1) Foreign body aspiration is common in children under 5 years old and can lodge in the larynx, trachea, or bronchi, most commonly the right main bronchus.
2) Clinical features depend on if the foreign body is acute or chronic, with acute presenting with choking and chronic presenting with coughing or wheezing. Diagnosis involves history, examination, and imaging like CXR.
3) Removal of tracheobronchial foreign bodies is typically done with rigid bronchoscopy under general anesthesia while laryngeal foreign bodies may require procedures like cricothyrotomy or tracheostomy.
This is a presentation I used for my seminar on 'Phonosurgery' on 4th November, 2015. I hope they are useful to you. Constructive as well as Destructive criticism welcomed.
laryngeal paralysis is a specific issue ENT have to deal with.
It is a sign of Disease and not a final diagnosis, should a patient present with the symptoms it is prudent to investigate and find cause of the paralysis
Cisterns of brain and its contents along with its classification and approach...Rajeev Bhandari
This presentation tell us about the basic of cistern , according to its classification both supra tentorial and infratentorial along with ventral and dorsal cistern. basically the cistern contains are well explained on this slide nerve , artery and vein. I hope it will help to rembember well about the contains of cistern and different location of cisterns.
This is a presentation I used for my seminar on 'Phonosurgery' on 4th November, 2015. I hope they are useful to you. Constructive as well as Destructive criticism welcomed.
laryngeal paralysis is a specific issue ENT have to deal with.
It is a sign of Disease and not a final diagnosis, should a patient present with the symptoms it is prudent to investigate and find cause of the paralysis
Cisterns of brain and its contents along with its classification and approach...Rajeev Bhandari
This presentation tell us about the basic of cistern , according to its classification both supra tentorial and infratentorial along with ventral and dorsal cistern. basically the cistern contains are well explained on this slide nerve , artery and vein. I hope it will help to rembember well about the contains of cistern and different location of cisterns.
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: October CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
- Tuberculosis
- Button Battery Ingestion
- Constipation
- Hirschprung's Disease
- Aspiration Pneumonia
- Generalized Lymphatic Anomaly
- Pediatric Acute Respiratory Distress
Foreign bodies in aerodigestive tract are common entity but in nasopharynx it’s very rare to find an impacted foreign body.The anatomical structure of nasopharynx prevents any lodgement of foreign body. It is capacious and having nasopharyngeal sphincter preventing regurgitation of foreign body from oropharynx. Through nasal cavity foreign body cannot travel to nasopharynx as the former is narrower.
Swallowing of any foregion body like coins, pins,seeds,buttton batteries and platic pieces is common in children.In older persons pieces of bone (fish or chicken) or part of loose denture is common. It becomes an emergency situation and needs urgent treatment.In this ppp I have discussed this problem in a brief and clear way
One Lung Ventilation Using Bronchial Blocker Through Endotracheal Tube in a C...Apollo Hospitals
One lung ventilation is being commonly used in children. Lung separation for one-lung ventilation can be accomplished by use of a double-lumen tube, a single-lumen tube (SLT) with intentional endobronchial intubation, a SLT with bronchial blocker or an arterial embolectomy catheter (Fogarty catheter), and a Univent tube. Placement of a bronchial blocker can be accomplished outside or within a SLT blindly and with the help of rigid or fiberoptic bronchoscope (FOB). We describe here successful placement of a bronchial blocker for one-lung ventilation through a SLT.
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery January CasesSean M. Fox
Drs. Potter and Richardson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Dr. Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology Topics including:
• Swallowed Magnets
• Complex Left Lower Lobe Pneumonia
• Empyema
• Right Middle Lobe Pneumonia
• Pulmonary Hemorrhage
• Multifocal Pneumonia + Influenza
• Pectus Excavatum
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: September CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
• Non-accidental Trauma (NAT)
• Hyperinflated Lungs
• Esophageal Foreign Body
• Neonatal Pulmonary Abscess
• Neonatal Pneumatocele
• Tuberculosis
• Interstitial Lung Disease of Prematurity
• Disseminated Neonatal HSV
• Aspirated Foreign Body
USMLE RESP 04 dev of respiratory sys medical anatomy .pdfAHMED ASHOUR
The development of the respiratory system is a complex and highly regulated process that begins early in embryonic life. It's important to note that the development of the respiratory system is closely linked to the development of the cardiovascular system.
