Technique for removing a foreign body from the respiratory tract. National Center for Mass Education

The problem of foreign bodies entering the respiratory tract is very relevant because it occurs at any age and requires an urgent and sometimes emergency assessment of the situation, examination and making the right decision.

According to clinical data, among all cases of foreign bodies of the airways, foreign bodies of the larynx occur in 12%, foreign bodies of the trachea - in 18%, foreign bodies of the bronchus - in 70% of cases. Foreign bodies of the airways are especially common in childhood. The share of bronchial foreign bodies in children accounts for 36%; Moreover, in a third of observations, the age of children is from 2 to 4 years. In 70% of cases, foreign bodies enter the right bronchus, since it is wider and straighter.

Reasons for foreign body entering the respiratory tract

This pathology develops many times more often in pediatric patients. This is due to the behavioral characteristics of babies - while eating they tend to play, talk, laugh or cry, and cough. In addition, children very often put various small objects in their mouths, which they can then accidentally inhale. The anatomical features of the oral cavity and the underdevelopment of protective reflexes in children also contribute to the increased incidence of aspiration (inhalation) of foreign bodies in young patients.

Adults most often suffer from this pathology when greedily absorbing food without chewing it or when actively talking while eating. The prerequisite for aspiration of foreign bodies in neurological disorders accompanied by a decrease in protective reflexes in the oral cavity, pharynx and larynx, and swallowing disorders (bulbar palsy, myasthenia gravis, traumatic brain injury, stroke) becomes very real. Persons who are heavily intoxicated find themselves in a similar situation. The cause of foreign bodies entering the respiratory tract can be medical manipulations in the oral cavity, incl. carried out under local conduction anesthesia.

Classification of foreign bodies in the respiratory tract:

1. endogenous (pieces of tissue not removed during tonsillectomy and adenotomy, extracted teeth, roundworms);

2. exogenous:

Organic (pieces of food, seeds and grains of plants, nuts, etc.),

Inorganic (coins, paper clips, nails, beads, buttons, toy parts, etc.).

Objects of organic origin, synthetic materials and fabrics are the most aggressive and difficult to diagnose. They do not contrast on x-rays, increase in size due to swelling, crumble, and decompose; penetrate into the distal parts of the bronchial tree, causing chronic suppuration of the lungs.

The severity of disorders caused by a foreign body entering the respiratory tract depends on the following circumstances:

– properties of the foreign body (its size, structure, structural features);

– the depth of its penetration, the presence or absence of fixation in the lumen of the respiratory tract;

– the degree of disruption caused to the passage of air and gas exchange.

The moment a foreign body enters the respiratory tract looks like this:

Suddenly the person stops talking, laughing, screaming or crying, and grabs his throat with his hands;

A severe cough occurs, the victim stops answering questions;

When the victim tries to breathe, either wheezing is heard or nothing is heard; the victim opens his mouth wide, but cannot inhale;

The face, which initially turns red, quickly becomes pale and then acquires a bluish color, especially in the area of ​​the upper lip;

Within a few tens of seconds, loss of consciousness occurs due to respiratory arrest;

In a very short time, the heart stops working and clinical death occurs.

Clinical picture when a foreign body enters the respiratory tract

Foreign bodies of the larynx: acute onset, inspiratory dyspnea, severe stridor breathing, cyanosis, paroxysmal whooping cough. With foreign bodies that have sharp edges or edges, hemoptysis often occurs.

Foreign bodies of the trachea: acute onset with a prolonged barking cough, turning into vomiting; stridor breathing; sometimes a dull pain behind the sternum; The characteristic symptom is flapping, which occurs as a result of a sharp displacement of a foreign body.

Foreign bodies of the bronchi:

1. Period of acute respiratory disorders (passage of a foreign body through the upper respiratory tract). Usually short-lived. Acute attack of cough, cyanosis, suffocation.

2. The period of latent flow (fixation of a foreign body in the peripheral bronchus). Duration - from several hours to 10 days.

