A. Ensuring the patency of the respiratory tract 1. Lay the patient on a hard surface on his back.2. Sharply bend your head back. With a suspected fracture or dislocation in cervical region spine (with a blow to the neck from behind, whiplash injury) -

Allergic diseases respiratory tract allergies ( hypersensitivity to any factors environment) may be accompanied various symptoms. It can be skin rashes, runny nose, inflammation of the eyes, cough, headache,

Very often there is a hit, by inhalation (aspiration), of a foreign body in the respiratory tract. This usually happens with young children who use small objects while playing, or inhale food while feeding. A variety of small objects can get into the respiratory tract of children. A foreign body in the upper respiratory tract in children can threaten their lives, so you need to urgently contact a specialist. ENT doctors very often take out all kinds of small objects, parts of toys and parts of food from the nose, lungs, bronchi, larynx and trachea of ​​children.

When a foreign body enters the bronchus or smaller airways, children experience coughing, weakening of respiratory sounds, and wheezing for the first time. This classic triad is observed only in 33% of children who have aspirated a foreign body. The longer foreign objects remain in place, the more likely the presence of a triad of symptoms, but even with significantly late diagnosis, it develops in 50% of children. Aspiration of a foreign body in children is common, the objects are diverse, but food products predominate among them: nuts (peanuts), apples, carrots, seeds, popcorn. In children who have inhaled a foreign body, there are signs of severe stenosis of the upper respiratory tract: attacks of suffocation with prolonged inspiration, with periodically strong cough and cyanosis of the face up to lightning asphyxia, weakening of respiratory noises, stridor, wheezing, sensation of a foreign body, wheezing. In the presence of a mobile body in the trachea, a popping sound can sometimes be heard during screaming and coughing.

Aspiration of a foreign body.

Information of a general nature.

The ingress of foreign objects into the respiratory organs is called aspiration of foreign bodies. This is a dangerous condition that can lead to serious injury to the larynx, airway obstruction and asphyxia. Aspiration of small bodies often occurs in the right, wider bronchus.

Most often, aspiration of foreign bodies, organic and inorganic, occurs in young children, but remains possible for people of any age and gender.

Causes of the disease.

The first and main reason for the pathology is the abandonment of babies 2-7 years old without adult supervision. A curious child pulls small objects into his mouth, accidentally inhales, and the foreign body ends up in the respiratory organs.

There are frequent cases of aspiration of food particles in the process of eating, both in children and in quite adults. Dangerous is the habit of holding small objects in the teeth (screws, buttons), rolling toothpicks in the mouth, etc. during work.

Symptoms of the disease.

Aspiration of a foreign body is manifested by difficulty in the respiratory process, a sharp unexpected attack of coughing (if a foreign object enters the trachea, the cough resembles the symptoms of whooping cough), blue skin, in severe cases - asphyxia with loss of consciousness, in extremely severe cases - death from suffocation with complete overlap by strangers body of the respiratory tract.

If the aspirated foreign body remains in the respiratory organs, it is characterized by attacks of suffocation with paroxysmal cough, persistence of stenosis manifestations, pain in the larynx, sometimes radiating to the ear area. Exacerbations of the condition are replaced by calmer periods. In almost all cases, hoarseness is noted, the patient feels the presence of a foreign body in the larynx. More specific signs depend on the location of the foreign object and its movements. If foreign bodies are in the bronchi, trachea or larynx long enough, inflammatory processes develop with suppuration.

Possible complications.

Due to the presence of aspirated bodies in the respiratory organs, chronic forms of bronchitis and pneumonia may occur, develop lung abscess purulent pleurisy.

Health care.

The task of physicians is to promptly remove the aspirated foreign body; treatment tactics are developed after determining the localization of the object that has entered the respiratory organs and its characteristics. If the situation allows, the extraction of foreign bodies should be carried out in a specialized (otolaryngological) department of the hospital.

