2. DISTRESS.. RESPIRATORY CAUSES
INFLAMATORY
NEOPLASTIC
CONGENITAL

3. LARYNGO-TRACHEO-BRONCHIAL TREE

4. ETIOLOGY USUAL VICTIMS: CHILDREN 12-48 MONTHS OF AGE. 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.

5. ETIOLOGY. (CONTD.) IN ADULTS
USUALLY ACCIDENTAL WITH COUGH OR SNEEZE WHEN SOMETHING IN MOUTH.
MAY OCCUR DURING SLEEP OR WHILE IN ALCOHOL INTOXICATION OR WITH EXTRACTION OF TEETH DURING LOCAL OR GENERAL ANESTHESIA.
RARE VICTIMS- MENTALLY RETARDED PEOPLE.

6. TYPES OF FOREIGN BODIES
EXTRINSIC
INTRINSIC
METALLIC
TYPES OF
FOREIGN BODIES IN
TRACHEO BRONCHIAL TREE.
VEGETABLE
NON METALLIC
NON
VEGETABLE
THICK SPUTUM

7. PREVALENCE OF F.B. IMPACTION

8. DECREASED AIR ENTRY UNILATERALLY
C L I N I C A L F E A T U R E S
INITIAL SYMPTOMS C Y A N O S I C H O K I N G C O U G H I N D Y S P N E A
STRIDOR
LATER
WHEEZING
DECREASED AIR ENTRY UNILATERALLY
FEVER

9. LARYNGEAL PROTECTION OF AIRWAY
LARYNGEAL INLET CLOSURE
APPROXIMATION OF VENTRICULAR FOLDS
APPROXMATION OF VOCAL FOLDS
CESSATION OF
RESPIRATION
COUGH REFLEX

10. F.B. CAUSING OBSTRUCTION AT LAYNGEAL LEVEL

11. LARYNX SMALL F.B. PARTIAL AIRWAY OBSTRUCTION COUGH PAIN DYSPNEA
CHIILDREN
BACK TAP WITH
HEAD DOWN.
HEIMLISCH
MANOEUVRE
IN ADULTS
LARGE F.B.
AIRWAY OCCLUSION
SUDDEN DEATH

12. REMOVE F.B. BY TRACHEOSCOPY
C L I N I C A L F E A T U R E S
TRACHEAL F.B.
COMPLETE OBSTRUCTION NOT POSSIBLE
PARTIAL OBSTRUCTION
F.B. MOVES UP & DOWN
WITH AIR MOVEMENT
CAUSING AUDIBLE SLAP
OR ASTHMATIC WHEEZE.
REMOVE F.B. BY TRACHEOSCOPY

13. SMALL F.B PARTIAL OBSTRUCTION
C L I N I C A L F E A T U R E S
BRONCHI
SMALL F.B PARTIAL OBSTRUCTION
TOTAL
OBSTRUCTION
LOBAR OR
SEGMENTAL
ATELACTASIS
LATER
EMPHYSEMATOUS BULLA
MAY RUPTURE LEADING TO
SPONTANEOUS
PNEUMOTHORAX
TOTAL OBSTRUCTION
DILATATION OF AIRWAY
DURING INSPIRATION
PUMPING OF AIR WITH
EACH INSPIRATION
EMPHYSEMA
LONG RETAINED F.B.
MAY GIVE RISE TO:
PNEUMONITIS
BRONCHIECTASIS
LUNG ABSCESS

14. LARYNGO/TRACHEO/BRONCHO
DIAGNOSIS
TYPICAL
HISTORY
&
CLINICAL FEATURES
X-RAY NECK AP
LATERAL
VIEWS
X-RAY CHEST
(PA VIEW)
INSPIRATION
EXPIRATION
LARYNGO/TRACHEO/BRONCHO
SCOPY

15. RADIOPAQUE F.B. IN RIGHT LUNG ON PA VIEW.

16. RADIOPAQUE F.B. IN BRONCHUS ON LATERAL RADIOGRAPH.

17. A METALLIC SCREW IN RIGHT MAIN BRONCHUS.

18. A DENTAL CROWN IN RIGHT MAIN BRONCHUS.

19. NAIL CLIPPERS IN LEFT MAIN BRONCHUS IN AN ADULT INHALED DURING MILD EPILEPTIC SEIZURE.

20. F.B. IN LEFT MAIN BRONCHUS CAUSING COMPLETE COLLAPSE LEFT LUNG & HYPER INFLATED RIGHT LUNG.

21. POST F.B. REMOVAL RADIOGRAPH WITH NORMAL RIGHT LUNG & EXPANDED LEFT LUNG.

22. PEANUT IN LEFT BRONCHUS JUST BELOW THE CARINA.

23. PEANUT SWOLLEN UP AFTER ABSORBING SECRETIONS.

24. MANAGEMENT ELECTIVE EMERGENCY BRONCHOSCOPY L A R Y N G E FB TRACHEAL
OBSTRUCTION:
IF CAUSING ACUTE RESPIRATORY
1. TAP BACK WITH PATIENT UPSIDE DOWN.
2. DO HEIMLICH MANOEUVRE.
3. CRICOTHYROTOMY.
4. EMERGENCY TRACHEOSTOMY.
TRACHEAL OR
BRONCHIAL
FOREIGN
BODY
ELECTIVE
EMERGENCY
BRONCHOSCOPY
SMALL
LARYNGEAL, OR

25. INDICATIONS OF TRACHEOSTOMY
TO BYPASS UPPER AIRWAY
OBSTRUCTION 1.
TO ASSIST VENTILATION 2.
TO PROTECT AIRWAY 4.
TO FACILITATE TRACHEO BRONCHIAL TOILETING 3.
INDICATIONS OF TRACHEOSTOMY

26. TO BYPASS UPPER AIRWAY OBSTRUCTION
Infections
Ac. Epiglottitis
Ac. Laryngo-
Tracheobronchitis
Laryngeal –
Diphtheria
Ludwig’s
angina.
Malignancies
Advanced tumors
Of larynx, tongue,
Pharynx with
Stridor.
Congenital
Subglottic stenosis
Laryngeal web
Laryngeal cysts
Tracheo esophageal
Anomalies
Laryngeal hemangioma.
Trauma
Gunshot or knife
Wounds of neck
Inhaled irritant
Fumes & smoke
Swallowed
corrosives.
Foreign body
Impaction
Swallowed or inhaled
Foreign bodies
Impacted in upper
Airway causing
Stridor.
Vocal cord paralysis
Operative
complications Of
Thyroid, cardiac &
Esophageal surgeries
Bulbar palsy.

27. TO ASSIST VENTILATION TETANUS BARBITURATE POISOING POLIOMYELITIS COMA
WITH
HEAD
INJURY
GCS,8
BARBITURATE
POISOING
TETANUS
POLIOMYELITIS

28. TO FASCILITATE TRACHEOBRONCHIAL TOILETING
BRONCHOPNEUMONIA
CHEST
INJURY
BRONCHITIS WITH
EMPHYSEMA

29. TO PROTECT AIRWAY
ELECTIVELY
BEFORE MAJOR
HEAD AND NECK
SURGERIES

30. TECHNIQUE
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.
ANIMATION VIDEO OF THE
TRACHEOSTOMY PROCEDURE

31. ANY QUESTIONS?

32. THANKS