3. Period of complications:

a) early complications: bleeding, atelectasis, acute pneumonia, bacterial destruction of the lungs, progressive mediastinal emphysema, pyopneumothorax, peritonitis;

b) late complications: bronchostenosis, bronchiectasis.

Emergency assistance if a foreign body enters the respiratory tract

Foreign bodies in the larynx that make breathing difficult require immediate removal. There are special techniques for removing foreign bodies.

1. If the victim is conscious, you need to stand behind him and ask him to tilt his torso forward at an angle of 30-45°, with your palm, not too hard, but sharply hit him between the shoulder blades 2-3 times.

2. If this does not help, you need to use more effective methods. If the victim is in an upright position, the person providing assistance approaches him from behind, clasps him with both hands at the level of the upper abdomen and sharply squeezes the abdomen and lower ribs in order to create a powerful reverse movement of air from the lungs, which pushes the foreign body out of the larynx. It should be remembered that immediately after the foreign body leaves the larynx, a deep breath will reflexively follow, during which the foreign body, if it remains in the mouth, may again enter the larynx. Therefore, the foreign body must be immediately removed from the mouth.

3. If the victim is in a horizontal position, then to remove the foreign body, the victim is placed on his back and sharply pressed with two fists on the upper abdomen towards the lungs, which ensures the mechanism already described.

4. If the victim is unconscious, he should be placed on his stomach on a bent knee, with his head lowered as low as possible. Hit 2-3 times with your palm between the shoulder blades quite sharply, but not very hard. If there is no effect, the manipulation is repeated.

5. After successful restoration of breathing, the victim requires medical supervision, since the methods used can lead to damage to internal organs.

In cases where there is no danger of suffocation, you should not resort to self-removal of foreign bodies, as this should be done by a specialist. Currently, foreign bodies in the upper respiratory tract are removed using a bronchoscope - a special instrument that allows you to examine the respiratory tract, detect the foreign body and remove it.

Features of the Heimlich maneuver in children

When removing a foreign body from the respiratory tract in children under 1 year of age, the rescuer must sit down, place the child on the left forearm, face down, holding the baby’s lower jaw with his fingers folded into a “claw.” The baby's head should be below the level of the body. After this, you should apply five medium-force blows with the heel of your palm to the interscapular area of ​​the back. The second stage - the child turns face up on the right forearm, after the forehead the rescuer makes five pushing movements along the sternum to a point located 1 finger below the internipple line. Don't press too hard to avoid breaking your ribs.

If a foreign body appears in the oropharynx, it is visible and can be removed without the danger of pushing it back - it is removed. If not, repeat the entire cycle either until a foreign body appears or until cardiac arrest, after which cardiopulmonary resuscitation must begin.

In children 1-8 years old, the Heimlich maneuver is performed by placing the child on the rescuer's thigh. The remaining actions are performed according to the general rules.

Diagnosis when a foreign body enters the respiratory tract

X-ray of the larynx or plain X-ray of the chest - identification of radiopaque foreign bodies, as well as atelectasis, emphysema.

Direct laryngoscopy, tracheoscopy, bronchoscopy are crucial in identifying foreign bodies in the corresponding parts of the respiratory tract.

Prevention of foreign body entry into the respiratory tract:

Do not keep small objects (needles, nails, pins) in your mouth;

Control by adults over the quality of toys and their suitability for the child’s age; weaning children from the habit of putting foreign objects in their mouths;

Do not talk while eating;

Exercise caution when performing medical procedures.

Success in providing assistance to the victim directly depends on the competent actions of the person providing assistance. The decisive factor here is the time factor. The sooner assistance is started, the higher the likelihood of the victim being revived. The most common mistake is panic. This feeling paralyzes both the mind and body and prevents you from acting correctly. Panic can be avoided if you practice on dolls or friends in advance. Then, in a critical situation, your brain itself will choose the optimal algorithm of action, and your hands will perform all the necessary manipulations without any admixture of emotions. And this is what makes a rescuer out of an ordinary person.