For citation: Svistushkin V.M., Mustafaev D.M. Foreign bodies in the respiratory tract // BC. 2013. No. 33. S. 1681

Foreign bodies in the respiratory tract lead to pronounced functional and morphological disorders in the body, up to severe asphyxia, life-threatening if there is a delay in providing assistance.

Most of the aspirated objects (65%) reach the bronchi of various calibers. A significant part of them are kept in the trachea (up to 22%) or larynx (13%). This ratio is due to the capabilities and state of physiological motor-regulatory defense mechanisms, features anatomical structure respiratory tract, as well as the properties and metric parameters of the foreign bodies themselves.
The cause of most cases of aspiration of foreign bodies is most often involuntary, less often associated with painful processes, the mismatch of the natural function of the epiglottis, which, synchronously with breathing, covers and opens the entrance to the larynx. Mostly it happens at the moment of taking a short deep breath during a conversation, a hasty meal, sudden laughter, crying or fright. As soon as the foreign body passes the glottis, a reflex tight closing of the vocal folds occurs, and the spasm of the vocal muscles does not make it possible to get rid of it even with a strong cough.
Conditions that increase the risk of aspiration of foreign bodies in the form of food parts of different sizes and textures include lack of teeth, the use of uncomfortable dentures, and various defects in the anatomical formations of the oral cavity. 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. Persons in a state of strong alcoholic intoxication 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 in local conduction anesthesia. Extracted teeth, removed crowns, pieces of a plaster cast made for subsequent prosthetics are brought into the larynx and trachea with a stream of inhaled air. In similar situations, cases of aspiration of parts of dental instruments used by a doctor are known: cutters, extractors, broken hooks.
Some living organisms can turn out to be very peculiar foreign bodies: − roundworms, leeches and the like, accidentally caught in the throat and independently penetrating during sleep into the upper respiratory tract.
The severity of disorders caused by a foreign body in the airway is largely determined by the interaction of several conditions. Among them, the main ones are distinguished, characterized by:
- properties of a foreign body (its size, structure, structural features);
- the depth of its penetration and the stability of fixation in the lumen of the respiratory tract;
- the degree of violations caused for the passage of air, gas exchange.
The size of an object in many cases plays a decisive role: − the larger it is, the greater the threat of blocking the airways in the larynx, trachea, and main bronchi. Soft foreign bodies, even relatively small ones (pieces of meat, fat), can cause severe respiratory disorders, getting stuck in a spasmodic glottis. Objects of complex configuration, having irregularities and protrusions (dentures), can be held by the walls of the trachea at its different levels up to bifurcation. They create unfavorable conditions conducive to the development of inflammation - mucus, fibrin, microorganisms easily settle and linger on them. On the contrary, dense objects with a smooth surface (metal, glass, plastic) contribute to such processes to a lesser extent. Pointed foreign bodies (needles, small nails) are introduced into the mucous membrane of the respiratory tract and can be kept here for a long time.
Light foreign bodies of small and medium sizes (seeds, nuts and their shells, pieces of plexiglass, etc.) are able to move in the airway lumen with an air stream, migrate, blocking one or the other bronchus or, reaching the glottis, wedged here and re-call severe violations gas exchange.
Objects made of metal and glass, which have a large mass with a small volume (balls, bolts, nuts), quickly reach the lobar and smaller bronchi, lingering in them for a long time.
It is known that light foreign objects are carried more often by the air flow into the bronchus of the right lung, which in its direction is a “continuation” of the trachea. Heavier metal objects are less affected by airflow. Once in the subglottic space, they "roll" into the right or left main bronchus, depending on the position of the victim at the time of aspiration.
In body tissues, foreign bodies always cause a more or less pronounced inflammatory reaction. Its intensity depends on the properties of the object that has entered the respiratory tract. The most violent inflammatory process accompanies the aspiration of foreign bodies organic nature.
Plant foreign bodies, often with irregular shape and uneven surface, as a rule, contribute to the rapid development of infection. The seeds of legumes (beans, peas) behave in a peculiar way in the respiratory tract. Already after a few hours of their stay in "thermostatic" conditions, they begin to swell, their initial size increases by 1.5-2 times. Then the sections of the respiratory tract previously passed for air lose this possibility, and the fixation and jamming of the foreign body are significantly enhanced.
Ears of cereal crops, if aspirated, quickly lead to a strong inflammatory reaction, followed by suppuration and displacement. This is due to the action of the valve mechanism of the bronchi. At the moment of inhalation and expansion of the walls of the bronchus, the antennae of the spikelet located in its lumen, like springs, straighten out, and at the moment of exhalation they rest against them, creating a force directed towards the base of the spikelet. This leads to its movement to the segmental, subsegmental bronchi and more distally - to the periphery of the lung. There are known cases of exit of aspirated ears beyond the lung with the formation of a limited empyema of the pleura and even suppuration of the chest wall.
