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