1、Foreign bodies in the trachea and bronchus Foreign body aspiration can result a spectrum of changes, from minimal symptoms, to respiratory compromise, failure, and even death. Etiology Foreign body aspiration is most common in children aged 6 months to 4 years. They lack molars for proper grinding o
2、f food. They tend to be running or playing at the time of aspiration. They tend to put objects in their mouth more frequently. They lack coordination of swallowing and glottic closure.Etiology Adults who are unable to protect the airway, are also at risk of aspiration due to decreased airway protect
3、ive mechanisms. Mental retardation Alcoholism Psychoses Neurologic disorders A drawing pin in the left main bronchus A peanut in the right main bronchusAnatomy Most foreign bodies lodged distal to the larynx and trachea in the right mainstem bronchus. The diameter of the right main bronchus is large
4、r than the left. The angle of divergence from the tracheal axis is smaller on the right. Airflow through the right lung is greater than through the left. The carina is more likely to be located to the left of midline rather than to the right. Pathophysiology Aspirated foreign bodies most commonly ar
5、e lodged in the right main stem and lower lobe. Peanuts are by far the most commonly aspirated material in children, followed by organic material such as sunflower seeds, pieces of vegetables, and hazelnuts. In adults, vegetable matter, meat, and bones rank highest, followed by dental and medical ap
6、pliances. Aspiration of teeth after trauma is observed occasionally. Clinical Features Tracheal foreign bodies An audible slap heard at the open mouth during cough. Palpable slap with respirations. Asthmatoid wheeze heard with the ear at the patients mouth.Clinical Features Bronchial foreign bodies
7、Three distinct stages of a foreign body accident: Initial phase - Choking and gasping, coughing, or airway obstruction at the time of aspiration Asymptomatic phase - Subsequent lodging of the object with relaxation of reflexes that often results in a reduction or cessation of symptoms, lasting hours to weeks. Complications phase - Foreign body producing erosion or obstruction leading to pneumonia, atelectasis, or abscess.Clinical Features Initial symptoms Cough and dyspnoea occur at the time of accident. Bloodstained expectoration is sometimes present.