Organic foreign bodies can fragment over time, and then their individual parts, moving, create new obstacles in other parts of the respiratory tract. Smaller ones are coughed up with sputum, creating a false impression of the complete disposal of a foreign object.
A foreign object lingering in the trachea rarely remains here in an unchanged position; it most often moves into one of the main bronchi. If a foreign body has a small mass, a smooth surface, and cannot freely go out through the glottis in size (pine nut peel, plastic objects, watermelon seeds in children), which then acts like a "piggy bank mechanism", a peculiar, coordinated with breathing and cough its movement in the lumen of the trachea: up and down (balloting). In this case, when exhaling and coughing, the foreign body moves with the air flow to the subglottic part of the trachea, and with the subsequent inhalation it is carried down to the bifurcation. This is repeated many times until the cough reflex is exhausted. In some cases, the balloting object alternately closes the entrance to the right, then to the left main bronchus. With a delay in one of them, a kind of valve can form, when a foreign body allows free flow of air into the lung during inhalation, but, occupying a certain position in relation to the lumen of the bronchus during exhalation, prevents its return. The valve mechanism resulting from the penetration of a foreign body into the lumen of the respiratory tract of one of the lungs leads to the formation of alveolar emphysema in it. In the presence of initial degenerative-dystrophic changes in the lung tissue, such an excessive increase in air pressure in it can cause the development of pneumothorax, mediastinal emphysema.
When the lumen of the respiratory tract is blocked, complete or partial atelectasis of the lung occurs. Subsequently, under the influence of the accumulated distal to the site obstruction of bronchial mucus, as well as due to suppuration and destruction of tissues around a foreign body, it can be released and re-penetrate the lumen of the trachea and even migrate into the bronchi of the opposite lung. When a foreign body enters the larynx, trachea or bronchi, the pathogenesis of the initial changes in the body of the victims is most often associated with the degree of overlap of the airway lumen and the disorder of gas exchange. In this first, most acute period of the disease, severe, even fatal respiratory and circulatory disorders can occur.
With a relatively favorable development of events, if the aspirated foreign body did not lead to severe respiratory disorders, the initial acute period of the disease is replaced by a period of subacute, protracted or latent disorders. It is characterized by transient, intermittent respiratory disorders of varying severity and the appearance of inflammatory changes that tend to have a long course. The pathogenesis of the third period of the disease - persistent chronic disorders - is characterized by infectious and inflammatory changes in the lung, caused and maintained by a foreign body that overlaps the lumen of the corresponding bronchus and is fixed in it. Clinical manifestations during aspiration of foreign bodies are distinguished by great diversity and dynamism, reflecting the features of the pathogenesis of the disease in different periods of its development.
Especially severe, often fatal, disorders are characteristic of manifestations of the initial - acute period, which includes the moment of aspiration and the time the foreign body stays in the wide sections of the respiratory tract: larynx, trachea, main bronchi. The delay here of a foreign body often creates a very significant obstacle to the passage of air, aggravated most often by reflex spasm. The situation becomes critical when the foreign body lingers in the larynx, in the region of the vocal folds. Reflex spasm of the vocal muscles, contributing to additional fixation of the foreign body, leads to a complete cessation of the possibility of breathing - asphyxia, or suffocation. Acutely increasing lack of oxygen in the blood, accumulation of carbon dioxide are accompanied by marked excitation, uncoordinated motor activity, which are quickly replaced by loss of consciousness, progressive fall, and further cessation of cardiac activity. The total duration of the period of reversible changes in acute asphyxia ranges from 8-10 minutes. .
In the case of maintaining some airway patency, the picture of increasing asphyxia develops less rapidly. Following the aspiration of a foreign body, patients experience an acute shortage of air, fear. Irritation of the receptor fields of the sensory nerves of the mucous membrane of the large sections of the airways activates the action of protective mechanisms. Among them, the leading place is occupied by cough. In this situation, cough is characterized by a special severity, hacking, recurrence in the form of severe attacks. Significant physical stress that accompanies coughing, and forced, labored breathing lead to an increase in intrathoracic pressure, deterioration of cardiac activity. The flow of venous blood to the heart is disturbed, there is an overflow of the bloodstream in the system of the superior vena cava with a visible appearance of the relief of dilated superficial veins in the neck, cyanosis of the skin of the face and even the upper half of the body. The duration of such an acute period is 10-20 minutes, after which, if due to coughing it was not possible to get rid of the foreign body, the defenses are depleted, and asphyxia is aggravated due to increasing edema.
