Foreign BodiesnForeign body ingestionnForeign body aspirationnToddlersnOral explorationnLack posterior dentitionnEasy distractibilitynCognitive development (edible?)2021/8/121Foreign Body IngestionnCoins 75%nBones (mainly fish bone) nMeatnVegetable matternFalse teethnLess than 24 hours in most2021/8/122Foreign Body IngestionnParental suspicionnSymptomsnChoking, coughing, dysphagia, odynophagianPhysical examnDrooling, refuses p.o., fussy childnRespiratory compromise 2021/8/123Foreign Body IngestionnCommon locationsnTonsilsnVallecula epiglotticanPyriform sinuses nCricopharyngeusnAorta/left mainstem bronchusnGastroesophageal junction2021/8/124Foreign Body IngestionnRadiopaquenCoinsnCartilage/bonesnRadiolucentnHot dogsnBarium swallow2021/8/125Foreign Body IngestionnBarium Swallow2021/8/126Foreign Body IngestionnObservationnRecent ingestionnBlunt object nEndoscopynComplete obstructionnAirway compromisenImpactednCausticsnAnomalies2021/8/127Foreign Body IngestionnRemovalnGeneral anesthesianIntubatednEsophagoscopynExamine for ulceration/perforation2021/8/128Foreign Body IngestionnDisc batteriesnEmergencynNaOH, KOH, mercuryn1 hour mucosal damagen2 to 4 hours muscular layersn8 to 12 hours perforationnEsophagoscopynObservation for gastric location for 4-7 daysnLaparotomy for bowel perforation2021/8/129Foreign Body IngestionnComplication Perforation of esophagus Subcutaneous/mediastinal emphysema Mediastinal abscess Break of the aorta Esophageal fistula/stricture 2021/8/1210n9、 人的价值，在招收诱惑的一瞬间被决定。2024/9/4 2024/9/4 Wednesday, September 4, 2024n10、低头要有勇气，抬头要有低气。2024/9/4 2024/9/4 2024/9/4 9/4/2024 2:04:05 PMn11、人总是珍惜为得到。2024/9/4 2024/9/4 2024/9/4 Sep-24 04-Sep-24n12、人乱于心，不宽余请。2024/9/4 2024/9/4 2024/9/4 Wednesday, September 4, 2024n13、生气是拿别人做错的事来惩罚自己。2024/9/4 2024/9/4 2024/9/4 2024/9/4 9/4/2024n14、抱最大的希望，作最大的努力。04 九月 20242024/9/4 2024/9/4 2024/9/4n15、一个人炫耀什么，说明他内心缺少什么。九月 242024/9/4 2024/9/4 2024/9/4 9/4/2024n16、业余生活要有意义，不要越轨。2024/9/4 2024/9/4 04 September 2024n17、一个人即使已登上顶峰，也仍要自强不息。2024/9/4 2024/9/4 2024/9/4 2024/9/42021/8/1211烦恼有何惧怕，既然躲不掉，就调好心态与它共存。心向阳光，何惧风霜。茫茫人海你我相遇就是缘分，欢迎下载！2021/8/1212nPerforationnTachycardianTachypneanFevernChest pain2021/8/1213Foreign Body IngestionnBalloon Catheter ExtractionnEffective in 90%nEndoscopy for failuresnComplicationsnEmesisnEpistaxisnLaryngospasmnAirway compromise2021/8/1214Foreign Body IngestionnPostoperative management Fasting 7d for perforation2021/8/1215Foreign Body AspirationnVegetable matter in 70-80%nPeanuts & other nuts (35%)nCarrot pieces, beans, sunflower & watermelon seedsnMetallic objectsnPlastic objects2021/8/1216Foreign Body AspirationnBronchi 80-90%nRight mainstem most commonnCarinanLess divergent anglenGreater diameternTracheanLarynxnLarger objects, irregular edgesnConforming objects2021/8/1217Foreign Body AspirationnHistorynChokingnGaggingnWheezingnHoarsenessnDysphonianCan mimic asthma, croup, pneumonian“A positive history must never be ignored, while a negative history