through the open mouth (Fig. 2.5).
Fig.2.5. Foreign bodies of the respiratory tract:
When a foreign body is detected, it is captured with tweezers, fingers and removed. The victim should be taken to a medical facility.
Three tricks are used to quickly open the mouth:
A - reception with the help of crossed fingers with a moderately relaxed lower jaw. Insert your index finger into the corner of the victim's mouth and press it in the direction opposite to the upper teeth. Then the thumb is placed against the index finger along the line of the upper teeth and the mouth is opened;
B - "finger behind the teeth" technique for a fixed jaw. An index finger is inserted between the cheeks and teeth of the victim and the tip is wedged behind the last molar;
B - the technique of "lifting the tongue and jaw" for a sufficiently relaxed lower jaw. The thumb is inserted into the mouth and throat of the patient and at the same time the root of the tongue is lifted with its tip. With other fingers, they grab the lower jaw in the chin area and push it forward.
After successful extraction of a foreign object and in the absence of breathing, it is necessary to continue the ventilation procedure.
At entry of a foreign body into the respiratory tract The first aid to the victim is as follows: the victim is laid on his stomach and bent knee, his head is lowered down as low as possible and the chest is shaken with hand blows on the back, while squeezing the epigastric region.
If the cough persists, a combination of gravity and patting should be tried. To do this, help the victim bend down so that his head is lower than his lungs, and sharply slam his palm between his shoulder blades. If necessary, you can do this three more times. Look into the mouth and if a foreign body pops up, remove it. If not, try to push it out with air pressure, which is created by sharp thrusts in the stomach. To do this, if the victim is conscious and able to stand, stand behind him and wrap your arms around his waist. Clench one hand into a fist and press it to the stomach with the side where the thumb is. Make sure that the fist is between the navel and the lower edge of the sternum. Place your other hand on your fist and press sharply up and into your abdomen (Figure 2.6).
Do this, if necessary, up to four times. Pause after each press and be prepared to quickly remove anything that might fly out of the windpipe. If the cough does not stop, alternate four slaps on the back and four pressures on the abdomen until the foreign body can be removed. If the cough persists, alternate hand thrusts into the victim's stomach with a slap on the back.
Rice. 2.6. Removal of a foreign body from the respiratory tract
If the victim is unconscious, then in order to press his stomach, turn him over on his back. Get on your knees so that he is between your legs, put your hand between your navel and sternum, and the other hand on the first. Make four clicks as described above. If the interference persists and the patient has stopped breathing, it is necessary to start artificial respiration and heart massage.
With complete closure of the airways, developed asphyxia and the inability to remove a foreign body, the only measure of salvation is an emergency tracheotomy. The victim should be immediately transported to a medical facility.
Most often, foreign bodies of the respiratory tract are observed in children. If the child has inhaled some small object, ask him to cough sharper, harder - sometimes, in this way, it is possible to push the foreign body out of the larynx. Or put the baby upside down on your lap and pat on the back. Try to take a small child firmly by the legs and lower it upside down, also patting on the back (Fig. 2.7).
Fig.2.7. Removal of a foreign body from the respiratory tract of a child
If this does not help, urgent medical care is needed, since a foreign body can also get into the bronchi, which is very dangerous. Special emergency measures are needed to extract it.
Treatment and first aid for extravasation - getting under the skin. The amount of intervention depends on the stage of extravasation, the solution administered and specific antidotes. The treatment regimen for injuries of the 3rd-4th stage has not been developed. In the absence of randomized controlled trials, some organizations have published treatment protocols based on their own experience, case series, and anecdotal evidence.
1. In all cases of extravasation - getting drugs under the skin do the following:
A. Immediately stop intravenous infusion.
b. Remove compressive bandages that can act as a tourniquet (for example, when fixing a limb).
V. Give the limb an elevated position to reduce swelling.
d. Local use of warming and cooling packs, which is debatable. Under the action of heat, local vasodilation occurs, which promotes the reabsorption of infiltrated solutions. However, according to the literature, moist warming packs can cause skin maceration.
2. Extravasation 1st and 2nd stage:
A. Remove the intravenous catheter.
b. Choose an antidote.