If a foreign body moves to the lower respiratory tract, the conditions for improving breathing and gas exchange become more favorable. Patients experience some relief, but note the appearance of a feeling of increasing weakness and sometimes fall into a short-term fainting state. Cyanosis disappears, replaced by pallor of the skin and the appearance of cold sweat. Cardiac activity improves, pulse slows down.
When balloting a foreign body in the trachea, some patients pay attention to unusual sensations associated with breathing, moving the body to a certain position. Sometimes these sensations are accompanied by subjectively perceived sound phenomena: buzzing, hissing, etc. .
When moving a foreign body to the bifurcation of the trachea and into one of the main bronchi, the conditions for normalizing breathing are somewhat improved. Following the primary reaction, characterized by severe disturbances in lung ventilation, the acute period of the disease in this situation is manifested mainly by the “switching off” of the corresponding lung from gas exchange. Then complaints of lack of air arise only when physical activity, the cough becomes less frequent and less painful, with phlegm. During the first day in the lung that has lost its normal airiness in the area of ​​atelectasis, pneumonic infiltration appears with characteristic local and general clinical signs of inflammation. Later, pulmonary heart failure joins.
With the valvular variant of the foreign body blocking one of the main bronchi in the corresponding lung, the so-called alveolar emphysema is formed, accompanied by difficulty in breathing, the appearance of shortness of breath, disorder general condition patients with progressive cardiovascular insufficiency. Sometimes there is a periodic migration of a foreign body from one main bronchus to another with alternate exclusion from the breath of either the right or the left lung, which leads to significant respiratory disorders and a progressive deterioration in the condition of patients, mainly associated with the development of bilateral pneumonia.
A foreign body that has shifted to the distal parts of the respiratory tract or a segmental bronchus, due to the absence of receptor fields here that form the so-called tussogenic zones, does not cause cough.
Other clinical manifestations associated inflammatory process in the lung, both local and general, are determined by the caliber and degree of obstruction of the bronchus into which the foreign body has penetrated. With complete obstruction, they appear earlier and can be clearly expressed, accompanied by fever, cough with purulent sputum, chest pain. With partial obstruction or the development of pathological changes in a relatively small part of the lung (segment, subsegment), the inflammation proceeds more torpidly and less noticeably, without disturbing the well-being of patients.
In the majority (52-65%) of the victims, the distal sections of the tracheobronchial tree become the place of final fixation of foreign bodies, which determines the subsequent development clinical manifestations. Then a relatively satisfactory or slightly disturbing state of health, which persisted for a long time in patients in the subacute period of the disease, is replaced by a progressive deterioration in their condition.
Foreign bodies that have entered the lumen of the respiratory tract are recognized using clinical, radiological and endoscopic methods of investigation. The urgency, possibility and availability of each of them are determined by the condition of the victims, the severity of respiratory and gas exchange disorders, inflammatory changes in the respiratory organs in certain periods of the disease.
It is far from always possible to simply determine that the basis of sudden severe disorders is the fact of aspiration of a foreign body. Diagnosis is somewhat simplified when, when collecting an anamnesis, the victim himself or witnesses of the incident talk about this. Meanwhile, the victim can often deny even a reasonable assumption about the probable aspiration of a foreign body. This is noted in persons who were in a state of intoxication, anesthesia, or the mentally ill. Young children left unattended can not always tell about what happened. Meanwhile, on childhood accounts for the majority of cases of aspiration of foreign bodies (up to 80-97%).
Most noticeably, often catastrophically fast, develop life threatening affected respiratory disorders, gas exchange and cardiac activity in the event of a foreign body entering the larynx, between vocal folds. This may be indicated by a sudden cough, hoarseness, or complete loss of voice. A noisy, elongated breath that appears at the same time, sometimes accompanied by a peculiar sharp whistling sound that can be heard at a distance, is characteristic - such breathing is called stridor (from Latin stridere - to hiss, whistle). Growing cyanosis of the lips, tip of the nose, face. Consciousness is quickly lost. There is no time left for other methods of examination. In such a situation, it is mandatory to perform an internal digital examination of the pharynx and the entrance to the larynx. This technique is often possible to diagnose the presence of a foreign body in this area.
Direct laryngoscopy, recommended for assessing the larynx, requires the use of an appropriate instrument, which may not always be available in a rapidly progressive emergency. In young children, inspection of the larynx is more difficult, and the finger can reach the entrance to the larynx and lower part of the pharynx. The use of mirror and direct laryngoscopy allows you to more accurately assess the condition of the larynx, vocal folds, subglottic space and accurately localize the foreign body that has lingered here.
