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

The problem of foreign bodies entering the respiratory tract is very relevant, because it occurs at any age, it 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 foreign bodies of the bronchi in children account for 36%; at the same time, 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.

Causes of a foreign body entering the respiratory tract

At times more often this pathology develops in patients of childhood. This is due to the peculiarities of the behavior of babies - while eating, they tend to play, talk, laugh or cry, cough. In addition, children very often take various small objects into 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 an increase in cases 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 from the oral cavity, pharynx and larynx, and swallowing disorders (bulbar palsy, myasthenia gravis, brain injury, stroke) becomes very real. In a similar situation are persons in a state of severe intoxication. The cause of foreign bodies entering the respiratory tract can be medical manipulations in the oral cavity, incl. performed under local conduction anesthesia.

Classification of foreign bodies in the respiratory tract:

1. endogenous (non-extracted pieces of tissue 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.).

The greatest aggressiveness and difficulty in diagnosis are objects of organic origin, synthetic materials and tissues. They do not contrast on X-ray, increase in size due to swelling, crumble, 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 that has entered the lumen of the respiratory tract depends on such circumstances:

- properties of a 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 violations caused for the passage of air, gas exchange.

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

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

There is a strong cough, the victim stops answering questions;

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

The face, initially flushed, quickly becomes pale, and then becomes bluish, especially in the region of the upper lip;

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

In a very short time, the work of the heart stops 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 prolonged barking cough, turning into vomiting; stridor breathing; sometimes dull pain behind the breastbone; a symptom of clapping, which occurs due to a sharp displacement of a foreign body, is characteristic.

Foreign bodies of the bronchi:

1. The 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: bronchoconstriction, bronchiectasis.

First aid in case of foreign body inhalation

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, it is necessary to stand behind him and ask him to tilt his body forward at an angle of 30-45 °, with the palm of his hand, not 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 a vertical position, the assisting person comes up to him from behind, clasps 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, can 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 provides the mechanism already described.

4. If the victim is unconscious, he should be laid on his stomach on a bent knee, head down as low as possible. Hit 2-3 times with the palm between the shoulder blades sharply enough, 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, self-removal of foreign bodies should not be resorted to, as this should be done by a specialist. Currently, foreign bodies in the upper respiratory tract are removed using a bronchoscope - a special tool that allows you to examine the airways, detect a foreign body and remove it.

Features of the Heimlich maneuver in children

When removing a foreign body in the respiratory tract in children under 1 year old, the rescuer should sit down, put the child on the left forearm face down, holding the lower jaw of the baby with fingers folded into a “claw”. The head of the child should be below the level of the body. After that, five medium-strength blows should be applied with the base of the palm to the interscapular region of the back. The second stage - the child turns face up on the right forearm, after the forehead, the rescuer makes five jerky movements along the sternum to a point located 1 finger below the inter-nipple line. Don't push too hard to break the ribs.

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

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

Diagnosis when a foreign body enters the respiratory tract

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

Direct laryngoscopy, tracheoscopy, bronchoscopy are of decisive importance in identifying foreign bodies in the relevant 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 compliance with the age of the child; weaning children from the habit of taking foreign objects into 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 time factor is decisive here. The sooner help is started, the higher the likelihood of resuscitation of the victim. The most common mistake is panic. This feeling paralyzes both the mind and the body and does not allow to act correctly. Panic can be avoided if you practice on dolls or friends in advance. Then, in a critical situation, your brain will choose the optimal algorithm of actions, and your hands will perform all the necessary manipulations without an admixture of emotions. And this is what makes a rescuer out of a simple 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 take coins, buttons and other small objects into their mouths. When inhaled, these objects can enter the larynx and get stuck in it, or descend into the trachea, and then into the bronchial tree.

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

Difficulty 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 temporarily disappear, 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 difficult (noisy) inspiration, participation in breathing of auxiliary muscles (retraction of the intercostal spaces, supraclavicular and subclavian fossae) during exercise, in infants - during sucking, crying;

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

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

The ingress 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.

The narrowing of the lumen of the trachea leads to respiratory disorders up to asphyxia when the lumen of the trachea is completely closed. Asphyxia can also occur when a foreign body is infringed in the glottis.

A small foreign body that has entered the respiratory tract can quickly slip into a bronchus of the appropriate diameter.

Perhaps a long asymptomatic stay of a foreign body in the bronchus. Often, an inflammatory process develops in the bronchus and the lung tissue surrounding it. If the entry of a foreign body into the respiratory tract of a child goes unnoticed and the foreign body is not diagnosed by a doctor, a long-term unsuccessful treatment of the inflammatory bronchopulmonary process is carried out.

If a foreign body of the larynx, trachea and bronchi is suspected, 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 state and death if the victim is not provided with immediate assistance. In this regard, measures aimed at the speedy removal of a foreign body from the upper respiratory tract are referred to as resuscitation even when the victim does not yet have impaired consciousness and satisfactory cardiac activity is maintained.

Measures to provide emergency care when a foreign body enters the respiratory tract of an adult who is conscious are as follows:

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

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

if it is not possible to inhale, then the foreign body is located in the region of the glottis or subglottic space (below the vocal folds), make 3-5 sharp coughing movements due to the residual air that is always present in the lungs after a normal unforced exhalation;

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

If the above methods are ineffective, apply the following self-help techniques: with both hands, with jerky jolts, press on the pancreas or lean forward sharply, resting your stomach against 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 contributes to the expulsion of foreign bodies from the respiratory tract (Fig. 4.29).