3. Extravasation 3rd and 4th stage:
A. Leave the IV catheter in place and aspirate as much of the injected fluid as possible using a 1 ml syringe.
b. The catheter is removed unless an antidote is needed.
V. Decide whether to use hyaluronidase or an antidote.
d. Method of multiple punctures. After extravasation with acidic or hyperosmolar solutions, tense edema develops with blanching of the skin over the site of infiltration. The use of the stylet after aseptic precautions allows the infiltrated solution to flow freely, while reducing swelling and the likelihood of necrosis. Then apply a dressing moistened with saline to improve drainage.
e. Flushing with saline. Some authors recommend using the method of washing with saline solution of subcutaneous tissues. After treatment and infiltration of the area with 1% lidocaine, 500-1000 units of hyaluronidase are injected subcutaneously. Then four small incisions are made with a scalpel along the periphery of the infiltration site. Washing is carried out. Physiological saline is injected through a catheter installed subcutaneously in one of the incisions, the liquid is poured out through another incision. The resulting swelling is squeezed out towards the incision with massaging movements to facilitate the removal of substances that have poured out of the vessel.
e. Hyaluronidase. Dispersants are effective in extravasation of calcium preparations, parenteral nutrition solutions, antibiotics, sodium bicarbonate, etc. According to some practice guidelines, hyaluronidase is not recommended for the treatment of damage resulting from the extravasation of vasopressors. However, there are also publications on the successful treatment of such extravasation by the use of hyaluronidase in combination with saline irrigation:
(1) Mechanism of action. The destruction of hyaluronic acid, interstitial substance or intercellular compounds contributes to an increase in the dispersion and reabsorption of fluid that has gone beyond the vascular bed, respectively, reduces tissue damage by mechanical means.
(2) Administration is most effective within an hour, may be administered up to 12 noon.
(3) Inject 1 ml (150 U/ml; 5 separate injections of 0.2 ml) around the site of extravasation with 25 or 26 gauge needles.
(4) Side effects. Cases of complications in newborns are not described in the literature, there are reports of rare cases of hypersensitivity reactions in adults.
4. Specific drug antidotes:
A. Phentolamine:
(1) Used in the treatment of injuries resulting from the extravasation of vasopressors such as dopamine and adrenaline, which cause tissue damage through intense vasoconstriction and ischemia.
(2) The effect develops almost immediately. Most effective within an hour, but can be administered up to 12 hours. The biological half-life of phentolamine when administered subcutaneously is less than 20 minutes.
(3) Mechanism of action: competitive blockade of α-adrenergic receptors, resulting in relaxation of smooth muscle cells and hyperemia.
(4) Doses have not been established for neonates. They depend on the size of the damage and the body weight of the newborn.
(5) Recommended doses range from 0.01 mg/kg per administration to 5 ml of a 1 mg/ml solution.
(6) The solution at a concentration of 0.5-1.0 mg/ml is injected subcutaneously into the infiltrated area after the removal of the intravenous catheter.
(7) Precautions. Hypotension, tachycardia, and rhythm disturbances may occur; should be administered with extreme caution in preterm infants; re-introduce in small doses.
b. Nitroglycerine locally:
(1) Effective in treating damage caused by dopamine extravasation.
(2) Mechanism of action: relaxation of vascular smooth muscle.
(3) Application: 2% nitroglycerin ointment at 4 mm/kg per affected area, may be reapplied every 8 hours if tissue perfusion does not improve.
(4) Transdermal patches are also used.
(5) Precautions. Absorption through the skin may lead to hypotension.
V. Terbutaline:
(1) Effective in the treatment of peripheral ischemia due to extravasation of vasopressors in adults and older children; there are no publications on its use in neonatological practice.
(2) Mechanism of action: Peripheral vasodilation due to activation of beta2-adrenergic receptors.
(3) Administer subcutaneously at a concentration of 0.5-1.0 mg/ml; doses in adults range from 0.5 to 1 mg.
