1 / 72

AERO-DIGESTIVE FOREIGN BODY & TRAUMA Dr. Ahmed Al Arfaj

AERO-DIGESTIVE FOREIGN BODY & TRAUMA Dr. Ahmed Al Arfaj. Trauma & Foreign Body II. FOREIGN BODIES IN MOUTH &PHARYNX. Trauma & Foreign Bodies II. Foreign Bodies in the Mouth and Pharynx. Small pointed F.B.

patriciahodge
Download Presentation

AERO-DIGESTIVE FOREIGN BODY & TRAUMA Dr. Ahmed Al Arfaj

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. AERO-DIGESTIVE FOREIGN BODY & TRAUMA Dr. Ahmed Al Arfaj

  2. Trauma & ForeignBody II FOREIGN BODIES IN MOUTH &PHARYNX

  3. Trauma & ForeignBodies II Foreign Bodies in the Mouth and Pharynx Small pointed F.B. splinters of bone, fish bones, bristles from a toothbrush, needles, nails, bits of wood and glass, etc. Site of impaction - tonsil - the valleculla - the base of the tongue - lat. wall of the pharynx

  4. Trauma & ForeignBodies II Foreign Bodies in the Mouth and Pharynx Large F.B. bits of toys, flat bones, coins, buttons, large fish bones, bite of false teeth, etc. Site of impaction - the piriform sinus - hypopharynx

  5. Trauma & ForeignBody II

  6. Trauma & ForeignBody II Foreign Bodies in the Mouth and Pharynx Odynophagia or dysphagia Diagnosis: - history - radiography - endoscopy

  7. Trauma & ForeignBody II Treatment of Foreign Bodies in the Mouth and Pharynx In the upper pharynx  direct vision rigid pharyngolaryngoscopy

  8. Trauma & ForeignBody II NOTE Attempts to dislodge F.B. by eating foods is not justifiable. • May causes delay and allows complications to develop.

  9. Trauma & ForeignBody II ESOPHAGEAL FOREIGN BODIES Five Levels -Cricopharyngeal -Thoracic inlet -Aortic arch -Tracheal bifurcation -Gastroesoesophageal

  10. Trauma & ForeignBody II Esophageal Foreign Bodies Unintentionally: CHILDREN: (3years) coins, toys, etc. ADULTS : bones, glass splinters, fish bones, false teeth, nails, needles, or cutlery [e.g., prisoners]

  11. Trauma & ForeignBody II Oesophageal Foreign Body coin plastic star

  12. Trauma & ForeignBody II Oesophageal Foreign Body Symptoms • dysphagia, odynophagia • drooling - coughing - early mediastinitis : • pain between shoulder blades • & behind sternum

  13. Trauma & ForeignBody II Foreign body. Coin in the cervical esophagus

  14. Trauma & ForeignBody II Esophageal Foreign Body Pathogenesis - upper esophageal sphincter - necrosis  mediastinitis, pleuritis, or peritonitis - paraesophageal abscess - surgical emphysema

  15. Trauma & ForeignBody II Esophageal Foreign Body Diagnosis History: Inspection: swelling or subcut.emphysema Palpation: neck & supra clavicular fossae Radiographs: Radiopaque F.B., Mediastinal emphysema Gastrografin: Radiolucent F.B. Esophagoscopy

  16. Trauma & ForeignBody II Differential Diagnosis Esophageal Foreign Body - mucosal lesions - obstructive tumor NOTE if a FB is suspected, always check hypopharyx & esophagus endoscopically using flexible fiberscope

  17. Trauma & ForeignBody II Esophageal Foreign Body Treatment Rigid Esophagoscope. Cervical esophagotomy Thoracotomy Perforation [ suture] Paraesophagitis & abscess  Drainage

  18. Trauma & ForeignBody II Esophageal Foreign Body Course & Complications - no sequelae &mostly pass spontaneously. - pressure nec.  mediastinitis - radiographs: Gas emphysema - perforation [gastrografin] - stool analysis

  19. Trauma & ForeignBody II

  20. Trauma & ForeignBody II

  21. Trauma & ForeignBody II flesh bolus hair pin

  22. Trauma & ForeignBody II

  23. Trauma & ForeignBody II hair pin flesh bolus

  24. Trauma & ForeignBody II

  25. Trauma & ForeignBody II FOREIGN BODIESOF THE LARYNX

  26. Trauma & ForeignBody II Laryngeal Foreign Body Symptoms - attacks of coughing - stabbing pains • dysphagia • dysphonia - dyspnea in infant’s - asphyxia in large F.B. eggshell,10, choked,stridor, dyspnea>aphonia