Similar to Removal of foreign body from aerodigestive tract (20)
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
1. Removal of Foreign Body from
Aerodigestive Tract
Dr. Basit Ali khan
House officer, ENT dep, HFH.
2. Though medical recorded histories are
not available, FB in ENT are as old as
mankind.
The well known Greek fabulist Aesop
(560 BC) tells the story of a wolf with
an impacted bone which was skillfully
removed by a crane.
3. FACT!
According to the American Academy of Pediatrics (AAP), one child dies
every five days from choking on food, making it the leading cause of
death in children ages 14 and under.
4. Case 1
A 39-year-old male presented to OPD with a 9-year history of intermittent
odynophagia and hoarseness, associated with noisy breathing. He recalled that
his symptoms began in a certain day after work; however, he did not seek
medical attention. He presented in the OPD 9 years later with mild biphasic
stridor and IDL revealed a subglottic proliferative growth.
X-ray neck lateral view revealed a subglottic narrowing at C6-C7 level.
CT neck showed a circumferential wall thickening involving the subglottic
region and adjoining trachea.
5. Case 1
A working diagnosis of subglottic growth/idiopathic subglottic stenosis was
made.
Tracheostomy was done prior to examination under anesthesia. A zero degree
telescopic assessment of the larynx was done and a single tablet foil was noted
at the level of the first and the second tracheal ring surrounded by thick
granulation tissue.
The foil was removed and the adjacent granulation tissue was excised by cold
steel excision. Histopathology of the granulation tissue revealed fibro
collagenous tissue.
Ref: Philip A, Rajan Sundaresan V, George P, et al. A reclusive foreign body in the airway: a case report and a
literature review. Case Rep Otolaryngol. 2013;2013:347325. doi:10.1155/2013/347325
6. Case 2
A 7 years old boy, presented in OPD with recurrent unresolved pneumonia.
Due to the long history of the patient and abnormal X-ray findings (not
shown) CT was requested.
CT revealed a partially calcified mass at the region of right hilum, causing
complete obstruction of bronchus intermedius and subsequent collapse of
right middle and lower lobes
The possibility of tuberculous lymphadenopathy was considered; but all
laboratory investigations for TB were negative.
7. Case 2
Rigid Bronchoscopy revealed a localized, vascular, easily bleeding, non
infiltrating mass lesion occluding the bronchius intermedius. A biopsy was
taken from this mass.
The result of biopsy revealed inflammatory granulation tissue.
This is at that time that the patient’s father revealed a history of aspiration of
a crackable plant seed wherein the boy suffered severe chocking before
aspirating this seed.
Ref: Bahnassy AA, Diab AB. Neglected bronchial foreign body in a child simulating a calcified
mass lesion: challenging computed tomography diagnosis. Int J Health Sci (Qassim).
2007;1(1):107‐109.
9. Foreign body Aspiration
More common in children below 5 years.
A foreign body aspirated into air passage can lodge in the:
larynx,
trachea or
Bronchi ( rt. main bronchus is the commonest)
10. Etiology
1. Children:
• Poor airway reflexes
• Lack of Molar teeth ,poor mastication
• Natural tendency to put objects in mouth.
2. Repeated aspiration may suggest neglect
3. Failure of protective mechanisms during coma, deep sleep or
alcoholic intoxication.
11. Types of foreign Body
Nonirritating type.
• Plastic, glass or metallic foreign bodies
Irritating type.
• Organic FB like Vegetables, peanuts, beans, seeds, etc.
• Congestion and oedema of the tracheobronchial mucosa—
“vegetal bronchitis.”
• They also swell up with time causing airway obstruction and
later suppuration in the lung.
12. Clinical features
Initial Period of choking, gagging and wheezing.
Symptomless interval:
Varies with the nature and size of the FB.
Later symptoms due to airway obstruction
15. Diagnosis/ clinical assessment
1. History
• Circumstances of ingestion,
• The related symptoms,
• The size, shape and nature of the FB must be investigated.
