What Are Respiratory Emergencies?

1. What is acute respiratory obstruction?

Basic Information

Visiting department

Emergency Department

Common causes

Some part of the respiratory tract is blocked by something

Common symptoms

Suddenly unable to speak, cough, and suffocate with distress

2. How does airway obstruction occur?

To understand the cause of foreign body blockage in the respiratory tract, it is best to understand the structure of the respiratory tract. Our respiratory tract looks like an overhanging tree [Figure 2]. The mouth, nose, and throat are the roots of the big tree. The trachea is the thickest trunk. The trachea is divided into two left and right general bronchial tubes. The two main bronchial tubes are bifurcated, and then bifurcated. After a total of 24 bifurcations, they are divided into the end of the airway-the alveoli, which is the place for gas exchange. Airways can be divided into upper airways, larger airways, and small airways. The upper airway includes the mouth, nose, throat, and trachea. This is where foreign body obstruction in the respiratory tract occurs.

The trachea is like a person with cleanliness. It is very picky about its "hygiene", that is, only air is allowed in the trachea, and any other tangible substances are foreign bodies in the trachea. Foreign objects, as the name implies, are foreign objects. The trachea is very sensitive to foreign bodies and has a strong repulsion to them. Once the foreign bodies enter, it will immediately cause a severe coughing reaction until the foreign bodies are coughed out. The peculiar thing is that the trachea and the esophagus are closely adjacent, and at the same time both are opened in the pharynx, but why usually food and water can only flow into the esophagus and not into the trachea?

If you compare the trachea to a well, there is a "well cover" above the opening of the trachea. This "well cover" is epiglottic cartilage. When food and water pass through the pharynx, the "well cover" can be closed in time, ensuring that the trachea is not "invaded" by foreign bodies. At other times, the "well cover" was opened again to allow air to pass through so we could breathe, speak, and sing. The human body is a very complex and precise machine. Each organ performs its duties, and works under the command and coordination of the nervous system. This precise and accurate cooperation between organs is breathtaking. The reason why the "well cover" can be closed in time is that it depends on the precise regulation of the nervous system. But sometimes there may be accidents. For example, when we drink water, we suddenly have a sharp cough, it is because the "well cover" did not bring it in time, so that the water entered the trachea. Therefore, whether the regulation and coordination functions of the nervous system are sound is of vital importance.

Acute respiratory tract obstruction

1. What are the types of airway obstruction?

(1) Postural blockage In a coma or cardiac arrest state, the body muscles lose tension and become extremely relaxed. At this time, if the patient is in a supine position, his throat tissue will fall due to gravity, which may block the respiratory tract 3]. Therefore, the greatest danger to the life of a coma patient is not the disease that causes the patient to coma, but the blockage of the respiratory tract. Before the arrival of professional rescuers, many coma patients lost their lives due to poor posture.

(2) Self foreign body clogging means that the foreign body comes from the patient itself. If bronchiectasis, pulmonary tuberculosis, or lung cancer patients rupture the lungs and bronchial blood vessels, bleeding can also cause blockages. In addition, thick sputum and phlegm can sometimes block the respiratory tract.

(3) External foreign body blockage means that a large foreign body blocks a part of the respiratory tract, and there are two common places of fatal blockage. The pharynx has a huge space to hold food. If a large piece of food accumulates in the pharynx before it enters the esophagus, it will suppress the "well cover", making it impossible to open and closing the airway. The patient was choked. Smaller foreign objects at the bifurcation of the trachea often fall into one side of the bronchus after entering the trachea. At this time, although the place where the foreign body fell is deep, the patient is relatively safe because, although the trachea on one side is blocked, the other trachea is blocked. But it is unobstructed, which can ensure that the patient will not die in a short period of time, and the larger foreign matter gets stuck at the bifurcation of the trachea after entering the trachea, thus blocking all the trachea [Figure 4].