Foreign bodies of the larynx, trachea and bronchi are especially common in children under 3 years of age. This is due to the fact that children often put coins, buttons and other small objects in their mouths. When inhaled, these objects can enter the larynx and become lodged in it, or descend into the trachea and then into the bronchial tree.

The entry of foreign bodies into the larynx is characterized by the following:

Difficulty in inhaling with a feeling of lack of air (sometimes short-term cessation of breathing due to spasm of the glottis);

blue face and convulsive cough; in children, lacrimation and vomiting;

These symptoms may disappear temporarily and then reappear. The severity of respiratory disorders when foreign bodies enter the

The larynx depends on the degree of narrowing of the lumen of the larynx:

A slight narrowing is manifested by shortness of breath with difficulty (noisy) inhalation, participation of auxiliary muscles in breathing (retraction of the intercostal spaces, supra- and subclavian fossae) during exercise, in infants - during sucking, crying;

With more pronounced narrowing, difficulty breathing with the participation of auxiliary muscles is observed at rest, cyanosis of the skin around the mouth appears during exercise, and anxiety;

Life-threatening narrowing of the larynx is accompanied by severe shortness of breath at rest with difficulty inhaling and exhaling, anxiety or lethargy, cyanosis around the mouth at rest, and the appearance of cyanosis of the entire skin during exercise. If help is not provided, loss of consciousness, convulsions, and respiratory arrest occur.

The entry of foreign bodies into the trachea is characterized by the following:

Paroxysmal cough, during which a popping sound is sometimes heard caused by the displacement of a foreign body;

blue face; vomit.

Narrowing of the tracheal lumen leads to respiratory disorders up to asphyxia when the tracheal lumen is completely closed. Asphyxia can also occur when a foreign body is strangulated in the glottis.

A small foreign body that gets into the respiratory tract can quickly slip into a bronchus of the corresponding diameter.

A long asymptomatic presence of a foreign body in the bronchus is possible. Often an inflammatory process develops in the bronchus and surrounding lung tissue. If a foreign body enters the child’s respiratory tract unnoticed and the foreign body is not diagnosed by a doctor, long-term unsuccessful treatment of the inflammatory bronchopulmonary process is carried out.

If a foreign body is suspected in the larynx, trachea and bronchi, it is necessary to urgently hospitalize the victim.

Accidental introduction of various foreign bodies (most often pieces of food, water or vomit during aspiration from the oral cavity) into the respiratory tract can extremely quickly lead to asphyxia, the development of a terminal condition and death if the victim is not provided immediate assistance. In this regard, measures aimed at the speedy removal of a foreign body from the upper respiratory tract are classified as resuscitation even when the victim does not yet have impaired consciousness and satisfactory cardiac activity remains.

Measures to provide emergency assistance if a foreign body enters the respiratory tract of a conscious adult are as follows:

The victim himself must try to push the foreign body out of the respiratory tract using self-help techniques:

stop talking, call for help; hold the breath; try to take a deep breath;

if you cannot take a breath, then the foreign body is located in the glottis or subglottic space (below the vocal folds), make 3-5 sharp coughing movements due to the residual air, which is always present in the lungs after normal unforced exhalation;

If you succeed in taking a deep breath, also make 3-5 sharp coughing movements. In this case, exhalation begins with the glottis closed; the pressure in the lower respiratory tract increases sharply, and at the moment of the subsequent reflex opening of the glottis, a stream of air coming from the glottis with very high force and speed pushes out the foreign body.

If the above methods are ineffective, use the following self-help techniques: apply jerky pressure to the pancreas with both hands or sharply lean forward, resting your stomach on the back of the chair and hanging over it. In this case, the increased pressure created in the abdominal cavity is transmitted through the diaphragm to the chest cavity, which helps push foreign bodies out of the respiratory tract (Fig. 4.29).

Rice. 4.29. Self-help techniques for foreign body aspiration: a - quickly tilt the torso forward with the upper abdomen resting on the back

chair; b - push-like pressure with both hands on the upper abdomen.