2. Examination
• Look for the signs of FB aspiration.
• Examination of chest esp. auscultation.
16. Investigations
X-ray Neck and Chest
PA and Lateral Views
Inspiratory and expiratory films
To investigate the indirect signs of a radiolucent object: during inspiration a reduced air
entry in the affected lung with deviation of the mediastinum towards the ipsilateral side. In
the expiratory phase, the air emission from the obstructed lung is reduced, giving rise to
obstructive emphysema (so-called “air trapping”) in this case the mediastinum is shifted
towards the contralateral side
22. Management
Cricothyrotomy or emergency tracheostomy
Once acute respiratory emergency is over, foreign body can be
removed by D/L or by laryngofissure, if impacted
23. Management
Tracheal and bronchial foreign bodies
Can be removed by bronchoscopy with full preparation and under
general anaesthesia.
Emergency removal of these foreign bodies is not indicated unless
there is airway obstruction or they are of organic nature.
A failure to perform bronchoscopy may be much more disastrous
than the risk involved in bronchoscopy (Jackson’s dictum)
24.
25. Management
Methods to remove tracheobronchial foreign body:
1. Conventional rigid bronchoscopy.
2. Rigid bronchoscopy with telescopic aid.
3. Bronchoscopy with C-arm fluoroscopy.
4. Use of Dormia basket or Fogarty’s balloon for rounded objects.
5. Tracheostomy first and then bronchoscopy through the tracheostome. (large
FB in sub glottis)
6. Thoracotomy and bronchotomy for peripheral foreign bodies.
7. Flexible fibreoptic bronchoscopy in selected adult patients.
27. Foreign Body ingestion
Etiology
1. Age.
Children are most often affected.
2. Loss of protective mechanism.
Loss of consciousness, epileptic seizures, deep sleep or alcoholic intoxication are other
factors.
3. Carelessness.
• Poorly prepared food, improper mastication, hasty eating and drinking.
33. Site of Lodgement
Once object passes the oesophagus it is likely to pass per rectum but
sometimes it gets obstructed at pylorus, duodenum, terminal ileum,
ileocaecal junction, caecum, sigmoid colon or even at the rectum.
38. Management
1. Observation
Usually for 24 hours
Immediate presentation
Blunt foreign body below the cricopharynx
Pt. is Stable
Spontaneous passage of foreign body into the stomach is expected
If it doesn’t pass into stomach, endoscopy is done
C/I: Disc Battery Ingestion: emergency removal
41. Management
3. Cervical oesophagotomy.
Impacted foreign bodies above thoracic inlet
4. Transthoracic oesophagotomy.
For impacted foreign bodies of thoracic oesophagus, chest is opened at the
appropriate level.
42. FB that has reached the stomach
It may pass through rest of gastrointestinal tract without difficulty
Stool should be examined daily.
Patient should take a normal diet.
43. FB that has reached the stomach
Operative interference is required when:
a) Patient complains of pain and tenderness in abdomen.
b) Foreign body is not showing any progress on periodic X-rays.
c) Objects are sharp and likely to penetrate or get obstructed, e.g. nails, pins,
needles, sharp bones.
d) Foreign body is 5 cm or longer (e.g. hair pin) in a child of 2 years; it is
unlikely to pass through turns of duodenum. A disc battery larger than 1.5
cm in a child of 6 years and remaining in stomach for 48 h.
e) There is pyloric stenosis.
44. Complications of FB inhalation
1. Respiratory obstruction.
2. Perioesophageal cellulitis and abscess.
3. Perforation..
4. Tracheo-oesophageal fistula.
5. Ulceration and stricture.
45. Don’ts of esophageal FB
It is not recommended to remove oesophageal foreign bodies by Foley’s or
balloon catheter, as they can be aspirated when pulled up into the pharynx.
Do not try to push foreign bodies down into the stomach .
Use of papain, a meat tenderizer, is not recommended if a bolus of meat is
stuck up. It can digest the oesophageal wall.
Do not use glucagon to relax lower oesophageal sphincter for foreign body to
pass. It does not relax a stricture or oesophageal ring if foreign body is held
due to that.