Tracheobronchial foreign body

　　How are tracheobronchial foreign bodies caused? Briefly described as follows:

　　First, the cause of the disease

　　The cause of the disease is the accidental entry of foreign bodies into the airway. According to the source of the foreign body, there are two types: endogenous and exogenous. The former is obstruction by pseudomembrane, dry crust, caseous necrosis, and other substances in the respiratory tract, while the tracheobronchial foreign bodies referred to commonly are all exogenous, which are all items accidentally inhaled through the mouth. The entry of foreign bodies into the trachea and bronchi is related to the following situations.

　　1. Young children like to grab and eat food and may inhale it into the trachea when crying or laughing.

　　2. Children have incomplete tooth development and poor masticatory function, unable to chew hard food. In addition, the protective function of the laryngeal defense reflex is poor, and the protective mechanism is not sound.

　　3. When laughing or working, if food or items are in the mouth, they may be inhaled into the trachea unintentionally or while laughing.

　　5. In patients under general anesthesia or coma, when intubation is performed, it is also possible to dislodge loose teeth or dentures without realizing it; in addition, if vomiting is not cleared in a timely manner, it can be inhaled into the trachea.

　　4. During upper respiratory surgery, if the instrument is unstable or the tissue to be resected suddenly falls into the airway.

　　6. Patients with mental illness or those attempting suicide.

　　Disease Mechanism

　　Pathological changes caused by foreign bodies entering the trachea and bronchi are related to the nature of the foreign body, the duration of its stay, and its shape. Generally speaking, plant foreign bodies such as peanuts, due to the presence of free fatty acids, are highly irritating to the mucosa. Inflammation of the bronchial mucosa can occur within 2 to 3 days after entering the trachea, manifested as mucosal congestion, edema, increased secretions, and partial obstruction. With the increase in secretions, coupled with the swelling of the foreign body after absorbing water, complete obstruction may occur, with secretions gradually becoming purulent. In some cases, granulation tissue can be seen around the foreign body, surrounding it. Sharp foreign bodies entering the trachea can sometimes cause mucosal damage, resulting in local mucosal bleeding and subsequent congestion and swelling. Metallic foreign bodies and animal and chemical products are not very irritating to the mucosa, and inflammation occurs less frequently. However, if the foreign body stays for a long time, inflammation of the trachea and bronchi may occur, followed by pneumonia, lung abscess, empyema, and other conditions.

　　What diseases can tracheobronchial foreign bodies cause? Briefly described as follows:

　　1, Lung infection

　　It can manifest as pneumonia, lung abscess, and empyema, etc. There may be fever, cough, expectoration of purulent sputum, difficulty in breathing, chest pain, hemoptysis, and weight loss. The duration of the complication period can last for several years or even decades, and the duration depends on the size of the foreign body, whether it is irritant, and the physical condition and age of the patient.

　　2, Respiratory obstruction

　　Mild cases may have difficulty in breathing and cyanosis, and severe cases may have atelectasis or emphysema, or even asphyxiation.

　　3, Heart failure

　　Long-term difficulty in breathing, the patient may suffer from heart failure due to respiratory difficulty and hypoxia. Mild cases may have bronchitis and pneumonia, and severe cases may have lung abscess and empyema and other clinical manifestations.

　　What are the symptoms of tracheobronchial foreign bodies? Briefly described as follows:

　　1, Clinical staging

　　(1) Inhalation period: When a foreign object enters the trachea, it must cause severe choking, and some may also have transient shortness of breath and blue complexion. If the foreign object is stuck in the glottis, it can cause hoarseness and difficulty in breathing, and severe cases can cause asphyxiation. If the foreign object enters the trachea or bronchi, in addition to slight coughing, there may be no other symptoms.

　　(2) Quiet period: After the foreign body enters the trachea and bronchi, it remains at a certain location, the irritability decreases, and at this time, the patient may have slight cough without other symptoms, which is often overlooked. The duration of this period is not fixed. If the foreign body blocks the trachea and causes inflammation, this period will end quickly and enter the third period.