2. Who is prone to airway obstruction?

(1) Children Children's nervous system Children's nervous system is not well developed. Therefore, "Jinger" has poor self-regulation and defense capabilities, so it is easy for foreign bodies to enter the trachea. Prone sleep generally occurs in children after 4 months. I took the initiative to turn over, but some children wo nt turn back after turning over into the prone position. At first, he or she can lift his head vigorously, but after a while, the child is weak and his face falls on. Choking on the mattress can cause suffocation [Figure 5] and even death. Especially in the evening, some parents slept deep and could not hear the cry of their children, and the worst consequences occurred in the end. Parents whose children's noses and noses are covered at the same time are afraid that their children will be frozen. They often cover their children with a lot of quilts, blankets, etc. Sometimes they even cover their faces, which can easily affect their breathing.

(2) Excessive drinkers and patients with diseases When excessive drinkers are in a state of intoxication (alcoholism), the patient's nervous system has been paralyzed by alcohol and cannot perform its regulating function. In addition, patients with vomiting often suffer from vomiting at this time. It is not uncommon for consciousness and lying in the supine position to be unable to expel vomit in time, causing suffocation and even death. Pulmonary tuberculosis, bronchiectasis and lung tumor patients may suffer from pulmonary vascular rupture and cause massive hemoptysis, which is an important cause of death in patients with this disease. In addition, there are patients with sequelae of cerebrovascular disease. Because of their impaired neuroregulatory function, coughing and blockage are very easy to occur.

(3) The nervous system regulatory function of the elderly has been weakened or damaged due to disease, so foreign bodies and blockages in the respiratory tract are prone to occur.

2. What behaviors can easily cause airway obstruction?

Bad behaviors that can lead to airway obstruction include: not paying attention while eating, playing while eating, or having your child play with food. Let the child play with the plastic bag. As a result, the child may put the plastic bag on his head, causing suffocation. Drop food into your child's mouth, or throw it into the air, then pick it up or drop it into the mouth, etc. Feeding young children, the elderly, or patients with sequelae of cerebrovascular disease is too anxious to feed, and another spoon is fed before the other person swallows, or the chunky food is too large, which causes food to accumulate in the throat. Insufficient monitoring of a child who just turned over while sleeping caused prone asphyxia. Laissez-faire patients and drunks were allowed to sleep on their own, and as a result of suffocation, there was no help and even death.

3. What are the dangerous items that can easily cause blockages and fall into the trachea?

Small, round, and slippery items are often the culprits that cause foreign body obstruction in the respiratory tract. Common in life are: small jelly within 3 cm in diameter, Tang Yuan (Lantern Lantern), longan, litchi, cherry, peanuts, soybeans, sunflower seeds, dates , Apricot kernels, coins, rubber, stoppers, etc.

Acute respiratory tract obstruction

1. Sudden severe coughing, redness on the face, pale face in severe cases, and bluish lips;

2. Sudden difficulty in breathing, especially manifested as inspiratory dyspnea, the patient is very laborious when inhaling, and can have tri-concave signs (significant depression in the upper part of the sternum and upper part of the clavicle on both sides)

3. Sometimes the breathing is accompanied by a special sharp wheezing sound, which is similar to a chicken call, so it is also called a "chicken sound";

4. When the airway is completely blocked, the patient suddenly cannot speak, cannot breathe, or even cough. At the same time, I have irritability, sweating, bruising, extremely painful expression, and panic. I often hold my throat with my hands. The patient s thumb and index finger are often the same as the letter V. This is the so-called suffocating painful expression [Figure 6] .

5. Patients with coma accompanied by vomiting, hemoptysis, and large hemoptysis should suddenly have difficulty breathing, facial bruising, and restlessness, and should consider whether there is an acute blockage of foreign body in the respiratory tract.

The above situations can occur individually or at the same time, and it is not difficult to judge. For the sake of memory, please remember the six characteristics of acute foreign body obstruction: sudden attack, dyspnea, painful expression, inability to speak, blue face, and V-shaped hand shape.

Acute respiratory tract obstruction

How to determine if an acute foreign body obstruction has occurred?