In the absence of an immediate threat to life, it is impossible to carry out techniques aimed at pushing foreign bodies out of the respiratory tract, since a foreign body from the trachea can displace and become pinched in the glottis, which leads to asphyxia (suffocation). If life-threatening respiratory disorders develop (shortness of breath with difficulty inhaling and exhaling, retraction of the yielding areas of the chest when inhaling, increasing bluishness of the skin, anxiety or lethargy, increased heart rate), before the doctor arrives, assistance to the victim should be provided by any person nearby.

Two methods of mutual assistance are used sequentially:

stand behind the victim, placing your foot between his legs. with the palm of your hand (closer to the wrist) apply 3-4 jerky blows

in the middle of the back at the level of the upper edge of the shoulder blades

Rice. 4.30. First aid for a conscious victim during aspiration of a foreign body:

a - passive removal by pressing the knee on the upper abdomen; b - delivering jerky blows with the proximal part of the palm on

interscapular area of ​​the victim

If there is no effect, continue to stand behind the victim and grab him by the waist with both hands.

Clenching one hand into a fist, press it with your thumb to the victim’s stomach on the midline just above the umbilical fossa, but below the xiphoid process (costal angle).

Grasping the hand clenched into a fist with the hand of the other hand with a quick jerk-like movement, push the victim’s stomach in the direction from bottom to top, from outside to inside (Fig. 4.31).

Rice. 4.31. First aid for a conscious victim during foreign body aspiration: push-like pressure

with both hands on the victim's upper abdomen.

The thrusts should be performed separately and distinctly until the foreign body is removed, or until the victim is unable to breathe or speak, or until the victim loses consciousness.

If the victim has lost consciousness, then lower him to the floor along his leg and perform the following manipulation.

The rescuer's algorithm for removing a foreign body from the respiratory tract of an unconscious victim:

lay the victim on his back; if the victim loses consciousness and lacks breathing

movements, begin artificial respiration using the mouth-to-mouth method;

Perform 2-3 blows of air into the victim’s lungs, controlling the expansion of the chest;

If there is no movement of the victim’s chest during air inflation (it should be assumed that this is caused by the lumen of the respiratory tract being blocked by a foreign body), perform the following techniques:

kneel at the side of the victim lying on his back; turn the victim on his side, facing him; taking your hand

the victim and holding him with one hand in this position;

Using the palm of your second hand, apply 3-4 jerky blows to his back between the shoulder blades;

Turn the victim on his back and check whether a foreign body has entered the oral cavity

Using the palm of your second hand, apply 3-4 jerky blows to his back between the shoulder blades (Fig. 4.32);

Rice. 4.32. First aid for an unconscious victim. Applying jerky strikes with the palm of the hand to the interscapular area

the victim.

remove the foreign body from the oropharynx with your finger.

perform a triple Safar maneuver and try to take two test breaths;

If there are signs of effectiveness of trial insufflations, begin artificial respiration;

If no foreign body is found and test breaths are not effective:

sit astride the victim's thighs, resting your knees on

Place one hand with the heel of the palm on his abdomen along the midline, just above the umbilical fossa, far enough from the end of the xiphoid process.

Place the other hand on top and press on the stomach with sharp jerking movements directed towards the head 5 times

Rice. 4.34. Perform resuscitation measures while sitting over the victim.

check the oral cavity for the presence of a foreign body and remove it; attempt artificial ventilation; repeat the activities in the specified sequence until

the victim will not begin to breathe on his own until surgery is possible or until mechanical ventilation becomes available. In the absence of a pulse, an indirect cardiac massage is performed at the same time.

Attention! It should be remembered that when performing emergency care, the contents of the stomach may enter the victim’s mouth and then into the respiratory tract. To prevent this from happening, after every 5 pressures the victim’s mouth must be checked for the presence of vomit and, if necessary, removed

Method for removing a foreign body from the respiratory tract in obese people and pregnant women

If an obese victim or a pregnant woman is conscious: stand behind the victim, place your foot between his feet, as if taking a step forward, and clasp his chest with your hands exactly at the level of the armpits;

Place the hand of one hand, clenched into a fist, with the thumb on the middle of the sternum, away from the xiphoid process and costal edge, clasp it with the hand of the other hand and perform jerking movements towards yourself until the foreign body comes out or until the victim loses consciousness ;

If the victim has lost consciousness, lower him to the floor along his leg and carry out the next step.