　　(3) Inflammatory period: Local irritation and secondary inflammation caused by the foreign body can worsen the obstruction of the trachea and bronchi, leading to symptoms such as cough, atelectasis, and emphysema. The patient may experience an increase in body temperature during this period.

　　(4) Complication period: With the development of inflammation, pneumonia, lung abscess, or empyema may occur, and the patient may have high fever, cough, purulent sputum, chest pain, hemoptysis, and difficulty breathing. The duration and severity of this period can vary due to the size, nature, physical condition of the patient, and treatment conditions.

　　2, Clinical manifestations: The symptoms can be different depending on the location of the foreign body.

　　(1) Laryngeal foreign body: When a foreign object enters the larynx, it causes reflex laryngeal spasm, leading to inspiratory respiratory difficulty and severe irritating cough. If the foreign object remains at the entrance of the larynx, there may be dysphagia or difficulty in swallowing; if the foreign object is located at the glottis slit, larger ones can cause asphyxiation, and smaller ones can cause coughing, hoarseness, difficulty in breathing, and laryngeal rales; if the foreign object is a small membrane-like sheet attached below the glottis, there may only be hoarseness without other symptoms. Sharp foreign objects that pierce the larynx can cause coughing up blood and subcutaneous emphysema.

　　(2) Tracheal foreign body: When a foreign object enters the airway, it immediately causes severe choking, red face and ears, and symptoms such as shortness of breath and difficulty breathing. As the foreign object adheres to the tracheal wall, the symptoms may temporarily subside; if the foreign object is light and smooth, and moves up and down between the glottis and bronchi with the respiratory airflow, it can cause irritating cough and a sound of striking; tracheal foreign bodies can be heard with wheezing sounds, and the respiratory sounds in both lungs are similar. If the foreign object is large and blocks the trachea, it can cause asphyxiation, which is a high-risk situation, and the foreign object may ascend to the glottis at any time, causing difficulty in breathing or asphyxiation.

　　3. The early symptoms of bronchial foreign bodies are similar to those of tracheal foreign bodies, with milder coughing symptoms. Plant foreign bodies often have more pronounced bronchial inflammation, that is, coughing, sputum, and the degree of respiratory distress is related to the location and degree of obstruction of the foreign body. When the large bronchus is completely blocked, the breath sound on the affected side disappears; when it is not completely blocked, the breath sound may decrease.

　　How to prevent tracheobronchial foreign bodies? Briefly described as follows:

　　1. Firstly, children should be educated not to develop the habit of keeping things in their mouths. When a child has food in their mouth, do not provoke them to cry, laugh, talk, or be startled. Be patient and persuade them to spit out, do not scold or beat them, as this may cause food to be inhaled into the trachea. If the child is crying and no longer wants to eat, do not force them to eat, as this may easily lead to foreign bodies entering the respiratory tract. Place small items that children can easily inhale out of their reach, and toys should be placed in safe places.

　　2. When a child vomits, the child's head should be turned to one side to make it easier to vomit and prevent aspiration into the trachea.

　　3. If there is a foreign body in the throat, it is absolutely forbidden to use a finger to dig it out, nor should large pieces of food be swallowed to push the foreign body down. Efforts should be made to induce vomiting.

　　4. Children under 3 years of age should eat less dried fruits and legumes, and parents and caregivers should pay attention to this in their daily care, not to give children seeds, peanuts, and other foods.

　　5. When feeding infants with a bottle, pay attention to not making the rubber nipple hole too large to prevent the baby from drinking milk too quickly or too strongly; do not overfeed or feed too much milk; do not let the baby cry too much before feeding; do not suck on a nipple with a hole; make sure the milk in the bottle fills the nipple while feeding. These measures can prevent the baby from inhaling too much air into the stomach, causing vomiting. In addition, do not move the baby too early after feeding, it is best to hold the baby upright and gently tap the back to make the baby burp a few times before placing the baby back in bed, which can prevent the baby from vomiting easily. For children who are prone to vomiting, it is best to raise the head of the bed slightly after feeding, sleep on the side, to prevent aspiration or respiratory distress during vomiting.

