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Choking or airway obstruction is an emergency and this situation can develop anywhere. This presentation can help everybody to deal this kind of emergency
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CHOKING
CHOKINGRESPIRATORY OBSTRUCTION
BY
Col Anwar ul HaqClassified ENT Specialist
NASOPHARYNX
OROPHARYNX
LARYNX
TRACHEA
NOSE
SITES OF OBSTRUCTION
OBSTRUCTION-NOSE
• NOSE – BYPASSED
• BREATHE– ORAL CAVITY
NOSE
NASOPHARYNX
CHOKING• UNCONSCIOUS– JAW FALLS BACK– AIRWAY OBSTRUCTION
• JAW THURST– AIRWAY IS MAINTAINED
OBS. AIRWAY
OPEN AIRWAY
CHOKING• TRAUMA–MECHANICAL• MANDIBLE• TONGUE• NECK – – penetrating – strangulation
–CHEMICAL–THERMAL–RADIOTHERAPY
• FOREIGN BODIES• INFECTIONS
TRAUMA• MECHANICAL–MANDIBLE– TONGUE– NECK – • PENETRATING • STRANGULATION
TRAUMA• MECHANICAL–MANDIBLE– TONGUE– NECK – • PENETRATING • STRANGULATION
TRAUMA• MECHANICAL–MANDIBLE– TONGUE– NECK – • PENETRATING • STRANGULATION
TRAUMA• MECHANICAL–MANDIBLE– TONGUE– NECK – • PENETRATING • STRANGULATION
TRAUMA ORAL CAVITY & TONGUE
• BLOOD• SECRETIONS• TONGUE - FALL BACK
• CONSCIOUS– SIT UP– LEAN FORWARD– SPIT
• UNCONSCIOUS / CHILD– LATERAL – MOUTH
• LOWER
– SUCTION CLEARANCE
• CRICOTHYROIDOTOMY• TRACHEOSTOMY
TRAUMA NECK
• LARYNX & TRACHEA–FRACTURES
–HAEMATOMA
–BLOOD
–SECRETIONS
HYOID
THYROID
CRICOID
TRAUMA NECK• SUCTION CLEARANCE• ENDOTRACHEAL TUBE• CRICOTHYROIDOTOMY• TRACHEOSTOMY
CRICOTHYROIDOTOMY
MAKING A HOLE IN CRICOTHYROID MEMBRANE
CRICOTHYROIDOTOMY
TRAUMA• CHEMICAL
• THERMAL
• RADIOTHERAPY
• DELAYED
• OBSERVATION
• OXYGEN
• ET INTUBATION
TRAUMA• CHEMICAL
• THERMAL
• RADIOTHERAPY
• DELAYED
• OBSERVATION
• OXYGEN
• ET INTUBATION
• TRACHEOSTOMY
TRACHEOSTOMY
TRACHEOSTOMY
CREASE INCISION
STRAP MUSCLESDISSECTED THYROID
ISTHMUSRETRACTED
TRACHEAL FENESTRATION
CUFFEDUNCUFFED
DOUBLE LUMEN METALLIC
AIR
• CHILDREN
• AGE < 5 YRS (84%)
• M:F :: 2 : 1• NATURE - VEGETABLE (55 – 95%) -
NUTS
- METAL (5 – 15%)
- PLASTIC (5 – 15%)
FOREIGN BODIES
• NOSE – BYPASSED
• BREATHE– ORAL CAVITY
• NEONATES– OBLIGATORY
NASAL BREATHERS
SITE OF OBSTRUCTION
SITE OF OBSTRUCTION(PHARYNX)
• BLUNT/SMALL - DO NOT STAY» SWALLOWED
• SHARP– TONSIL, BASE OF TONGUE,
VALLECULAE, PYRIFORM FOSSAE–MORE DISCOMFORT – LESS OBSTRUCTION
• VERY BIG- CHILDREN» DO NOT GAG MUCH» CANNOT TAKE OUT
– SEVERE RESPIRATORY OBSTRUCTION
RIGHTMAIN
BRONCHUS
WIDESTRAIGHT
SITE OF OBSTRUCTION (LARYNX & TRACHEA)
COMPLETE OBSTRUCTION– FATAL OUTCOME– IF DISLODGEMENT FAILS
SITE OF OBSTRUCTION (LARYNX & TRACHEA)
COMPLETE OBSTRUCTION– FATAL OUTCOME– IF DISLODGEMENT FAILS
• INCOMPLETE OBST.– HOARSENESS – APHONIA– COUGH– DYSPNOEA
FART WHISTLE
MUSICAL CHILD
STAGES OF PRESENTATION
• INITIAL PERIOD - EMERGENCY– CHOKING – GAGGING–WHEEZING
• SYMPTOMLESS INTERVAL–VARIABLE• DURATION• NATURE OF FORGEIN BODY• 20-50% NOT DETECTED WITHIN FIRST WEEK
• LATE SYMPTOMS - COMPLICATIONS• OBSTRUCTION• INFLAMMATION
• TRAUMA
CHOKING WITNESSEDCOMPLETE OBSTRUCTION
• HEIMLICH’S MANOEUVRE• BACK BLOW• CHEST THRUST• ABDOMINAL THRUST• AIM– USE THE AIR IN LUNGS– TOOL TO DISLODGE THE F.B.