5. Treatment of a wound after extravasation - getting the drug under the skin:
Purpose of neonatal wound care with partial or complete loss of the skin is to achieve healing by primary or secondary intention without scarring, contractures and surgical intervention. Different treatment regimens are used in different medical institutions.
A. Wash the injured area with sterile saline.
b. Apply sulfadiazine ointment to the affected area and change the bandages every 8 hours, carefully cleaning the wound surface, re-apply the ointment. Sulfonamides increase the risk of kernicterus, therefore, they are contraindicated in newborns in the first 30 days of life.
V. Water-based amorphous gels containing carboxymethyl cellulose polymer, propylene glycol and water keep the wound moist and facilitate healing. They are produced in the form of gels and films that can be applied directly to the wound surface and left in place for repeated dressings. The gel is easily removed with saline and changed every 3 days. More frequent change of dressings is carried out with excessive exudation.
d. Wet-dry dressings with saline and povidone-iodine dressings are also effective. Massive application of povidone-iodine to an open wound is not recommended in very low birth weight neonates because iodine absorption may depress thyroid function.
e. The effectiveness of the use of antibacterial ointments has not been proven.
e. Wound healing is assessed every day. Healing takes 7 days to 3 months.
and. If the wound is on the flexion surface, perform passive exercises within physiological volume with each dressing change in order to prevent contractures.
6. Plastic surgeon's consultation:
A. Carried out with damage to the entire thickness of the skin and significant areas of individual damage due to extravasation.
b. Enzymatic or surgical debridement or skin grafting may be required.
Of course, it is impossible to predict in advance who and what will manage to choke. Tragedy can play out in the dining room or on the street, in a car or plane.
At the same time, it is not at all necessary to talk or laugh with your mouth full. It is enough just to think a little or be very surprised so that the ill-fated piece gets into the wrong throat.
A candy or chewing gum, a tablet or a match sandwiched between the teeth can equally well end up in the windpipe.
The variety of foreign bodies that enter the larynx and trachea can only be amazed. Sometimes it's hard to imagine what might be in a person's mouth. This is especially true for children.
REMEMBER! What an unintelligent baby has in his hands, it will definitely be in his mouth.
That's why adults need to be so careful about what their child plays with.
Depending on the shape, all foreign bodies can be divided into three groups.
Wide and flat objects are classified as coin-like bodies(coins, buttons, as well as any flat rounded plates).
Another group includes items that have spherical shape or the shape of a pea (dragée, monpensier, pellets, balls, unchewed pieces of sausage, cucumbers, potatoes or apples, as a rule, do not have sharp corners and are able to move freely over long distances).
And finally, the last group, which follows pay special attention, includes foreign bodies, shaped like a rocker. Most often, these are pieces of barbecue, connected by a thin, but very strong fascial film.
Such a classification is of fundamental importance for the choice of tactics of emergency assistance.
Stages of asphyxia (suffocation)
After hitting a foreign body, the victim begins coughing a lot and blushing. Before our eyes tears come out, A coughing induces vomiting.
If a person fails to get rid of a foreign body, then, depending on the degree of closure of the lumen of the airway, a sharp cough may be accompanied by stridor breathing with a characteristic hoarseness on inspiration.
In this case, the foreign body will move further and further with each breath, greatly irritating the mucous membrane of the larynx or trachea.
This quickly leads to their swelling, copious excretion and accumulation of mucus. The most dangerous: swelling of the vocal folds and spasm of the glottis.
REMEMBER! Even a small object with sharp edges that injure the mucous membrane of the respiratory tract can be fatal.
Any foreign body, irritating the mucous membrane of the larynx and trachea, significantly impairs airway patency.
Even if in the first minutes the state of the choking person was relatively well, then in the next 10-15 minutes it can worsen significantly.
Redness of the skin of the face and neck is replaced by severe cyanosis (blue). The coughing movements become less and less frequent.
Adynamia and apathy appear. Very soon the victim loses consciousness. The description of the state is called blue asphyxia.
Signs of blue asphyxia:
· Loss of consciousness.
· Blue lips, face, neck.
Swelling of the vessels of the neck.
Vulture and retraction of supraclavicular and subclavian fossae on inspiration.
The presence of a pulse on the carotid artery.
