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

1. CHOKING

3. CHOKING
RESPIRATORY OBSTRUCTION
BY
Col Anwar ul Haq
Classified ENT Specialist

5. SITES OF OBSTRUCTION
NOSE
NASOPHARYNX
OROPHARYNX
LARYNX
TRACHEA

6. OBSTRUCTION-NOSE
• NOSE
– BYPASSED NOSE
NASOPHARYNX
• BREATHE
– ORAL CAVITY

7. CHOKING
• UNCONSCIOUS
– JAW FALLS BACK
– AIRWAY OBSTRUCTION
OBS. AIRWAY
• JAW THURST
– AIRWAY IS MAINTAINED
OPEN AIRWAY

8. CHOKING
• TRAUMA
– MECHANICAL
• MANDIBLE
• TONGUE
• NECK –
– penetrating
– strangulation
– CHEMICAL
– THERMAL
– RADIOTHERAPY
• FOREIGN BODIES
• INFECTIONS

9. TRAUMA
• MECHANICAL
– MANDIBLE
– TONGUE
– NECK –
• PENETRATING
• STRANGULATION

10. TRAUMA
• MECHANICAL
– MANDIBLE
– TONGUE
– NECK –
• PENETRATING
• STRANGULATION

11. TRAUMA
• MECHANICAL
– MANDIBLE
– TONGUE
– NECK –
• PENETRATING
• STRANGULATION

12. TRAUMA
• MECHANICAL
– MANDIBLE
– TONGUE
– NECK –
• PENETRATING
• STRANGULATION

13. TRAUMA
ORAL CAVITY & TONGUE
• BLOOD • CONSCIOUS
– SIT UP
• SECRETIONS
– LEAN FORWARD
• TONGUE - FALL BACK
– SPIT
• UNCONSCIOUS / CHILD
– LATERAL
– MOUTH
• LOWER
– SUCTION CLEARANCE
• CRICOTHYROIDOTOMY
• TRACHEOSTOMY

14. TRAUMA NECK
• LARYNX &
TRACHEA HYOID
– FRACTURES
– HAEMATOMA THYROID
– BLOOD
– SECRETIONS CRICOID

15. TRAUMA NECK
• SUCTION CLEARANCE
• ENDOTRACHEAL TUBE
• CRICOTHYROIDOTOMY
• TRACHEOSTOMY

16. CRICOTHYROIDOTOMY
MAKING A HOLE IN CRICOTHYROID MEMBRANE

20. CRICOTHYROIDOTOMY

21. TRAUMA
• CHEMICAL • DELAYED
• THERMAL • OBSERVATION
• RADIOTHERAPY
• OXYGEN
• ET INTUBATION

22. TRAUMA
• CHEMICAL • DELAYED
• THERMAL • OBSERVATION
• RADIOTHERAPY
• OXYGEN
• ET INTUBATION
• TRACHEOSTOMY

23. TRACHEOSTOMY

24. TRACHEOSTOMY
CREASE INCISION

25. STRAP MUSCLES
DISSECTED THYROID
ISTHMUS
RETRACTED

26. TRACHEAL FENESTRATION

27. CUFFED
UNCUFFED
DOUBLE LUMEN METALLIC

29. AIR

30. FOREIGN BODIES
• CHILDREN
• AGE < 5 YRS (84%)
• M:F :: 2:1
• NATURE - VEGETABLE (55 – 95%) -
NUTS
- METAL (5 – 15%)
- PLASTIC (5 – 15%)

31. SITE OF OBSTRUCTION
• NOSE
– BYPASSED
• BREATHE
– ORAL CAVITY
• NEONATES
– OBLIGATORY
NASAL
BREATHERS

32. 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

33. RIGHT
MAIN
BRONCHU
S
WIDE
STRAIGHT

34. SITE OF OBSTRUCTION
(LARYNX & TRACHEA)
COMPLETE OBSTRUCTION
– FATAL OUTCOME
– IF DISLODGEMENT FAILS

35. SITE OF OBSTRUCTION
(LARYNX & TRACHEA)
COMPLETE OBSTRUCTION
– FATAL OUTCOME
– IF DISLODGEMENT FAILS
• INCOMPLETE OBST.
– HOARSENESS
– APHONIA
– COUGH
– DYSPNOEA

36. FART WHISTLE
MUSICAL CHILD

37. 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

38. 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.

