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Slide 2 DISTRESS.. RESPIRATORY CAUSES CONGENITAL CONGENITAL Slide 3 Slide 4 USUAL VICTIMS: USUAL VICTIMS: CHILDREN 12-48 MONTHS OF AGE. CHILDREN 12-48 MONTHS OF AGE. REASONS: REASONS: TENDENCY TO PUT THINGS INTO MOUTH. POOR CHEWING ABILITY BECAUSE OF LACK OF POSTERIOR DENTITION. TENDENCY TO HAVE FREQUENT VIGOROUS UN INHIBITED INSPIRATION WHEN STARTLED,LAUGHING & COUGHING. USUAL VICTIMS: USUAL VICTIMS: CHILDREN 12-48 MONTHS OF AGE. CHILDREN 12-48 MONTHS OF AGE. REASONS: REASONS: TENDENCY TO PUT THINGS INTO MOUTH. POOR CHEWING ABILITY BECAUSE OF LACK OF POSTERIOR DENTITION. TENDENCY TO HAVE FREQUENT VIGOROUS UN INHIBITED INSPIRATION WHEN STARTLED,LAUGHING & COUGHING. Slide 5 Slide 6 EXTRINSIC INTRINSIC TYPES OF FOREIGN BODIES IN TRACHEO BRONCHIAL TREE TRACHEO BRONCHIAL TREE. METALLIC NON METALLIC VEGETABLE NON NONVEGETABLE THICK SPUTUM Slide 7 Slide 8 CHOKING DYSPNEADYSPNEA COUGHING CYANOSIS LATER STRIDORSTRIDORSTRIDORSTRIDOR Slide 9 LARYNGEAL PROTECTION OF AIRWAY LARYNGEAL INLET CLOSURE APPROXIMATION OF VENTRICULAR FOLDS APPROXMATION OF VOCAL FOLDS CESSATIONOFRESPIRATION COUGH REFLEX Slide 10 F.B. CAUSING OBSTRUCTION AT LAYNGEAL LEVEL Slide 11 LARYNXLARYNX LARGE F.B. AIRWAY OCCLUSION SUDDEN DEATH SMALL SMALL F.B. F.B. PARTIAL PARTIAL AIRWAY AIRWAYOBSTRUCTION COUGH COUGH PAIN PAIN DYSPNEA DYSPNEA IN IN CHIILDREN CHIILDREN BACK TAP WITH BACK TAP WITH HEAD DOWN. HEAD DOWN. HEIMLISCH MANOEUVRE MANOEUVRE IN ADULTS IN ADULTS Slide 12 C C L I N I C A L F E A T U R E S TRACHEAL F.B TRACHEAL F.B. Slide 13 TOTAL OBSTRUCTION LOBAR OR OR SEGMENTAL SEGMENTAL ATELACTASIS TOTAL OBSTRUCTION TOTAL OBSTRUCTION DILATATION OF AIRWAY DILATATION OF AIRWAY DURING INSPIRATION DURING INSPIRATION PUMPING OF AIR WITH PUMPING OF AIR WITH EACH INSPIRATION EACH INSPIRATION EMPHYSEMA EMPHYSEMA C L I N I C A L F E A T U R E S BRONCHIBRONCHI LATER EMPHYSEMATOUS BULLA MAY RUPTURE LEADING TO TO SPONTANEOUS SPONTANEOUS PNEUMOTHORAX PNEUMOTHORAX LONG RETAINED F.B. MAY GIVE RISE TO: MAY GIVE RISE TO:PNEUMONITISBRONCHIECTASIS LUNG ABSCESS SMALL F.B PARTIAL OBSTRUCTION Slide 14 TYPICALHISTORY& CLINICAL FEATURES X-RAY NECK AP&LATERALVIEWS X-RAY CHEST (PA VIEW) INSPIRATION&EXPIRATION LARYNGO/ TRACHEO/ BRONCHO SCOPY Slide 15 RADIOPAQUE F.B. IN RIGHT LUNG ON PA VIEW. RADIOPAQUE F.B. IN RIGHT LUNG ON PA VIEW. Slide 16 RADIOPAQUE F.B. IN BRONCHUS ON LATERAL RADIOGRAPH. Slide 17 A METALLIC SCREW IN RIGHT MAIN BRONCHUS. Slide 18 A DENTAL CROWN IN RIGHT MAIN BRONCHUS. A DENTAL CROWN IN RIGHT MAIN BRONCHUS. Slide 19 NAIL CLIPPERS IN LEFT MAIN BRONCHUS IN AN ADULT INHALED DURING MILD EPILEPTIC SEIZURE. Slide 20 F.B. IN LEFT MAIN BRONCHUS CAUSING COMPLETE COLLAPSE LEFT LUNG & HYPER INFLATED RIGHT LUNG. Slide 21 POST F.B. REMOVAL RADIOGRAPH WITH NORMAL RIGHT LUNG & EXPANDED LEFT LUNG. Slide 22 PEANUT IN LEFT BRONCHUS JUST BELOW THE CARINA. Slide 23 PEANUT SWOLLEN UP AFTER ABSORBING SECRETIONS. Slide 24 IF CAUSING ACUTE RESPIRATORY OBSTRUCTION: 1. TAP BACK WITH PATIENT UPSIDE DOWN. 2. DO HEIMLICH MANOEUVRE. 3. CRICOTHYROTOMY. 4. EMERGENCY TRACHEOSTOMY. LARYNGEALFBELECTIVEOREMERGENCYBRONCHOSCOPYTRACHEALORBRONCHIALFOREIGNBODY SMALL SMALLLARYNGEAL, OR Slide 25 Slide 26 Infections Ac. Epiglottitis Ac. Laryngo- Tracheobronchitis Laryngeal Diphtheria Ludwigs angina. Infections Ac. Epiglottitis Ac. Laryngo- Tracheobronchitis Laryngeal Diphtheria Ludwigs angina. Vocal cord paralysis Operative complications Of Thyroid, cardiac & Esophageal surgeries Bulbar palsy. Foreign body Impaction Swallowed or inhaled Foreign bodies Impacted in upper Airway causing Stridor. Trauma Gunshot or knife Wounds of neck Inhaled irritant Fumes & smoke Swallowed corrosives. Malignancies Advanced tumors Of larynx, tongue, Pharynx with Stridor. Congenital Subglottic stenosis Laryngeal web Laryngeal cysts Tracheo esophageal Anomalies Laryngeal hemangioma. Slide 27 Slide 28 Slide 29 ELECTIVELY BEFORE MAJOR HEAD AND NECK SURGERIES Slide 30 ANIMATION VIDEO OF THE TRACHEOSTOMY PROCEDURE INCISION. DIVISION OF SUBCUTANEOUS TISSUE & DEEP CERVICAL FASCIA. SEPARATION OF STRAP MUSCLES. DIVISION OF THYROID ISTHMUS. INCISION IN THE TRACHEA. INSERTION OF TRACHEOSTOMY TUBE. CLOSURE OF THE WOUND. Slide 31 A N Y Q U E S T I O N S? Slide 32