After a few minutes, this stage will move to the stage pale asphyxia.
The skin will become a pale gray color. The reaction of the pupils to light and the pulse on the carotid artery will disappear.
In other words, clinical death will occur.
Signs of pale asphyxia,
when the victim is in a state of clinical death:
· Pale with a grayish tinge of the skin of the face and neck.
Large, light-responsive pupils.
Absence of a pulse in the carotid artery.
· Zapadshie supraclavicular and subclavian fossae.
The entry of foreign bodies into the upper respiratory tract is one of the types of accidents that often end in death within a few minutes.
Be that as it may, but someone's life will depend on the actions of people who happen to be nearby.
REMEMBER! When helping, rely only on your own strength.
The most common mistakes in helping
REMEMBER! Do not do it:
· Start emergency care by wasting time on oral examination.
· Try to remove the foreign body with a finger or tweezers.
As a rule, under the influence of saliva, a fatal piece of sausage or apple softens so much that even with careful extraction, some part of it will definitely come off and, like in a vacuum cleaner hose, rush into the larynx. Thus, you will lose the only chance for salvation.
First aid methods
Extraction of spherical objects
REMEMBER! If the child chokes on a pea, then you should immediately turn the baby upside down and tap the back several times with your palm at the level of the shoulder blades.
The first place to start helping is:
· Turn the victim on his stomach.
Throw it over the back of a chair or your own thigh.
Strike several times with an open palm between the shoulder blades.
If, after several blows between the shoulder blades, the foreign body did not fall to the floor, then it is necessary to immediately proceed to other methods of extracting it.
Emergency assistance in case of hit of coin-like objects
REMEMBER! When a coin hits, it is not necessary to expect success from the previous method: the effect of the piggy bank is triggered.
In this situation, you need to resort to methods aimed at concussion of the chest.
It is necessary to force the foreign body to change its position.
Then there will be a hope that as a result of a strong concussion of the chest, it will either turn around its axis, freeing the passage of air, or, moving down the trachea, will eventually end up in one of the bronchi.
By virtue of anatomical features the foreign body is most often found in the right bronchus.
Of course, this will make it difficult to extract it in the future, but it will enable a person to breathe at least one lung and, therefore, to survive.
Unacceptable! Strike the back with a fist or the edge of the palm.
There are several ways to concussion chest. The most common of these is tapping on the back with the palm of your hand.
The most effective are short but frequent blows to the interscapular region.
Remember! Blows to the back can only be applied with an open palm.
Another method, more effective, was called the "Method of the American Police".
To carry it out, you need to stand behind the victim, wrap your arms around him so that the hands folded into the lock are below his xiphoid process, and then with a sharp movement, press hard under the diaphragm and hit your chest with your back.
This will allow not only to shake strongly, but also, as a result of a sharp displacement of the diaphragm, to squeeze out the rest of the air from the lungs and thereby significantly increase the likelihood of displacement of the foreign body.
REMEMBER! A blow to the epigastric region can lead to loss of consciousness and sudden cardiac arrest, so you should not unclench your hands immediately after the blow.
Using this option, one must be prepared for the likelihood of the victim developing a state of clinical death.
All of these methods can be used if choked is conscious.
If he is in a coma, then it should immediately turn over to the right side and hit the back with the palm of your hand several times. But, as a rule, one cannot count on success from such an action.
Respiratory tract (trachea, larynx, bronchi, nasal cavity, throat), most often by accident, sometimes food and small objects, which in medicine are called foreign bodies, get in. More often there are foreign objects in the larynx, as it is quite narrow and does not let them pass further. When any object enters the respiratory tract, a person begins coughing. If even with the help of coughing it is not possible to get rid of a piece of food or another object, you should contact a specialist who will correctly and immediately provide first aid.
Types of foreign bodies entering the respiratory tract
Depending on the shape and parameters, all alien objects are divided into 3 main groups. The first group includes bodies with a spherical shape: balls, tablets, capsules, soft pieces of food. These bodies are characterized by non-sharp edges and can penetrate into the trachea. Doctors remove such foreign objects, if possible, using the “Pinocchio effect” (it is necessary to turn upside down and hit with an open palm between the shoulder blades).