　　What examinations should be done for tracheobronchial foreign bodies? Briefly described as follows:

　　1. X-ray examination:Non-radio-opaque foreign bodies can be immediately visible. Radio-opaque foreign bodies can be diagnosed based on clinical manifestations, such as unexplained atelectasis, emphysema, bronchopneumonia, and mediastinal shift. Chest X-ray has its advantages over chest radiography, allowing for dynamic observation of mediastinal changes. In the case of foreign bodies in the trachea or main bronchus, the mediastinum can be seen to widen during inspiration. In the case of a foreign body in one bronchus, the mediastinum can be seen to move with respiration. Chest front and lateral tomography can sometimes detect smaller foreign bodies, and CT or ultrasound can be performed if necessary to assist in diagnosis.

　　2. Bronchoscopy:If the time of foreign body retention is long and it is difficult to make a clear diagnosis, it is necessary to discuss with a pulmonologist and perform bronchoscopy for an accurate diagnosis.

　　The following is a brief description of the dietary principles for tracheobronchial foreign body patients:

　　1. Eat light and nutritious food, pay attention to dietary balance.

　　2. Avoid spicy and刺激性 food.

　　3. Avoid laughing and talking during meals.

　　Tracheobronchial foreign bodies should be diagnosed and removed as soon as possible to maintain respiratory tract patency and prevent heart failure due to respiratory distress and hypoxia.

　　1. Foreign Body Removal

　　(1) Tracheal foreign bodies: can be grasped with the 'wait for the fox to come to the trap' method under the direct laryngoscope or anesthetic laryngoscope, and if the grasping fails, the foreign body can be removed under the bronchoscope.

　　(2) Bronchial foreign bodies: introduce the bronchoscope into the bronchus using the direct method or indirect method, grasp it with forceps, and then remove it. The direct method is suitable for adults, and the indirect method is suitable for children.

　　① Direct method: enter the mirror from the middle of the mouth, use the uvula and epiglottis as landmarks, pick up the epiglottis, and expose the glottis. Turn the distal edge of the mirror to the left, and only the left vocal cord can be seen inside the mirror. Enter the glottis, return the mirror to its original position, and then check the subglottis, trachea, carina, and left and right main bronchi in turn. This method is suitable for those who are more skilled in operation.

　　② Indirect method: namely, first pick up the epiglottis with a direct laryngoscope, expose the glottis, and then insert the bronchoscope into the trachea through the direct laryngoscope, and then remove the direct laryngoscope, so that the bronchoscope can continue to descend and check. Currently, the method of removing foreign bodies with a rigid bronchoscope is still the most commonly used method.

　　(3) For small foreign bodies that are difficult to see under the rigid bronchoscope, fiber bronchoscope forceps can be used. However, there are also limitations in use:

　　① Not suitable for children, as the airway of children is relatively narrow, and the fiber bronchoscope is a solid non-aerated structure, using this method affects the patency of children's respiratory tract;

　　② The fiber bronchoscope forceps are small and delicate, and it is difficult to grasp larger foreign bodies. Therefore, for foreign bodies that are not guaranteed to be successfully removed, it is necessary to first perform tracheal intubation to prevent vocal cord injury (needles, nails), or for the foreign body to slip or become stuck below the glottis.

　　2. Treatment of Complications

　　(1) In cases of heart failure caused by foreign bodies, strong heart drugs should be used appropriately, and the foreign body should be removed in time under electrocardiographic monitoring.

　　(2) In cases of severe pneumothorax or mediastinal emphysema, timely drainage should be performed.

　　(3) For secondary infections of the respiratory tract, sufficient and effective antibiotics should be used.