On auscultation, a few dry rales are heard over the lungs. A change in the position of the victim's body during the examination can cause a sudden onset of severe coughing that has previously stopped. This is due to the movement of a foreign body in the lumen of the trachea and irritation of new areas of the surface of its mucous membrane, which is characteristic diagnostic sign. As a rule, in such situations, the appearance of chest pains, resembling the phenomena of acute tracheitis, is noted. The free movement of a small foreign body during breathing is perceived by patients as a "feeling of blows in the chest", which can sometimes be heard at close range, resembling the sound of cotton. More clearly, such blows and other sounds created by a balloting foreign body can be caught during auscultation.
When a foreign body is located in the region of the tracheal bifurcation, episodic alternating obstruction of the patency of one or the other main bronchus often occurs. Then, when examining patients, attention is drawn to the periodic change in well-being associated with such a peculiar violation and restoration of breathing. Using auscultation, it is possible to note how the weakening of breathing over one lung is replaced by its restoration with a reverse sound picture over the opposite half. chest. Such idiosyncratic changes can be clearly associated with a change in body position during the examination.
In the case of deep penetration of a foreign body into one of the main bronchi, complaints of patients about respiratory disorders that were present immediately after aspiration almost or even completely disappear. At the same time, the completeness of diagnostic information largely depends on the thoroughness of the physical examination. With incomplete obstruction of the lumen of the bronchus, by analogy with the larynx and trachea, stridor breathing can be felt and auscultated above this place. In other cases, auscultation here can detect breathing only with a bronchial shade. If the obstacle blocks the lumen of the bronchus by more than half, then a peculiar sound effect appears, perceived as a slow, prolonged exhalation on the side of the lung, in which there is a violation of the bronchus. Partial stenosis of the bronchus leads to a slower filling of the lung with air during inhalation and difficulty exhaling. Then, upon examination, one can note a slowdown in the excursions of the corresponding half of the chest.
When the valve closes the lumen of the bronchus, when the passage of air is maintained in only one direction (during inspiration), auscultation shows a progressive weakening of breathing over the corresponding half of the chest. With complete occlusion of the bronchus with the development of atelectasis of the lung and the displacement of the mediastinum to the affected side, with the help of percussion, a shortening of the percussion sound is established, and during auscultation - complete absence breath sounds.
An obligatory element of a comprehensive examination of patients with foreign bodies of the respiratory tract is the use of radiation methods. At the first stage, a traditional x-ray examination is carried out with the performance of images in frontal and lateral projections. Based on the changes identified in this case, it is already possible (with varying degrees of certainty) to judge the cause and mechanism of development given state. Thus, diffuse bilateral changes in the form of multiple focal small and medium-sized shadows, mainly in the lower parts of the lungs, are a reflection of mainly lobular atelectasis, which is characteristic of the aspiration of various fluids (vomit, blood, gastric contents, etc.). A diffuse increase in the transparency of the lung fields with a low position and low mobility of the diaphragm is characteristic of bronchospastic syndrome.
The X-ray picture of the changes that occur when foreign bodies enter depends on the level of obturation (larynx, trachea, main bronchus, lobar, segmental) and its degree (complete, partial, valve). A direct striking sign is the image of the foreign body itself. With complete obturation, atelectasis of the lung tissue develops, ventilated by the corresponding sections of the airways; with partial - hypoventilation, with the valve mechanism of obturation - bloating.
Foreign bodies of the respiratory tract from the standpoint of X-ray diagnostics (as the main method of radiological examination in such cases) should be divided into high-contrast, low-contrast and non-contrast. If a foreign body on radiographs does not give any shadow at all, then according to the existing signs of impaired patency of the bronchus, the zone of tomography is determined. However, the foreign body itself is usually not visualized in this study, only the fact of bronchoconstriction of one degree or another is established. In these, as well as in all other diagnostically difficult cases, a spiral computed tomography followed by image reconstruction. Bronchography, even directed, is not able to resolve the issue of the presence of a foreign body. It confirms only the fact of bronchial obturation.
Bronchoscopy studies significantly complement the methods X-ray diagnostics, mainly due to the ability to accurately verify foreign bodies in the airways that do not absorb x-rays. For many patients, this diagnostic technique is the only one that allows differential diagnosis between a foreign body that has been in the lumen of the bronchus for a long time, and diseases of a different nature, often giving a similar clinical and radiological picture (lung tumors, purulent-destructive processes, hemoptysis and pulmonary bleeding of various nature). Bronchoscopy is a mandatory diagnostic procedures taken at the slightest suspicion of penetration into the airways of foreign bodies.