The second group includes bodies with a flat and wide surface, which are somewhat similar to coins. These items include buttons, coins, plates, body jewelry, rings, artificial nails, and others. Foreign bodies of the second group easily penetrate the glottis, but it is almost impossible to remove them in a natural way. To slightly reduce the pain of a person when a coin enters the respiratory tract, a strong tapping of the palm between the shoulder blades can. This is done so that the foreign body changes its place of localization and the person can breathe.
The third group of foreign bodies includes objects whose shape resembles a rocker. The most dangerous objects that can disrupt a person's breathing and get into the larynx are pieces of meat with a strong film. Pork or lamb meat becomes a rubber stopper that prevents a person from breathing in and out.
The only chance to extract a piece of meat from the respiratory tract is a strong blow made just below the diaphragm or an instant cricothyrotomy (conicotomy). Dissection of the larynx can only be carried out by a medical professional who is trained in the technique of the procedure and can actually save a person's life.
Symptoms when a foreign body enters the respiratory tract
The first symptom that appears when there is a foreign object in the respiratory tract is a strong cough to redness of the face, then vomiting, tears in the eyes and suffocation. If symptoms occur, it is recommended to exhale sharply so that the object blocking the larynx comes out under air pressure.
If a person cannot get rid of a foreign body, then along with a cough, stridor breathing appears with characteristic wheezing when inhaling. With each new breath, the object moves further, irritation of the mucous membrane of the trachea or larynx occurs. Due to the irritating factor, the airways begin to swell, mucus is abundantly secreted and accumulates. The most dangerous is the spasm of the glottis and swelling of the vocal folds.
When strangulated, the red color of the skin of the neck and face begins to change to blue, and the cough becomes more frequent. Then apathy and adynamia appear, the choking person loses consciousness. After losing consciousness of the patient, you need to monitor his pulse and send him to the hospital for medical care. If this is not done, a coma may occur.
The onset of coma (blue asphyxia) is evidenced by:
- lack of consciousness;
- blue skin of the neck, face, lips;
- an increase in blood vessels in the neck;
- vulture and retraction of the supraclavicular and subclavian cavities during inspiration;
- weak pulse on the carotid artery.
After blue strangulation, after 5-10 minutes pale asphyxia begins. Pale suffocation is accompanied by pallor of the skin, the reaction of the pupils to light disappears, and the pulse is not felt.
When foreign objects enter the respiratory tract, a person has several minutes before the onset of an attack and the appearance clinical symptoms therefore, the surrounding people must provide the correct first aid and take appropriate measures. The following two mistakes should not be made when saving a person: additionally examine the oral cavity (significant loss of time), try to remove food with a finger or other objects (part of the food or a foreign body can come off and enter the trachea, resulting in suffocation).
"Pinocchio effect" when a foreign body enters
When removing spherical bodies, you should use the "Pinocchio effect". If the baby chokes on, for example, peas, you need to turn it over so that the head is down, then hit the palm between the shoulder blades 3-4 times. In case the food did not fall on the floor, you need to proceed to other methods. The basic technique is the “Pinocchio effect”: we turn over the choking one on the stomach, then we throw it over our thigh or the back of the chair, and only then we hit the palm of our hand several times between two shoulder blades. This method is used to extract foreign bodies from children, adolescents and adult men and women.
You can save the injured baby using this technique: we put the baby on our own forearm, insert 2 fingers into the oral cavity (if there is a piece of paper from a candy or a bag in the mouth, it should be carefully removed), then lightly beat the baby on the back until a foreign object falls out ( strong blows can injure the spinal cord and lead to disability, so their strength must be monitored). It is forbidden to shake or hold the legs upside down, as children have a very weak spine.
If after 15-30 seconds the food does not fall out of the throat, you need to change tactics. If the foreign object looks like a coin or plate, this technique will not be effective. Doctors recommend that if the method is ineffective, use the "American police method" (see below).