Rice. 4.29. Self-help techniques for aspiration of a foreign body: a - a quick tilt of the torso forward with an emphasis on the back of the upper abdomen

stool b - jerky 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 move and be pinched in the glottis, which leads to asphyxia (suffocation). With the development of life-threatening respiratory disorders (shortness of breath with difficulty inhaling and exhaling, retraction of compliant parts of the chest during inhalation, increasing cyanosis of the skin, anxiety or lethargy, increased heart rate), before the arrival of a doctor, assistance to the victim should be provided by any person nearby.

Two methods of mutual assistance are applied sequentially:

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

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

Rice. 4.30. Reception of first aid to the victim, who is conscious, with aspiration of a foreign body:

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

interscapular region of the victim

If there is no effect, while continuing to stand behind the victim, wrap both hands around his waist.

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

Grasping the hand clenched into a fist with the brush of the other hand with a quick jerky movement, jerkily press on the victim's stomach in the direction from bottom to top, from outside to inside (Fig. 4.31).

Rice. 4.31. Reception of first aid to the victim, who is conscious, with aspiration of a foreign body: jerky pressure

both hands on the victim's upper abdomen.

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

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

Algorithm of the rescuer's actions to remove a foreign body from the respiratory tract of an unconscious victim:

lay the victim on his back; loss of consciousness and lack of respiratory

movements, start artificial respiration by the mouth-to-mouth method;

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

If there is no movement of the chest of the victim during the blowing of air (it should be assumed that this is caused by the closure of the lumen of the respiratory tract by a foreign body), carry out the following techniques:

kneel on the side of the victim, lying on his back; turn the victim on his side, facing you; taking by the hand

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

With the palm of the second hand, inflict 3-4 jerky blows on his back between the shoulder blades;

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

With the palm of the second hand, inflict 3-4 jerky blows on his back between the shoulder blades (Fig. 4.32);

Rice. 4.32. First aid for an unconscious victim. Application of jerky blows with the palm of the hand to the interscapular region

the victim.

remove the foreign body from the oropharynx with a finger.

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

With signs of effectiveness of test breaths, proceed to artificial respiration;

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

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

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

From above, lay the brush of the other hand and press on the stomach with sharp jerky movements directed to the head, 5 times

Rice. 4.34. Performing resuscitation in a sitting position over the victim.

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

the casualty will not begin to breathe spontaneously either until surgery is possible or until ventilators are available. In the absence of a pulse, an indirect heart massage is simultaneously performed.

Attention! It should be remembered that when performing emergency assistance, the contents of the stomach can enter the mouth and further into the respiratory tract of the victim. To prevent this from happening, after every 5 pressures on the victim, it is necessary to check the oral cavity for the presence of vomit and, if necessary, remove them.

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

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

Put the hand of one hand, clenched into a fist, with your thumb on the middle of the sternum, away from the xiphoid process and the costal edge, grab it with the other hand and perform jerky 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 the leg and carry out the activities of the next stage.

4.24. Measures to provide emergency care when a foreign body enters the respiratory tract of a child

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

Blindly clean the upper respiratory tract with your finger, as at this moment you can push the foreign body deeper;

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

Algorithm of the rescuer's actions to remove a foreign body from the child's respiratory tract:

if the foreign body is visible, remove it using a clamp; a child under one year old can be helped by holding it on the arm in

position of the "horseman" with the head lowered below the body (Fig. 4.35):

Rice. 4.35. The release of the upper respiratory tract from a foreign body (Heimlik's maneuver) in children under one year old.

Above - 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 and with the head lowered below the body, face down and 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, it is placed on the thigh so that the head is lower than the torso;

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

Lay the child on the second hand of the rescuer on his back (belly up) so that the head of the victim was lower than the body during the entire reception;

With the other hand, perform four pressures on the child's chest.

In the case of the development of a life-threatening condition in young children, the following technique can also be used:

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

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

Rice. 4.36. The method of removing foreign bodies of 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 cleaning the airways and restoring their free patency in the absence of spontaneous breathing, proceed to 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 prolonged immobile standing or a sudden transition to an upright position after being in bed for days. In some cases, loss of consciousness is caused by a lack of oxygen in the inhaled air (for example, in high altitude conditions).

In addition, fainting can be caused by sharp pain, emotional stress (conflict situation, type of blood), the use of vasodilator drugs. An unconscious state is usually preceded by a sharp deterioration in well-being: 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 slowed down, the pulse is weak, breathing is quickened, the muscles are relaxed. Consciousness is usually quickly restored.

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

Place the person in such a way that the legs are raised by 20-30 cm (Fig.

Rice. 4.38. The position of the victim during fainting.

Wipe your face and neck with cool water. Pat on the cheeks and, if possible, let the victim smell the cotton wool moistened with ammonia.

With loss of consciousness, there is always a danger of retraction of the tongue or ingestion of vomit into the respiratory tract. Therefore, when providing first aid, it is necessary, first of all, to ensure the patency of the respiratory tract. For this, the victim, lying on his back, must be turned on his side. To do this, you must perform the following steps:

victim from a supine position