Emergency care and other therapeutic measures in each of the periods of the development of the disease are determined by the severity of the clinical manifestations of aspiration of foreign bodies. In the acute period, mainly due to increasing respiratory and gas exchange disorders, up to asphyxia, assistance is provided on an urgent basis. Its primary and main tasks are to remove the obstruction and restore airway patency. In an emergency situation, often in the absence of any medical instruments at hand, they use techniques that encourage the discharge of foreign bodies with a cough. These include directed blows to the back and pushes with the hands.
Reception "blows on the back" is performed with the base of the palm, applying them between the shoulder blades with one hand and holding the victim in front with the other hand at the middle of the chest during a coughing fit. Reception includes 4-5 fairly intense blows applied at short intervals.
“Hand pushes” (Heimlich maneuver) are jerky movements of the hand from the bottom up into the upper abdomen (abdominal push) or from front to back into the lower chest wall (thoracic push). Perform 4-5 such rapidly repetitive movements. These methods are resorted to sequentially, if one of them did not lead to success, but such attempts are not extended for more than 1-2 minutes.
When helping young children, a foreign body can sometimes be removed by turning the child upside down, holding it by the legs and shaking it in weight. This technique can be successful when aspirating small, round, smooth or rather heavy objects: balls, buttons, corn kernels, etc.
If a foreign body is found in the larynx, between the vocal folds, when performing an internal digital examination through the oral cavity, steps should be taken immediately to remove it. To do this, they grab the tongue and bring it out, and with the second finger, following along the inner surface of the cheek, they reach the pharynx and larynx. The foreign body stuck here is displaced, advancing into the oral cavity. If this fails, then it is pushed into the trachea (the wider part of the respiratory tract), thereby providing an opportunity for air to pass and some reserve time for more complete assistance.
If there is a tool at hand (tweezers, surgical clamp), then it is more expedient to use it to remove a large foreign body found in the larynx. The instrument is brought in and captured by the aspirated object, controlling these actions with a finger.
The failure of the actions taken within 2-4 minutes. from the moment of the incident and the increase in the phenomena of asphyxia are indications for emergency tracheotomy or conicotomy. Both interventions are performed not to remove the aspirated object, but to provide air access to the lungs and alleviate the condition of the victims. This makes it possible to transport them to a specialized medical institution. Acute hypoxia with loss of consciousness, lowering of the threshold pain sensitivity justifies the performance of such operations without spending time on anesthesia, often using improvised means.
In all cases, when spontaneous breathing is absent after restoration of airway patency, artificial ventilation of the lungs is performed, and in case of weakening or cardiac arrest, closed heart massage, a set of resuscitation measures.
If in the acute period of the disease, aspiration of a foreign body did not lead to catastrophic respiratory and gas exchange disorders, but only made them difficult, then it becomes possible to immediately transport the victims to a specialized medical institution, where there is everything necessary to provide full assistance. Similarly, they act in the subacute period of the development of the disease, i.e. several hours or even days after the incident. In specialized institutions, laryngo-, tracheo- or bronchoscopy methods are used to remove aspirated objects.
With the advent and improvement of various models of endoscopes, the possibilities for removing aspirated foreign bodies have expanded significantly. The set of modern endoscopes includes special extractors for extracting foreign bodies: double and triple forks, flexible loops, folding basket traps. With their help, foreign bodies of various sizes and configurations can be removed from the trachea, main, lobar and smaller bronchi. It should be borne in mind that even after successful endoscopic removal foreign body, there is a possibility that in the lumen of the respiratory tract there is still a small fragment of it or a second, previously unnoticed foreign body. This determines the feasibility of continuing to monitor such patients. They are prescribed a course of inhalations, anti-inflammatory treatment, and after 5-7 days they perform control fibrobronchoscopy. Only after that, with full confidence in the absence of a foreign body, the treatment can be considered completed.
Long-term results of treatment of patients with foreign bodies in the respiratory tract largely depend on the timeliness of their removal, the period of development of the disease. As a rule, they are favorable. Postoperative mortality does not exceed 0.5-0.7%, and complete recovery is more than 86%.
Thus, the problem of foreign bodies in the respiratory tract seems to be extremely relevant, because. occurs at any age, requires an urgent, and sometimes emergency assessment of the situation, examination and making the right decision.