The first is that the patient has a predisposition to the onset of the disease. For example, the elderly were eating solid food before the onset, and small items were contained in the mouth of children when they were playing. Under this premise, the following situations should occur, whether there is a blockage of foreign bodies in the respiratory tract:

1. Sudden onset.

2. Judgment based on the patient's clinical manifestations.

Acute respiratory tract obstruction

1. Emergency self-rescue for acute foreign body obstruction

After the acute blockage of foreign bodies in the respiratory tract, the situation is very urgent, especially if the respiratory tract is completely blocked, the patient will be in danger immediately. At this time, it is too late to find someone or to call for help. The personnel present only have to take decisive measures, do it themselves, remove foreign bodies in the airway, relieve the symptoms of respiratory irritation and make the airway unobstructed. If you have mastered the self-rescue method, you don't need to call an ambulance, and you can take the patient to the hospital while you rescue yourself. Never go to the hospital without a rescue, as that will have the most terrible consequences. In addition to calling 120 immediately, the following measures should be taken immediately according to the specific situation of the patient:

(1) When the liquid occludes the respiratory tract, patients with liquid occlusion (large hemoptysis, large vomiting blood) should adopt the method of postural drainage as soon as possible, so that the patient becomes a stable lateral position (also known as a recovery supine position) often used in coma Figure 7], and conscious patients were instructed to gently cough, and to relieve the blockage of airway fluid by drainage.

(2) When foreign body gets stuck in the throat For patients with foreign body getting stuck in the throat, it is necessary to quickly clear the mouth and throat food and other items. Those who have dentures first remove their dentures. The rescuer extended one middle finger (for children, the little finger) from the corner of the patient's mouth, with the palm facing the patient's mouth, and extended along the side cheek to the patient's throat, and then the fingers were hooked to hook out the foreign objects caught in the throat [Figure 8], or use a pair of tweezers to pinch out the foreign object. Can be repeated until the airway is blocked. Be careful not to pinch foreign objects deep into the throat or into the trachea.

(3) When a foreign body has fallen into the trachea, patients with foreign bodies that have fallen into the trachea should be instructed to repeatedly cough hard and have their heads lowered to the hips. And the impact of the gas, so that foreign objects in the trachea escape [Figure 9].

(4) When the baby has an acute respiratory foreign body obstruction, the left palm of the operator supports the baby's chest and abdomen with his face down, and leans over the operator's arm. The operator's index and middle fingers are in a V shape. The baby's face is facing down, so that the baby's mouth is between the two fingers, and then the thumb, ring finger and little finger are closed to fix the baby's head and neck, and the left hand is placed on his left thigh, so that the baby's head is lower than the hip. Then tap the baby's back 5 times with the root of his right palm [Figure 10A]. Put the right hand like the left hand on the baby's back, turn it over so that the baby's face is facing up, and the position is the same as that of the abdomen. Turn the baby over again, and repeat the operation in this way, or go to the hospital while operating until the foreign body is coughed out or arrive at the hospital.

Note: When you go to the hospital, you must contact the destination hospital in advance on the way, and prepare the hospital for rescue, so as to save time and save the child's life to the maximum.

2. Heimlick Abdominal Impact

(1) Introduction Heimlich Maneuver is also called Hai's hand technique, which was invented by the American doctor Mr. Heimlich [Figure 11]. In 1974, he first applied the method to successfully rescue a patient who was suffocated due to food clogging the respiratory tract. Since then, the method has been widely used throughout the world, saving countless patients, including former US President Reagan and former Mayor of New York Germany, famous actress Elizabeth Taylor and so on. Therefore the law is called "the hug of life".

(2) The principle can conceive a human lung as a balloon. The trachea is the mouthpiece of the balloon. If the mouthpiece is blocked by a foreign object, you can squeeze the balloon with your hands. The foreign matter of the gas mouth burst out, which is the physics principle of Hai's abdominal impact method. The first aider embracing the patient suddenly put pressure on his upper abdomen, forcing his upper abdomen to sag, causing the diaphragm to rise suddenly. This will cause the chest pressure of the patient to suddenly increase. Since the chest cavity is closed, there is only one opening of the trachea, so the chest The gas in the lungs will naturally flow into the trachea under the effect of pressure, and each impact will generate 450 ~ 500 ml of gas, so it is possible to expel foreign matter and restore the airway's patency.

