Choking

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Choking or airway obstruction is an emergency and this situation can develop anywhere. This presentation can help everybody to deal this kind of emergency

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Choking

  1. 1. CHOKING
  2. 2. CHOKINGRESPIRATORY OBSTRUCTION BY Col Anwar ul Haq Classified ENT Specialist
  3. 3. SITES OF OBSTRUCTIONNOSE NASOPHARYNX OROPHARYNX LARYNX TRACHEA
  4. 4. OBSTRUCTION-NOSE• NOSE – BYPASSED NOSE NASOPHARYNX• BREATHE – ORAL CAVITY
  5. 5. CHOKING• UNCONSCIOUS – JAW FALLS BACK – AIRWAY OBSTRUCTION OBS. AIRWAY• JAW THURST – AIRWAY IS MAINTAINED OPEN AIRWAY
  6. 6. CHOKING• TRAUMA – MECHANICAL • MANDIBLE • TONGUE • NECK – – penetrating – strangulation – CHEMICAL – THERMAL – RADIOTHERAPY• FOREIGN BODIES• INFECTIONS
  7. 7. TRAUMA• MECHANICAL – MANDIBLE – TONGUE – NECK – • PENETRATING • STRANGULATION
  8. 8. TRAUMA• MECHANICAL – MANDIBLE – TONGUE – NECK – • PENETRATING • STRANGULATION
  9. 9. TRAUMA• MECHANICAL – MANDIBLE – TONGUE – NECK – • PENETRATING • STRANGULATION
  10. 10. TRAUMA• MECHANICAL – MANDIBLE – TONGUE – NECK – • PENETRATING • STRANGULATION
  11. 11. TRAUMA ORAL CAVITY & TONGUE• BLOOD • CONSCIOUS – SIT UP• SECRETIONS – LEAN FORWARD• TONGUE - FALL BACK – SPIT • UNCONSCIOUS / CHILD – LATERAL – MOUTH • LOWER – SUCTION CLEARANCE • CRICOTHYROIDOTOMY • TRACHEOSTOMY
  12. 12. TRAUMA NECK• LARYNX & TRACHEA HYOID – FRACTURES – HAEMATOMA THYROID – BLOOD – SECRETIONS CRICOID
  13. 13. TRAUMA NECK• SUCTION CLEARANCE• ENDOTRACHEAL TUBE• CRICOTHYROIDOTOMY• TRACHEOSTOMY
  14. 14. CRICOTHYROIDOTOMY MAKING A HOLE IN CRICOTHYROID MEMBRANE
  15. 15. CRICOTHYROIDOTOMY
  16. 16. TRAUMA• CHEMICAL • DELAYED• THERMAL • OBSERVATION• RADIOTHERAPY • OXYGEN • ET INTUBATION
  17. 17. TRAUMA• CHEMICAL • DELAYED• THERMAL • OBSERVATION• RADIOTHERAPY • OXYGEN • ET INTUBATION • TRACHEOSTOMY
  18. 18. TRACHEOSTOMY
  19. 19. TRACHEOSTOMY CREASE INCISION
  20. 20. STRAP MUSCLESDISSECTED THYROID ISTHMUS RETRACTED
  21. 21. TRACHEAL FENESTRATION
  22. 22. CUFFED UNCUFFEDDOUBLE LUMEN METALLIC
  23. 23. AIR
  24. 24. FOREIGN BODIES• CHILDREN• AGE < 5 YRS (84%)• M:F :: 2:1• NATURE - VEGETABLE (55 – 95%) - NUTS - METAL (5 – 15%) - PLASTIC (5 – 15%)
  25. 25. SITE OF OBSTRUCTION• NOSE – BYPASSED• BREATHE – ORAL CAVITY• NEONATES – OBLIGATORY NASAL BREATHERS
  26. 26. 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
  27. 27. RIGHT MAINBRONCHU S WIDE STRAIGHT
  28. 28. SITE OF OBSTRUCTION (LARYNX & TRACHEA)COMPLETE OBSTRUCTION – FATAL OUTCOME – IF DISLODGEMENT FAILS
  29. 29. SITE OF OBSTRUCTION (LARYNX & TRACHEA)COMPLETE OBSTRUCTION – FATAL OUTCOME – IF DISLODGEMENT FAILS• INCOMPLETE OBST. – HOARSENESS – APHONIA – COUGH – DYSPNOEA
  30. 30. FART WHISTLE MUSICAL CHILD