Literature
1. Akhmatnurova N.V. Unusual foreign bodies of large sizes in the lower respiratory tract and soft tissues of the neck. Bulletin of Otorhinolaryngology. 2009. No. 2. S. 60-61.
2. Children's otorhinolaryngology: A guide for doctors / ed. M.R. Bogomilsky, V.R. Chistyakova. In 2 vols. T. 1. M.: Medicine, 2005. 660 p.
3. Lepnev P.G. Clinic of foreign bodies of the larynx, trachea and bronchi. L.: Medgiz, 1956. S. 210.
4. Lvova E.A. Features of the clinic, diagnosis and treatment of children with foreign bodies of the respiratory tract: Ph.D. dis. … cand. honey. Sciences. M., 1997. 24 p.
5. Mustafaev D.M., Ashurov Z.M., Akhmedov I.N. Large foreign body of the respiratory tract in an adult. Bulletin of Otorhinolaryngology. 2007. No. 3. S. 66-67.
6. Mustafaev D.M., Zenger V.G., Isaev V.M. and other Unusual foreign body of the respiratory tract in a child // Russian otorhinolaryngology. 2008. No. 2 (33). pp. 117-120.
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The pharynx, esophagus and respiratory tract often get food fish and meat bones during meals, as well as pins, buttons, small nails and other objects that are taken into the mouth during work. This can cause pain, difficulty breathing, coughing, and even suffocation.