  27. Trauma & ForeignBody II

  28. Trauma & ForeignBody II Laryngeal Foreign Body glass

  29. Trauma & ForeignBody II Laryngeal Foreign Body Pathogenesis common sharp-edged, Pointed or large F.B. F.B. aspiration: - sudden fright, laughing or absence of the sensory innervation of the larynx nut shell

  30. Trauma & ForeignBody II Laryngeal Foreign Body Treatment Heimlich Maneuver? Slapping the back with the patient’s head down? Manual removal? Removal by laryngoscopy Tracheostomy or laryngostomy (cricothyrotomy)

  31. Trauma & ForeignBody II

  32. Trauma & ForeignBody II FOREIGN BODIES IN THE TRACHEOBRONCHIAL TREE

  33. Trauma & ForeignBody II FOREIGN BODIES IN THE TRACHEOBRONCHIAL TREE ETIOLOGY Usually in infants and children (> 50% under 4 years of age) Male predominance (> 60%) Most FB’s are organic material (mostly food derivatives) Location: Mostly in the right side ( >60%)

  34. Trauma & ForeignBody II Tracheobronchial Foreign Body Peanuts, nails, coins, balls

  35. Trauma & ForeignBody II PATHOLOGY • Depends upon: nature, morphology and the position of the F.B. No obstruction: no immediate effect By pass valve obstruction: wheeze Expiratory check valve: obstructive emphysema Stop valve: atelectasis

  36. Trauma & ForeignBody II CLINICALPRESENTATION Choking, cough, gagging & cyanosis Caused by laryngeal reflexes Asymptomatic phase Due to fatigue of cough reflex Wheeze, intractable cough, persistent or recurrent chest infection. Due to emphysema, atelectasis or infection

  37. Trauma & ForeignBody II Tracheobronchial Foreign Body Symptoms - Episodes of coughing - dyspnea - cyanosis - pain - intermittent hoarseness - sudden death - symptom-free intervals metal joy

  38. Trauma & ForeignBody II RADIOLOGICAL FINDINGS Normal findings Obstructive emphysema Atelectasis Radio-opaque F. B. Pneumonia, pneumothorax etc.

  39. Trauma & ForeignBody II Tracheobronchial Foreign Body Size & Shape The Rt. main bronchus Type & duration: trachitis or bronchitis + edema, granulations, bleeding, resp. valvular stenosis, emphysema, atelectasis

  40. Trauma & ForeignBody II Tracheobronchial Foreign Body Differential Diagnosis - diphtheria - pseudocroup - laryngeal spasm - whooping cough - bronchial asthma - intraluminal tumors - pulmonary tuberculosis - pneumonia - laryngeal stenosis - tracheal stenosis (absent larynx movements)

  41. Trauma & ForeignBody II Tracheobronchial Foreign Body Treatment Endoscopy extracted Important: Suspicion of a tracheobronchial foreign body is an absolute indication for endoscopy

  42. Trauma & ForeignBody II TREATMENT To be initiated on clinical suspicion Bronchoscopy: in most cases Bronchotomy

  43. Trauma & ForeignBody II Esophageal Rupture and Perforation CAUSES: • iatrogenic instrumentation • (most common cause) • blunt and penetrating trauma • neoplasms • increased abdominal pressure

  44. Trauma & ForeignBody II Esophageal Rupture and Perforation VARIANTS: • Mallory Weiss Syndrome: incomplete tear of esophageal mucosa and laceration of submucosal arteries from increased abdominal pressure (emesis in alcoholics),; treatment: usually self limiting, • Boerhaave Syndrome: increased abdominal pressure results spontaneous rupture of all 3 layers of the esophagus (usually distal, posterior wall)

  45. Trauma & ForeignBody II Esophageal Rupture and Perforation SIGNS & SYMPTOMS: • chest pain - tachycardia • fever - respiratory distress • dysphagia - subcutaneous emphysema • Hammer’s sign (crunching sound over heart from subcutaneous emphysema)

  46. Trauma & ForeignBody II Esophageal Rupture and Perforation DIAGNOSIS: • clinical exam • chest x-ray mediastinal widening or pneumothorax • esophagogram (gastrogaffrin)

  47. Trauma & ForeignBody II

  48. Trauma & ForeignBody II Esophageal Rupture and Perforation COMPLICATIONS: • chemical mediastinitis • (saliva, bile, gastric acid) • septic shock.

  49. Trauma & ForeignBody II Esophageal Rupture and Perforation TREATMENTS: Early surgical repair and drainage (thoracotomy) may consider medical therapy (antibiotics and observation) for smaller perforation in select patients

  50. Trauma & ForeignBody II

More Related