Foreign bodies in the airways. Health care

FUNDAMENTALS OF FIRST AID
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Foreign bodies in the airways. Health care

Fundamentals of First Aid (OPMP)

В Airways often get pins, buttons, small nails and other items that are taken into the mouth in the course of any activity. Even more often, small objects penetrate into the respiratory tract of children when playing with them (sunflower seeds, nut shells, coins, etc.).

Evidence

If an adult usually complains about the ingress of a foreign body into the respiratory tract, then the child often cannot explain anything. Difficulty breathing and a coughing fit in an adult indicate the ingress and presence of a foreign body in the respiratory tract. With a sudden attack of suffocation and coughing in an unattended child, people around should always think about the possibility of a foreign body entering the respiratory tract. Help depends on the cause and severity of airway obstruction, as well as on the level of consciousness, the adequacy of gas exchange.

If an obstruction (blockage) is suspected and the patient is conscious, ask if he or she feels suffocating. Immediate intervention is not indicated for partial airway obstruction, when normal skin color and ability to cough persist, even if wheezing is heard between coughing fits.

In case of incomplete airway obstruction with impaired breathing (weakness, ineffective cough, wheezing on inspiration, increasing difficulty in breathing and, often, cyanosis), active intervention is sometimes indicated.

With complete airway obstruction (the patient is unable to speak, breathe, or cough and often clutches at the throat), urgent intervention is necessary.

Used to relieve airway obstruction in adults Heimlich maneuver. The purpose of this maneuver is to abruptly expel enough air from the lungs, causing an artificial cough of sufficient intensity to remove the foreign body. Keep in mind the following aspects of this procedure:

1. Correct technique: approach the standing or sitting patient from behind, clasp his hands around his waist, press on his stomach and make a sharp push up. It must be ensured that the push is performed at the correct anatomical point (in the midline of the abdomen between the navel and the xiphoid process) to minimize the chance of internal injury.

2. Each thrust should be performed as a stand-alone move, with the firm intention of releasing the obstruction in one motion.

In the case of suspected obstruction in an unconscious adult, an attempt at digital removal of the foreign body is appropriate. The resuscitator opens the patient's mouth with the fingers of one hand and inserts the index finger of the other hand along the inner surface of the cheek deep into the throat, to the root of the tongue. By bending the index finger in the distal phalanx, the resuscitator tries to use this "hook" to displace and remove the object that causes obstruction. Special care must be taken not to push the foreign body deeper into the airways.

The sequence of resuscitation measures:

if there are good reasons to assume obstruction of the airways by a foreign body, then an attempt at digital removal is made in the first place;
if there is no airway obstruction, then resuscitation begins with mechanical ventilation (ALV).
When attempts to ventilate without success even after changing the position of the head, obstruction by a foreign body should be assumed. In such cases, it is recommended:
perform the Heimlich maneuver (if necessary, repeat up to 5 times);
open the mouth of the resuscitated person and try to make a digital removal of the foreign body;
try artificial respiration again;
repeat the cycle of events described above as many times as necessary until the foreign body is removed.

In a conscious adult who suddenly begins to choke, the presence of an obstruction is usually not in doubt. Faced with circulatory arrest under unclear circumstances, the diagnosis is much more difficult to make.

The most common cause of airway obstruction in an unconscious person is retraction of the tongue or incorrect position of the head of the resuscitator. And only unsuccessful attempts to conduct mechanical ventilation after changing the position of the head indicate a foreign body.

The possibility of airway obstruction should always be considered in an adult or child if there is sudden respiratory arrest and cyanosis, or if the victim is found unconscious.

Authors: Aizman R.I., Krivoshchekov S.G.

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