Emergency care in case of inhalation of coin-shaped bodies
When hit by objects that look like a coin, it is advisable to use a technique called the “piggy bank effect”. If a person swallowed a coin, you need to force the alien object to change its location. With strong blows in the chest area, it is likely that the foreign object will turn the other way and free the air passage or move to the bronchi (when the coin or button is in one bronchus, the victim will be able to breathe and have time to get to the ambulance).
The most common way to shake the chest is to tap on the back with the palm of your hand. The “method of American policemen” is also considered an effective procedure. Technique: you should stand behind the victim and take him by the shoulders, then move him away from you to outstretched arms and only then sharply hit him with his back against his own chest. This manipulation can be carried out 3-4 times. The technique is effective if the rescuer has a flat male chest.
Features of the "Heimlich method"
The "Heimlich method" is effective in removing foreign particles from the upper respiratory tract. The technique is considered one of the most risky and should be carried out exclusively by medical professionals. During a sharp blow just below the diaphragm, from 250 to 300 ml of air is pushed out of the lungs, and a foreign body flies out with the air. The risk is that with a sharp blow, reflex cardiac arrest, injury to internal organs, and bleeding can occur.
The "Heimlich method" is forbidden for babies who are not yet 3 years old. Even if the food came out with air, the victim should be taken to the hospital in an ambulance, because after such a radical method of removing a foreign body, internal organs and systems can be damaged. It is forbidden to learn this technique from each other, there are specialized courses and conferences for this.
Features of the implementation of the "Heimlich method": you need to stand behind a choking person and wrap your arms around him, folded into a castle. In this case, the lock should be between the lower ribs and the navel. Next, the rescuer must remove the victim from himself and with all his strength hit him with his back against his chest, and press the epigastric region with folded brushes.
Cricothyrotomy
Only medical professionals are authorized to perform a cricothyrotomy, as this is a serious procedure that needs to be trained and mastered. During the manipulation, an incision is made between the cricoid and thyroid cartilages (the hole will be above the trachea and the victim will be able to breathe freely).
Surrounding people can help to carry out emergency manipulation, for this it is necessary: to fix the head of the choking person (it is advisable to hold it between both knees so that the medical worker makes an accurate cut), press the hands of the victim to the floor or ground, ask people for an object in the form of a tube (it will help let air in and out of the lungs).
Rules to help avoid getting a foreign body into the respiratory tract
To prevent food and other objects from getting into the trachea and larynx, you need to follow a few simple rules. First, you can’t eat on the street, because something can frighten a person and a piece of food will get into the respiratory tract. Secondly, you should not talk during the meal, because not only soft food, but also bones from meat or fish can end up in the throat. Thirdly, you should not keep metal objects and other foreign bodies between your teeth, which can inadvertently get into the trachea or larynx. Fourth - if a child holds a small toy near his face or licks it, you need to immediately pick it up, since the actions of the baby are often unpredictable (it is advisable to give the child a soft large toy so that he does not get upset and start crying).
Serious mistakes when removing a foreign object
With incorrect (too strong and intense) blows to the back, a foreign particle can move forward and end up in the tracheobronchial tree, thereby blocking the airways. If a foreign object has entered the tracheobronchial tree, a tracheotomy should be performed immediately.
It is forbidden to turn the child upside down and shake, because the baby's body is still too weak and may not withstand such a load (there is a risk of dislocation and even fracture of the cervical vertebrae). The most serious mistake during a rescue operation is panic. The surrounding people and medical workers are no less afraid than the victim himself, so you need to gather your will into a fist and act according to the technique of extracting a foreign particle from the respiratory tract.
There are many techniques and methods that will help remove a foreign object from the larynx and other internal organs, but there are also ways of first self-help. Doctors recommend that when a foreign particle enters the respiratory tract, exhale sharply, throwing straight arms forward. Along with these movements, you need to quickly lean forward. If this event does not help and the actions of the surrounding people are not effective, you need to take the choking person to the hospital for surgical intervention.
Speciality: infectious disease specialist, gastroenterologist, pulmonologist.
General experience: 35 years .
Education:1975-1982, 1MMI, San-Gig, highest qualification, infectious diseases doctor.
Science degree: doctor of the highest category, candidate of medical sciences.