10Right Lung collapse & Left emphysema Radio-lucent F.B.Right Lung collapse & Left emphysema
11Management of choking in an unconscious patient 1. Patient placed in supine position2. Open airway + mouth to mouth ventilation3. Correct airway obstruction
12Opening the airwayHead-tilt: Extension of neck by backward pressure on forehead
13Opening the airway2. Head-tilt, chin-lift: Extension of neck by backward pressure on forehead + lift pt’s chin keeping mouth open.
14Opening the airway3. Head-tilt, neck-lift: Lift pt’s neck while pushing down on forehead. Prevents falling back of tongue.
15Opening the airway4. Modified jaw-thrust: For pt with neck / spinal injuries. Push patient’s jaw forward by applying pressure at angle of mandible. Avoid head tilt.
16Correcting airway obstruction Back blowsAbdominal thrustsChest thrusts (for pregnancy, age < 8 yrs)All 3 raise subglottic pressure, to dislodge out FBOpen pt’s mouthBlind finger sweeps in mouth
17Back blows Place pt in lateral position, supporting pt’s chest against your knees.Use free hand to deliverfive rapid blows to spinalArea b/w scapulae, todislodge F.B.
18Abdominal thrusts Straddle supine pt at his hip. Place your hand heel b/w pt’s umbilicus & ribcage, in midline.Hold that hand with your other hand & apply 5 rapid, inward + upward thrusts, to dislodge FB.
19Chest thrustsKneel beside supine pt at chest level. Place hand heel on centre of pt’s sternum.Lock hands. Apply 5 rapid downward thrusts.Only 2 fingers used for a small child.
20Opening patient’s mouth Tongue-jaw lift technique:Hold pt’s tongue + lower jaw b/w your thumb & fingers.Lift pt’s tongue to move itaway from pharyngeal wall.
21Opening patient’s mouth Crossed-finger technique:Cross your thumb under your index finger.Place your thumb against pt’s lower lip & index finger against his upper teeth.Uncross your fingers to open pt’s mouth.
22Blind finger sweepsOpen pt’s mouth. Insert index finger of free hand into pt’s mouth, along pt’s cheek, till tongue base Use it as a hook to roll out FB.Avoid pushing FB further back Avoid blind sweeps in a child.Attempt to remove visible FB only.
23Correcting airway obstruction in an unconscious pt 5 Back blows failure5 Abdominal thrusts Or 5 Chest thrustsOpen pt’s mouth + blind finger sweeps.Continue this sequence till FB is removed or pt is ready to be shifted to operation theatre.
24Management of choking in a conscious pt If patient can speak, cough, or breathe:Do not interfere. Patient to be examined by an ENT specialist as soon as possible.If the patient cannot speak, cough, or breathe: Begin treatment for obstructed airway.
25Correcting airway obstruction in a conscious pt > 1 yr old 5 Back blows failure5 Abdominal thrusts (Heimlich maneuver)Or 5 Chest thrusts (for pregnancy, age < 8 yrs)Continue this sequence till FB is removed or ptbecomes unconscious.
26Back blowsPlace pt in sitting / standing position. Support pt’s chest while bending pt at the waist.Use your free hand to deliver 5 rapid blows to spinal area b/w two scapulae.
28Heimlich ManeuverStand behind sitting / standing pt & pass your arms around pt’s waist.Hold your fist against pt’s abdomen b/w umbilicus & ribcage.Lock hands & apply 5 rapid, inward + upward thrusts to dislodge FB.
29Chest thrusts Stand behind standing pt & pass your arms around pt’s chest. Hold your fist againstpt’s sternum in its centre. Lockhands & apply 5 rapid, back-ward thrusts to dislodge FB.
30Correcting airway obstruction in an infant 5 Back blows failure5 Chest thrustsContinue this sequence till FB is removed or ptis ready to be shifted to operation theatre.
31Back blows in an infantStraddle infant face down, head lower than trunk, over your forearm, supported on your thigh.Deliver five rapid back blows, with heel of other hand b/w shoulder blades.
32Chest thrusts in an infant Supporting pt’s head, keepinfant supine b/w yourhands, with head lowerthan trunk.Using 2 fingers, deliver 5rapid backward thrusts onsternum.
33Surgical Management For life threatening stridor Cricothyrotomy Emergency TracheostomyFor foreign body removalDirect LaryngoscopyRigid BronchoscopyThoracotomy & Bronchotomy
34Prevention of choking Adults: Infants & Children: Cut food into small pieces Chew food slowly & thoroughly Avoid laughing / talking during eating Avoid excess alcohol with / before mealsInfants & Children: Keep small objects away from children Avoid playing with food or toys in mouth
45Pharyngeal FBCommon sites: tonsil, pyriform fossa, vallecula, base tongueDiagnosis confirmed by indirect laryngoscopyUsually removed in OPD but may require removal by Hypo-pharyngoscopy GA
46Oesophageal & Gastric FB Common sites: cricopharynx, aortic indentation & cardiac endUsually removed by rigid oesophagoscopy GAAdvancement into stomach is safe in difficult FBOesophagotomy rarely required for impacted FBFB reaching stomach, usually passes out in stoolEmetic & Cathartic agents are contraindicated
47Indications for Immediate Intervention Associated respiratory obstruction Total oesophageal obstruction Disc battery (perforation occurs in 8-12 hrs) Sharp, impacted foreign body Gastro-intestinal FB > 5 cm in a child < 2 yr Gastro-intestinal FB with acute abdominal pain No progress of FB in serial X-ray after 24 hr Gastric FB with pyloric stenosis