(3) Indications For the removal of foreign bodies in the respiratory tract, mainly for patients with complete or severe blockage of the respiratory tract. It is used to rescue drowning patients to exclude the fluid from their respiratory tract.

[Note: Some people think that this method can not discharge enough water from the airways or lungs to help resuscitation. It may also cause gastroesophageal reflux and aspiration pneumonia. At the same time, using this method may delay the time of cardiopulmonary resuscitation, so that Conducive to successful recovery, see the International American Red Cross and Red Crescent Society's 2011 On-Site First Aid and Cardiopulmonary Resuscitation Guide (1)].

(4) Method of operation First responders first stand with their front legs arched and hind legs in a standing position, and then make the patient sit on their arched thighs and let their body lean forward slightly [Figure 12]. Then stretch your arms forward from both arms of the patient and hug the patient. Hold the fist in the left hand, and hold the left wrist from the front with the right hand [Figure 13], so that the left fist is placed under the patient's chest and the center of the upper abdomen above the navel to form a "enclosing" trend. Then suddenly tighten the arms and use the left fist Hukou violently pressured the patient's upper abdomen, forcing his upper abdomen to sink. In this way, due to the sag of the abdomen, the content of the abdominal cavity moves upward, forcing the diaphragm to rise and squeeze the lungs and bronchi. This way, each impact can provide a certain amount of air to the airway, thereby flushing foreign matter out of the trachea. Immediately relax the arm after applying pressure, and then repeat the operation until the foreign matter is discharged.

When there is an acute blockage of foreign bodies in the respiratory tract, if there is no one around, the patient can also perform abdominal impact on his own, the same method, or press the upper abdomen on any hard, protruding objects, and repeat it.

For patients with extreme obesity and foreign body obstruction in the second trimester of pregnancy, the chest impact method should be used with the same posture, except that the tiger's mouth of the left hand is attached to the lower end of the patient's sternum. Be careful not to deviate from the sternum to avoid rib fractures [Figure 14].

For unconscious patients, the first responder can first make the patient in a supine position, and then ride on the patient's thigh or on both sides of the patient, with both hands and palms overlapping the patient's navel, and use the root of the palm to press forward and downward suddenly. Repeat [Figure 15].

If the patient has suffered a cardiac arrest, the patient should follow the usual CPR procedures at this time until the patient arrives.

(5) Comorbidities and Precautions Although the Hai impact method has certain effects, it may also bring certain harm, especially for the elderly, because of the poor elasticity and compliance of the thoracic and abdominal tissues, it is easy to cause damage. Such as abdominal or chest internal organs rupture, tearing and bleeding, rib fractures, etc., when the occurrence of respiratory tract obstruction, other methods should be used to exclude foreign bodies, other methods can not be used and the patient's emergency can be used in this method.

Summary: Points for diagnosis and treatment of acute foreign body obstruction [Figure 16]

Acute respiratory tract obstruction

1. Quit bad health habits, such as eating and drinking while talking and laughing;

2. Do not allow children to walk, play or do other sports while eating;

3. Do not let small children have small, round, slippery items such as coins, pinballs, buttons, etc .;

4. For the elderly, especially those who have suffered from cerebrovascular disease and the elderly with dementia, as well as patients who usually suffer from cough, remind the patient to chew slowly and slowly when eating; Eaters, you must make solid food into small pieces. When feeding, make sure that the last bite has been completely swallowed before feeding the next bite. Especially when eating dumplings and Lantern Festival, please be careful not to put the entire Lantern Festival in the elderly;

5. For patients with coma and alcoholism (drunk), they should be placed in a side-lying position, and there are people around at all times, find out the situation and deal with it in time.

6. Patients with tuberculosis, bronchiectasis and lung tumors should avoid severe coughing in order to avoid rupture and bleeding of chest blood vessels.

References:

1.InternationalFederationofRedCrossandRedCrescentSocieties: Internationalfirst

aidandresuscitationguidelines2011 (http://www.ifrc.org)