4.24. Measures to provide emergency assistance if a foreign body enters the child’s respiratory tract

The method of eliminating airway obstruction caused by a foreign body depends on the age of the child.

Clean the upper respiratory tract with your finger blindly, since at this moment you can push the foreign body deeper;

Apply pressure on the abdomen in children under one year of age, since there is a risk of damage to the abdominal organs, especially the liver.

The rescuer’s algorithm for removing a foreign body from the child’s respiratory tract:

if a foreign body is visible, remove it using a clamp; You can help a child up to one year old by holding him in your hand.

“rider” position with the head lowered below the body (Fig. 4.35):

Rice. 4.35. Clearing the upper respiratory tract from a foreign body (Heimlik maneuver) in children under one year of age.

At the top - shifting to the right hand and patting. Below - shifting to the left hand and pressing on the chest.

Place the child on the rescuer’s arm in the “rider” position with the head lowered below the body, face down, and the back up, while supporting the head with the hand around the lower jaw. If the child is too large to be placed on the forearm, he is placed on the hip so that the head is lower than the body;

With the second hand, quickly strike four times with the proximal part (closer to the wrist) of the palm on the back between the shoulder blades;

Place the child on the rescuer’s second arm on his back (stomach up) so that the victim’s head is lower than his body during the entire reception;

With your other hand, apply four pressures to the child’s chest.

If a life-threatening condition develops in young children, the following technique can also be used:

Take the child by the legs and hold him upside down (for a short time!);

tap him on the back in this position several times (Fig.

Rice. 4.36. Method for removing foreign bodies from the respiratory tract in young children

In older children or adults, use the Heimlik maneuver - a series of subdiaphragmatic pressures (Fig. 4.36).

Rice. 4.37. Heimlich maneuver in children

After clearing the airways and restoring their free patency in the absence of spontaneous breathing, begin artificial ventilation of the lungs

4.25. First aid for fainting.

Fainting is a sudden short-term loss of consciousness caused by insufficient blood supply to the brain. Fainting can even occur in

physically strong and balanced people, weakened by intoxication, malnutrition, lack of sleep, overwork. Sometimes the cause of fainting can be standing motionless for a long time or a sudden transition to a vertical position after staying in bed for many days. In some cases, loss of consciousness is caused by a lack of oxygen in the inhaled air (for example, at high altitudes).

In addition, fainting can be caused by severe pain, emotional stress (conflict situation, type of blood), or the use of vasodilating drugs. The unconscious state is usually preceded by a sharp deterioration in health: weakness increases, nausea, dizziness, noise or ringing in the ears appear. Then the person turns pale, begins to yawn, breaks out in a cold sweat and suddenly loses consciousness. The pupils are dilated, their reaction to light is slow, the pulse is weak, breathing is rapid, the muscles are relaxed. Consciousness is usually restored quickly.

First aid should be aimed at improving blood supply to the brain and ensuring free breathing. Unbutton the victim's shirt collar, free the chest and stomach from the clothing that is constricting them. If the victim is in a stuffy, poorly ventilated room, open a window, turn on a fan, or take the unconscious person out into the air.

Place the person so that the legs are elevated by 20 - 30 cm (Fig.

Rice. 4.38. Position of the victim during fainting.

Wipe your face and neck with cool water. Pat the cheeks and, if possible, let the victim sniff a cotton swab soaked in ammonia.

If you lose consciousness, there is always a danger of the tongue retracting or vomit getting into the respiratory tract. Therefore, when providing first aid, it is necessary, first of all, to ensure airway patency. To do this, the victim lying on his back must be turned on his side. To do this you need to do the following:

the victim from a supine position in