  31. 31. 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
  32. 32. CHOKING WITNESSED COMPLETE OBSTRUCTION• HEIMLICH’S MANOEUVRE• BACK BLOW• CHEST THRUST• ABDOMINAL THRUST• AIM – USE THE AIR IN LUNGS – TOOL TO DISLODGE THE F.B.
  33. 33. HEIMLICH’S MANOEUVRE USE THE AIR IN LUNGS TOOL TO DISLODGE THE F.B.
  34. 34. USE THE AIR IN LUNGSTOOL TO DISLODGE THE F.B.
  35. 35. CHOKING WITNESSED COMPLETE OBSTRUCTION• HEIMLICH’S MANOEUVRE• BACK BLOW• CHEST THRUST• ABDOMINAL THRUST
  36. 36. CHOKING WITNESSED COMPLETE OBSTRUCTION CHEST THRUST BELOW CHEST THORACIC SPINE• HEIMLICH’S MANOEUVRE• BACK BLOW• CHEST THRUST• ABDOMINAL THRUST
  37. 37. CHOKING WITNESSED COMPLETE OBSTRUCTION• HEIMLICH’S MANOEUVRE• BACK BLOW• CHEST THRUST• ABDOMINAL THRUST ABDOMINAL THRUST ABDOMEN LUMBER SPINE
  38. 38. CHILDREN - CHOKING WITNESSED COMPLETE OBSTRUCTION• IF ALL FAIL – BACK BLOW – CHEST THRUST – ABDOMINAL THRUST• AIRWAY NOT ESTB. – CRICOTHYROIDOTOMY – TRACHEOSTOMY
  39. 39. CHILDREN - CHOKING WITNESSED COMPLETE OBSTRUCTION• IF ALL FAIL – BACK BLOW – CHEST THRUST – ABDOMINAL THRUST• AIRWAY NOT ESTB. – CRICOTHYROIDOTOMY – TRACHEOSTOMY• AIRWAY ESTB.(HOSPITAL) – LARYNGOSCOPY – TRACHEOSCOPY – BRONCHOSCOPY
  40. 40. CHILDREN - CHOKING UNWITNESSED COMPLETE OBSTRUCTION DEATH
  41. 41. CHILDREN - CHOKING WITNESSED ADULTS - HISTORY POSITIVE (INCOMPLETE OBSTRUCTION)• DO NOT ATTEMPT – REMOVE – PROBE – MANOEUVRE• OXYGEN• REMOVAL – LARYNGOSCOPE – TRACHEOSCOPE – BRONCHOSCOPE
  42. 42. FB IN ADULTS• HISTORY POSITIVE – NO SYMPTOMS AND SIGNS • INVESTIGATE • TREAT• NO HISTORY – SYMPTOMS AND SIGNS • INVESTIGATE • TREAT
  43. 43. INFECTIONS• LUDWIG’S ANGINA• AC. EPIGLOTTITIS• LARYNGOTRACHEOBRONCHITIS
  44. 44. LUDWIG’S ANGINA• SWELLING OF THE FLOOR OF MOUTH• TONGUE.... SUP AND POSTERIORLY• SITS - LEANING FORWARD• TRACHEOSTOMY.....
  45. 45. AC EPIGLOTTITIS• SWELLING OF THE EPIGLOTTIS• POSITION - LEANING FORWARD• THUMB SIGN• EXAM IN OT• ET TUBE...• TRACHEOSTOMY
  46. 46. LARYNGOTRACHEOBRONCHITIS• INFLAMATION OF AIRWAY• GRADUAL ONSET• STEEPLE SIGN• O2 INHALATION ....
  47. 47. LARYNGOTRACHEOBRONCHITIS• INFLAMATION OF AIRWAY• GRADUAL ONSET• STEEPLE SIGN• O2 INHALATION ....• ET TUBE
  48. 48. CONCLUSION• C -CIRCULATION
  49. 49. CONCLUSION• A - AIRWAY• B -BREATHING• C -CIRCULATION
  50. 50. CONCLUSION• A - AIRWAY• B - BREATHING• C - CIRCULATION• ABC IS TRUE SEQUENCE OF – BASIC – LIFE – SUPPORT
  51. 51. THANK YOU
  52. 52. CHOKING
  53. 53. SITUATION-1 MOTHER• ONE MONTH OLD BABY• SUDDENLY FOUND APOENIC• MOTHER CAME OUT OF WASHROOM
  54. 54. SITUATION-2PATIENT+ATTENDANT+DOCTOR IN MRC• FOUR SOLDIERS PLAYING LUDDO – CMH UNIT LINES• ONE KEEPING GOAT IN MOUTH• SUDDENLY STARTED DYSPNOEA• BECAME RESTLESS• NOISY BREATHING

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