may be misleading”2021/8/1218Foreign Body AspirationnChoking episode with coughing, gagging or wheezing nAsymptomatic intervaln20-50% not detected for one weeknInflammation and ComplicationsnCoughnEmphysemanObstructive atelectasisnHemoptysis nPneumonianLung abscessnFever2021/8/1219Foreign Body AspirationnPhysical examnLarynx/cervical tracheanInspiratory or biphasic stridornIntrathoracic tracheanProlonged expiratory wheezenBronchinUnequal breath soundsnDiagnostic triad - 50%nUnilateral wheezenCoughnIpsilaterally diminished breath soundsnFiberoptic laryngoscopy2021/8/1220Foreign Body AspirationnRadiographynPA & lateral views of chest & necknInspiration & expirationnLateral decubitus viewsnAirway fluoroscopyn25% have normal radiography2021/8/122102021/8/1222Foreign Body Aspiration2021/8/1223Foreign Body Aspiration2021/8/1224Foreign Body Aspiration2021/8/1225Foreign Body Aspiration2021/8/1226Foreign Body AspirationnGoal of treatment nPrompt endoscopic removal under conditions of maximal safety and minimal trauma2021/8/1227Foreign Body AspirationnUsually NOT A DIRE EMERGENCYnTrained personnelnInstruments assembled and checkednAwait for emptying of stomachnFind duplicate FB to test instruments and techniques2021/8/1228Foreign Body AspirationnGeneral anesthesianSpontaneous ventilationnLaryngoscopesnBronchoscopesnSuctionnForcepsnRod-lens telescopes2021/8/1229Foreign Body AspirationnReady to assume airway during inductionnLaryngoscopynTopical anesthesianExamination of upper airwaynAtraumatic insertion of bronchoscopenBronchoscopynAttached to ventilating circuit2021/8/1230Foreign Body AspirationnBronchoscopynSuction opposite bronchus nAdvance to foreign bodynAtraumatically grasp foreign bodynRepeat bronchoscopynSuction bronchusnMultiple foreign bodies in 5-19%nRemove granulation tissuenTopical vasoconstrictors for bleeding2021/8/1231Foreign Body AspirationnSlipped foreign bodynPush back into bronchusnSharp foreign bodynAdvance bronchoscope over FB2021/8/1232Foreign Body AspirationnComplicationsnPneumonianAntibiotics, physiotherapynAtelectasisnExpectant management, physiotherapynPneumothoraxnPneumomediastinum 2021/8/1233Caustic Ingestionn5,000 lye ingestions in children 7nLiquefaction necrosisnAcids pH 7nCoagulation necrosisnBleaches pH = 7nIrritants 2021/8/1235Caustic IngestionnAmountnTypenConcentrationnTime of contact2021/8/1236Caustic IngestionnGrade 1 - superficial injurynGrade 2 transmucosal injurynGrade 3 transmural injurynCircumferential vs. localized injury 2021/8/1237Caustic IngestionnAcute phase(1-2w) Local GeneralnLatent period(1-2w)nStricture formation2021/8/1238Caustic Ingestion nInitial management requires diagnosisnHistorynObtain containernPoison controlnEmesis?2021/8/1239Caustic IngestionnLaryngeal injury?nHoarseness, stridor, dyspneanSevere injury?nOdynophagia, drooling, refusal of foodnPerforation?nChest pain, abdominal pain, rigidity2021/8/1240Caustic IngestionnNeighboring injurynExamination of