39. HEIMLICH’S MANOEUVRE
USE THE AIR IN LUNGS
TOOL TO DISLODGE THE F.B.

40. USE THE AIR IN LUNGS
TOOL TO DISLODGE THE F.B.

41. CHOKING WITNESSED
COMPLETE OBSTRUCTION
• HEIMLICH’S
MANOEUVRE
• BACK BLOW
• CHEST THRUST
• ABDOMINAL THRUST

42. CHOKING WITNESSED
COMPLETE OBSTRUCTION
CHEST THRUST
BELOW CHEST
THORACIC SPINE
• HEIMLICH’S
MANOEUVRE
• BACK BLOW
• CHEST THRUST
• ABDOMINAL THRUST

43. CHOKING WITNESSED
COMPLETE OBSTRUCTION
• HEIMLICH’S
MANOEUVRE
• BACK BLOW
• CHEST THRUST
• ABDOMINAL THRUST
ABDOMINAL THRUST
ABDOMEN
LUMBER SPINE

46. CHILDREN - CHOKING WITNESSED
COMPLETE OBSTRUCTION
• IF ALL FAIL
– BACK BLOW
– CHEST THRUST
– ABDOMINAL THRUST
• AIRWAY NOT ESTB.
– CRICOTHYROIDOTOMY
– TRACHEOSTOMY

47. 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

48. CHILDREN - CHOKING UNWITNESSED
COMPLETE OBSTRUCTION
DEATH

49. CHILDREN - CHOKING WITNESSED
ADULTS - HISTORY POSITIVE
(INCOMPLETE OBSTRUCTION)
• DO NOT ATTEMPT
– REMOVE
– PROBE
– MANOEUVRE
• OXYGEN
• REMOVAL
– LARYNGOSCOPE
– TRACHEOSCOPE
– BRONCHOSCOPE

52. FB IN ADULTS
• HISTORY POSITIVE
– NO SYMPTOMS AND SIGNS
• INVESTIGATE
• TREAT
• NO HISTORY
– SYMPTOMS AND SIGNS
• INVESTIGATE
• TREAT

53. INFECTIONS
• LUDWIG’S ANGINA
• AC. EPIGLOTTITIS
• LARYNGOTRACHEOBRONCHITIS

54. LUDWIG’S ANGINA
• SWELLING OF THE FLOOR OF MOUTH
• TONGUE.... SUP AND POSTERIORLY
• SITS - LEANING FORWARD
• TRACHEOSTOMY.....

55. AC EPIGLOTTITIS
• SWELLING OF THE EPIGLOTTIS
• POSITION - LEANING FORWARD
• THUMB SIGN
• EXAM IN OT
• ET TUBE...
• TRACHEOSTOMY

56. LARYNGOTRACHEOBRONCHITIS
• INFLAMATION OF AIRWAY
• GRADUAL ONSET
• STEEPLE SIGN
• O2 INHALATION ....

57. LARYNGOTRACHEOBRONCHITIS
• INFLAMATION OF AIRWAY
• GRADUAL ONSET
• STEEPLE SIGN
• O2 INHALATION ....
• ET TUBE

58. CONCLUSION
• C -CIRCULATION

59. CONCLUSION
• A - AIRWAY
• B -BREATHING
• C -CIRCULATION

60. CONCLUSION
• A - AIRWAY
• B - BREATHING
• C - CIRCULATION
• ABC IS TRUE SEQUENCE OF
– BASIC
– LIFE
– SUPPORT

61. THANK YOU

62. CHOKING

63. SITUATION-1
MOTHER
• ONE MONTH OLD BABY
• SUDDENLY FOUND APOENIC
• MOTHER CAME OUT OF WASHROOM

64. SITUATION-2
PATIENT+ATTENDANT+DOCTOR IN MRC
• FOUR SOLDIERS PLAYING LUDDO
– CMH UNIT LINES
• ONE KEEPING GOAT IN MOUTH
• SUDDENLY STARTED DYSPNOEA
• BECAME RESTLESS
• NOISY BREATHING