Attempts to cause the passage of a foreign body through the esophagus into the stomach by eating crusts of bread, porridge, potatoes in most cases do not give success, so in any case it is necessary to contact a medical institution.

In those cases when, during mechanical ventilation, when trying to inflate the lungs under positive pressure, an obstacle is encountered, despite the fact that the patient's head is thrown back, the lower jaw is pushed forward, and the mouth is open, a foreign body in the upper respiratory tract can be suspected. If there is no effect, the victim is laid on the table, the head is sharply bent back and the larynx area is examined through the open mouth (Fig. 2.5).

Fig.2.5. Foreign bodies of the respiratory tract:

When a foreign body is detected, it is captured with tweezers, fingers and removed. The victim should be taken to a medical facility.

Three tricks are used to quickly open the mouth:

A - reception with the help of crossed fingers with a moderately relaxed lower jaw. Insert your index finger into the corner of the victim's mouth and press it in the direction opposite to the upper teeth. Then against the index finger is placed thumb along the line of the upper teeth and open the mouth;

B - "finger behind the teeth" technique for a fixed jaw. An index finger is inserted between the cheeks and teeth of the victim and the tip is wedged behind the last molar;

B - the technique of "lifting the tongue and jaw" for a sufficiently relaxed lower jaw. The thumb is inserted into the mouth and throat of the patient and at the same time the root of the tongue is lifted with its tip. With other fingers, they grab the lower jaw in the chin area and push it forward.

After successful extraction of a foreign object and in the absence of breathing, it is necessary to continue the ventilation procedure.

At entry of a foreign body into the respiratory tract injured rendering first aid consists in the following: the victim is laid with his stomach and bent knee, his head is lowered down as low as possible and the chest is shaken with hand blows on the back, while squeezing the epigastric region.

If the cough persists, a combination of gravity and patting should be tried. To do this, help the victim bend down so that his head is lower than his lungs, and sharply slam his palm between his shoulder blades. If necessary, you can do this three more times. Look into the mouth and if a foreign body pops up, remove it. If not, try to push it out with air pressure, which is created by sharp thrusts in the stomach. To do this, if the victim is conscious and able to stand, stand behind him and wrap your arms around his waist. Clench one hand into a fist and press it to the stomach with the side where the thumb is. Make sure that the fist is between the navel and the lower edge of the sternum. Place your other hand on your fist and press sharply up and into your abdomen (Figure 2.6).

Do this, if necessary, up to four times. Pause after each press and be prepared to quickly remove anything that might fly out of the windpipe. If the cough does not stop, alternate four slaps on the back and four pressures on the abdomen until the foreign body can be removed. If the cough persists, alternate hand thrusts into the victim's stomach with a slap on the back.

Rice. 2.6. Removal of a foreign body from the respiratory tract

If the victim is unconscious, then in order to press his stomach, turn him over on his back. Get on your knees so that he is between your legs, put your hand between your navel and sternum, and the other hand on the first. Make four clicks as described above. If the interference persists and the patient has stopped breathing, it is necessary to start artificial respiration and heart massage.

With complete closure of the airways, developed asphyxia and the inability to remove a foreign body, the only measure of salvation is an emergency tracheotomy. The victim should be immediately transported to a medical facility.

Most often, foreign bodies of the respiratory tract are observed in children. If the child has inhaled some small object, ask him to cough sharper, harder - sometimes, in this way, it is possible to push the foreign body out of the larynx. Or put the baby upside down on your lap and pat on the back. Try to take a small child firmly by the legs and lower it upside down, also patting on the back (Fig. 2.7).

Fig.2.7. Removal of a foreign body from the respiratory tract of a child

If this does not help, urgent medical care is needed, since a foreign body can also get into the bronchi, which is very dangerous. Special emergency measures are needed to extract it.