HEIMLICH’S MANOEUVRE
USE THE AIR IN LUNGSTOOL TO DISLODGE THE F.B.
USE THE AIR IN LUNGSTOOL TO DISLODGE THE F.B.
CHOKING WITNESSEDCOMPLETE OBSTRUCTION
• HEIMLICH’S MANOEUVRE
• BACK BLOW• CHEST THRUST• ABDOMINAL THRUST
CHOKING WITNESSEDCOMPLETE OBSTRUCTION
• HEIMLICH’S MANOEUVRE
• BACK BLOW• CHEST THRUST• ABDOMINAL THRUST
CHEST THRUSTBELOW CHESTTHORACIC SPINE
CHOKING WITNESSEDCOMPLETE OBSTRUCTION
• HEIMLICH’S MANOEUVRE
• BACK BLOW• CHEST THRUST• ABDOMINAL THRUST
ABDOMINAL THRUSTABDOMENLUMBER SPINE
CHILDREN - CHOKING WITNESSEDCOMPLETE OBSTRUCTION
• IF ALL FAIL– BACK BLOW– CHEST THRUST– ABDOMINAL THRUST
• AIRWAY NOT ESTB.– CRICOTHYROIDOTOMY– TRACHEOSTOMY
CHILDREN - CHOKING WITNESSEDCOMPLETE OBSTRUCTION
• IF ALL FAIL– BACK BLOW– CHEST THRUST– ABDOMINAL THRUST
• AIRWAY NOT ESTB.– CRICOTHYROIDOTOMY– TRACHEOSTOMY
• AIRWAY ESTB.(HOSPITAL)
– LARYNGOSCOPY– TRACHEOSCOPY– BRONCHOSCOPY
CHILDREN - CHOKING UNWITNESSED
COMPLETE OBSTRUCTION
DEATH
CHILDREN - CHOKING WITNESSED ADULTS - HISTORY POSITIVE
(INCOMPLETE OBSTRUCTION)• DO NOT ATTEMPT– REMOVE– PROBE– MANOEUVRE
• OXYGEN• REMOVAL– LARYNGOSCOPE– TRACHEOSCOPE– BRONCHOSCOPE
FB IN ADULTS
• HISTORY POSITIVE– NO SYMPTOMS AND SIGNS • INVESTIGATE• TREAT
• NO HISTORY– SYMPTOMS AND SIGNS • INVESTIGATE • TREAT
INFECTIONS
• LUDWIG’S ANGINA
• AC. EPIGLOTTITIS
• LARYNGOTRACHEOBRONCHITIS
LUDWIG’S ANGINA
• SWELLING OF THE FLOOR OF MOUTH
• TONGUE.... SUP AND POSTERIORLY
• SITS - LEANING FORWARD
• TRACHEOSTOMY.....
AC EPIGLOTTITIS
• SWELLING OF THE EPIGLOTTIS
• POSITION - LEANING FORWARD
• THUMB SIGN
• EXAM IN OT
• ET TUBE...
• TRACHEOSTOMY
LARYNGOTRACHEOBRONCHITIS
• INFLAMATION OF AIRWAY
• GRADUAL ONSET
• STEEPLE SIGN
• O2 INHALATION ....
LARYNGOTRACHEOBRONCHITIS
• INFLAMATION OF AIRWAY
• GRADUAL ONSET
• STEEPLE SIGN
• O2 INHALATION ....
• ET TUBE
CONCLUSION
• C -CIRCULATION
CONCLUSION
• A - AIRWAY
• B -BREATHING
• C -CIRCULATION
CONCLUSION
• A - AIRWAY• B - BREATHING• C - CIRCULATION• ABC IS TRUE SEQUENCE OF– BASIC– LIFE– SUPPORT
THANK YOU
CHOKING
SITUATION-1MOTHER
• ONE MONTH OLD BABY
• SUDDENLY FOUND APOENIC
• MOTHER CAME OUT OF WASHROOM
• FOUR SOLDIERS PLAYING LUDDO– CMH UNIT LINES
• ONE KEEPING GOAT IN MOUTH
• SUDDENLY STARTED DYSPNOEA
• BECAME RESTLESS
• NOISY BREATHING
SITUATION-2PATIENT+ATTENDANT+DOCTOR IN MRC