《异物讲座课件》由会员分享，可在线阅读，更多相关《异物讲座课件（58页珍藏版）》请在金锄头文库上搜索。
1、Foreign BodiesnForeign body ingestionnForeign body aspirationnToddlersnOral explorationnLack posterior dentitionnEasy distractibilitynCognitive development (edible?)2021/5/71Foreign Body IngestionnCoins 75%nBones (mainly fish bone) nMeatnVegetable matternFalse teethnLess than 24 hours in most2021/5/
2、72Foreign Body IngestionnParental suspicionnSymptomsnChoking, coughing, dysphagia, odynophagianPhysical examnDrooling, refuses p.o., fussy childnRespiratory compromise 2021/5/73Foreign Body IngestionnCommon locationsnTonsilsnVallecula epiglotticanPyriform sinuses nCricopharyngeusnAorta/left mainstem
3、 bronchusnGastroesophageal junction2021/5/74Foreign Body IngestionnRadiopaquenCoinsnCartilage/bonesnRadiolucentnHot dogsnBarium swallow2021/5/75Foreign Body IngestionnBarium Swallow2021/5/76Foreign Body IngestionnObservationnRecent ingestionnBlunt object nEndoscopynComplete obstructionnAirway compro
4、misenImpactednCausticsnAnomalies2021/5/77Foreign Body IngestionnRemovalnGeneral anesthesianIntubatednEsophagoscopynExamine for ulceration/perforation2021/5/78Foreign Body IngestionnDisc batteriesnEmergencynNaOH, KOH, mercuryn1 hour mucosal damagen2 to 4 hours muscular layersn8 to 12 hours perforatio
5、nnEsophagoscopynObservation for gastric location for 4-7 daysnLaparotomy for bowel perforation2021/5/79Foreign Body IngestionnComplication Perforation of esophagus Subcutaneous/mediastinal emphysema Mediastinal abscess Break of the aorta Esophageal fistula/stricture 2021/5/710n9、 人的价值，在招收诱惑的一瞬间被决定。2
6、024/8/24 2024/8/24 Saturday, August 24, 2024n10、低头要有勇气，抬头要有低气。2024/8/24 2024/8/24 2024/8/24 8/24/2024 5:42:30 PMn11、人总是珍惜为得到。2024/8/24 2024/8/24 2024/8/24 Aug-2424-Aug-24n12、人乱于心，不宽余请。2024/8/24 2024/8/24 2024/8/24 Saturday, August 24, 2024n13、生气是拿别人做错的事来惩罚自己。2024/8/24 2024/8/24 2024/8/24 2024/8/24 8
7、/24/2024n14、抱最大的希望，作最大的努力。24 八月 20242024/8/24 2024/8/24 2024/8/24n15、一个人炫耀什么，说明他内心缺少什么。八月 242024/8/24 2024/8/24 2024/8/24 8/24/2024n16、业余生活要有意义，不要越轨。2024/8/24 2024/8/24 24 August 2024n17、一个人即使已登上顶峰，也仍要自强不息。2024/8/24 2024/8/24 2024/8/24 2024/8/242021/5/711nPerforationnTachycardianTachypneanFevernChes
8、t pain2021/5/712Foreign Body IngestionnBalloon Catheter ExtractionnEffective in 90%nEndoscopy for failuresnComplicationsnEmesisnEpistaxisnLaryngospasmnAirway compromise2021/5/713Foreign Body IngestionnPostoperative management Fasting 7d for perforation2021/5/714Foreign Body AspirationnVegetable matt
9、er in 70-80%nPeanuts & other nuts (35%)nCarrot pieces, beans, sunflower & watermelon seedsnMetallic objectsnPlastic objects2021/5/715Foreign Body AspirationnBronchi 80-90%nRight mainstem most commonnCarinanLess divergent anglenGreater diameternTracheanLarynxnLarger objects, irregular edgesnConformin
10、g objects2021/5/716Foreign Body AspirationnHistorynChokingnGaggingnWheezingnHoarsenessnDysphonianCan mimic asthma, croup, pneumonian“A positive history must never be ignored, while a negative history may be misleading”2021/5/717Foreign Body AspirationnChoking episode with coughing, gagging or wheezi
11、ng nAsymptomatic intervaln20-50% not detected for one weeknInflammation and ComplicationsnCoughnEmphysemanObstructive atelectasisnHemoptysis nPneumonianLung abscessnFever2021/5/718Foreign Body AspirationnPhysical examnLarynx/cervical tracheanInspiratory or biphasic stridornIntrathoracic tracheanProl
12、onged expiratory wheezenBronchinUnequal breath soundsnDiagnostic triad - 50%nUnilateral wheezenCoughnIpsilaterally diminished breath soundsnFiberoptic laryngoscopy2021/5/719Foreign Body AspirationnRadiographynPA & lateral views of chest & necknInspiration & expirationnLateral decubitus viewsnAirway
13、fluoroscopyn25% have normal radiography2021/5/72002021/5/721Foreign Body Aspiration2021/5/722Foreign Body Aspiration2021/5/723Foreign Body Aspiration2021/5/724Foreign Body Aspiration2021/5/725Foreign Body AspirationnGoal of treatment nPrompt endoscopic removal under conditions of maximal safety and
14、minimal trauma2021/5/726Foreign Body AspirationnUsually NOT A DIRE EMERGENCYnTrained personnelnInstruments assembled and checkednAwait for emptying of stomachnFind duplicate FB to test instruments and techniques2021/5/727Foreign Body AspirationnGeneral anesthesianSpontaneous ventilationnLaryngoscope