lips, chin, hands, chest, clothingnOropharynxnSuction, lighting, restraintnLarynx/hypopharynxnFlexible fiberoptic scope, mirror2021/8/1241Caustic IngestionnRadiologic examnChest & neck radiographs nBarium swallownWill not reveal 1st and 2nd degree injuries2021/8/1242Caustic 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 limit of severe burn2021/8/1243Caustic IngestionnBleach ingestionn5-6% sodium hypochloritenProduce ulcerationnNormal oropharynx barium swallownBurned oropharynx - esophagoscopy2021/8/1244Caustic IngestionnGoal of treatmentnPreventing permanent injury or stricture in esophagus2021/8/1245Caustic IngestionnDilutionnWater or milknNeutralizing substances contraindicatednExothermic reactionnAnalgesics2021/8/1246Caustic IngestionnAntibioticsnPronDecrease bacterial countsnReduction in granulationnConnInflux of gram negativesnMask infectionnNo reduction in stricturesnAmpicillin 50 mg/kg/day2021/8/1247Caustic IngestionnSteroidsnPrednisone 2 mg/kg/day x 21 days then tapernMost effective for grade 2 injuriesnStrictures easier to manage2021/8/1248Caustic IngestionnPrevention of acid refluxnH2 blockersnProton pump inhibitors2021/8/1249Caustic IngestionnNasogastric tubenEsophageal stentnPrevent adherence of anterior and posterior walls of esophagus2021/8/1250Caustic IngestionnStrictures develop in 10-15%nDilationnProgradenRetrogradenBalloon cathetersnEsophageal replacement2021/8/1251Caustic IngestionnPrograde dilationnJackson silk-woven bougiesnHurst dilatorsnMaloney dilators2021/8/1252Caustic IngestionnRetrograde dilationnSafer?nTucker dilators2021/8/1253Caustic IngestionnGruntzig balloon catheternRadial direction of dilation2021/8/1254Caustic Ingestion2021/8/1255Caustic IngestionnEsophageal replacementnColonic interpositionnJejunal interpositionnGastric pull-ups2021/8/1256Caustic IngestionnEsophageal carcinoman1,000x increased riskn13 to 71 years after injurynBetter prognosis than usual esophageal cancer2021/8/1257Caustic Ingestion2021/8/1258n9、 人的价值，在招收诱惑的一瞬间被决定。04-9月-2404-9月-24Wednesday, September 4, 2024n10、低头要有勇气，抬头要有低气。*9/4/2024 2:04:06 PMn11、人总是珍惜为得到。04-9月-24*Sep-24 04-Sep-24n12、人乱于心，不宽余请。*Wednesday, September 4, 2024n13、生气是拿别人做错的事来惩罚自己。04-9月-2404-9月-24*04 September 2024n14、抱最大的希望，作最大的努力。04 九月 2024*04-9月-24n15、一个人炫耀什么，说明他内心缺少什么。九月 24*04-9月-24*04 September 2024n16、业余生活要有意义，不要越轨。*9/4/2024n17、一个人即使已登上顶峰，也仍要自强不息。*04-9月-24谢谢大家谢谢大家2021/8/1259n9、 人的价值，在招收诱惑的一瞬间被决定。2024/9/4 2024/9/4 Wednesday, September 4, 2024n10、低头要有勇气，抬头要有低气。2024/9/4 2024/9/4 2024/9/4 9/4/2024 2:04:06 PMn11、人总是珍惜为得到。2024/9/4 2024/9/4 2024/9/4 Sep-24 04-Sep-24n12、人乱于心，不宽余请。2024/9/4 2024/9/4 2024/9/4 Wednesday, September 4, 2024n13、生气是拿别人做错的事来惩罚自己。2024/9/4 2024/9/4 2024/9/4 2024/9/4 9/4/2024n14、抱最大的希望，作最大的努力。04 九月 20242024/9/4 2024/9/4 2024/9/4n15、一个人炫耀什么，说明他内心缺少什么。九月 242024/9/4 2024/9/4 2024/9/4 9/4/2024n16、业余生活要有意义，不要越轨。2024/9/4 2024/9/4 04 September 2024n17、一个人即使已登上顶峰，也仍要自强不息。2024/9/4 2024/9/4 2024/9/4 2024/9/4谢谢大家谢谢大家2021/8/1260