15、snBronchoscopesnSuctionnForcepsnRod-lens telescopes2021/5/728Foreign Body AspirationnReady to assume airway during inductionnLaryngoscopynTopical anesthesianExamination of upper airwaynAtraumatic insertion of bronchoscopenBronchoscopynAttached to ventilating circuit2021/5/729Foreign Body Aspirationn
16、BronchoscopynSuction opposite bronchus nAdvance to foreign bodynAtraumatically grasp foreign bodynRepeat bronchoscopynSuction bronchusnMultiple foreign bodies in 5-19%nRemove granulation tissuenTopical vasoconstrictors for bleeding2021/5/730Foreign Body AspirationnSlipped foreign bodynPush back into
17、 bronchusnSharp foreign bodynAdvance bronchoscope over FB2021/5/731Foreign Body AspirationnComplicationsnPneumonianAntibiotics, physiotherapynAtelectasisnExpectant management, physiotherapynPneumothoraxnPneumomediastinum 2021/5/732Caustic Ingestionn5,000 lye ingestions in children 7nLiquefaction nec
18、rosisnAcids pH 7nCoagulation necrosisnBleaches pH = 7nIrritants 2021/5/734Caustic IngestionnAmountnTypenConcentrationnTime of contact2021/5/735Caustic IngestionnGrade 1 - superficial injurynGrade 2 transmucosal injurynGrade 3 transmural injurynCircumferential vs. localized injury 2021/5/736Caustic I
19、ngestionnAcute phase(1-2w) Local GeneralnLatent period(1-2w)nStricture formation2021/5/737Caustic Ingestion nInitial management requires diagnosisnHistorynObtain containernPoison controlnEmesis?2021/5/738Caustic IngestionnLaryngeal injury?nHoarseness, stridor, dyspneanSevere injury?nOdynophagia, dro
20、oling, refusal of foodnPerforation?nChest pain, abdominal pain, rigidity2021/5/739Caustic IngestionnNeighboring injurynExamination of lips, chin, hands, chest, clothingnOropharynxnSuction, lighting, restraintnLarynx/hypopharynxnFlexible fiberoptic scope, mirror2021/5/740Caustic IngestionnRadiologic
21、examnChest & neck radiographs nBarium swallownWill not reveal 1st and 2nd degree injuries2021/5/741Caustic IngestionnEsophagoscopy in virtually all patients at 24-48 hours post-ingestionn 48-72 hours with risk of iatrogenic perforation barium swallownRigid vs. flexible debatablenEndoscopy to upper l
22、imit of severe burn2021/5/742Caustic IngestionnBleach ingestionn5-6% sodium hypochloritenProduce ulcerationnNormal oropharynx barium swallownBurned oropharynx - esophagoscopy2021/5/743Caustic IngestionnGoal of treatmentnPreventing permanent injury or stricture in esophagus2021/5/744Caustic Ingestion
23、nDilutionnWater or milknNeutralizing substances contraindicatednExothermic reactionnAnalgesics2021/5/745Caustic IngestionnAntibioticsnPronDecrease bacterial countsnReduction in granulationnConnInflux of gram negativesnMask infectionnNo reduction in stricturesnAmpicillin 50 mg/kg/day2021/5/746Caustic
24、 IngestionnSteroidsnPrednisone 2 mg/kg/day x 21 days then tapernMost effective for grade 2 injuriesnStrictures easier to manage2021/5/747Caustic IngestionnPrevention of acid refluxnH2 blockersnProton pump inhibitors2021/5/748Caustic IngestionnNasogastric tubenEsophageal stentnPrevent adherence of an
25、terior and posterior walls of esophagus2021/5/749Caustic IngestionnStrictures develop in 10-15%nDilationnProgradenRetrogradenBalloon cathetersnEsophageal replacement2021/5/750Caustic IngestionnPrograde dilationnJackson silk-woven bougiesnHurst dilatorsnMaloney dilators2021/5/751Caustic IngestionnRet
26、rograde dilationnSafer?nTucker dilators2021/5/752Caustic IngestionnGruntzig balloon catheternRadial direction of dilation2021/5/753Caustic Ingestion2021/5/754Caustic IngestionnEsophageal replacementnColonic interpositionnJejunal interpositionnGastric pull-ups2021/5/755Caustic IngestionnEsophageal ca
27、rcinoman1,000x increased riskn13 to 71 years after injurynBetter prognosis than usual esophageal cancer2021/5/756Caustic Ingestion2021/5/757n9、 人的价值，在招收诱惑的一瞬间被决定。24-8月-2424-8月-24Saturday, August 24, 2024n10、低头要有勇气，抬头要有低气。*8/24/2024 5:42:33 PMn11、人总是珍惜为得到。24-8月-24*Aug-2424-Aug-24n12、人乱于心，不宽余请。*Saturday, August 24, 2024n13、生气是拿别人做错的事来惩罚自己。24-8月-2424-8月-24*24 August 2024n14、抱最大的希望，作最大的努力。24 八月 2024*24-8月-24n15、一个人炫耀什么，说明他内心缺少什么。八月 24*24-8月-24*24 August 2024n16、业余生活要有意义，不要越轨。*8/24/2024n17、一个人即使已登上顶峰，也仍要自强不息。*24-8月-24谢谢大家谢谢大家2021/5/758
