There is a foreign body in the airway of a delicate child, the anesthesiologist will quietly teach you how to deal with it!

How complicated is it to introduce food into the airway? Source: Knowledge platform of peace: Ling Chu sleep I am a anesthesiologists, every day dealing with the respiratory tract.

How complicated is it for food to enter the airway? Let’s start with the previous case.

Source: The case shown by Dr.
Ling Chumian is a painful lesson.

Can you see clearly what the surgical forceps are under the thoracoscope? It is the pen tip, the most common gel pen tip.

Source: Internet.
This 7-year-old boy did something common at his age-eating pens and playing with pens.
Unfortunately, the pen got stuck in his throat and fell deeper and deeper in the violent choking, and eventually got stuck in a doctor that was unimaginable.
Place-the deep part of the right main bronchus.

Regrettably, the child missed the best time for treatment due to fear of not confessing to his parents.
It was not until the continuous coughing two days later that the careless parents questioned him, and he went to the hospital for examination.

In the hospital, due to the location of the foreign body too deep, the otolaryngologist tried hard oral and soft lenses to successfully remove the foreign body; however, under continuous operation, the child’s airway had local edema and spasm, in order to prevent infection caused by the foreign body And the subsequent airway puncture and other serious consequences, in desperation, the thoracic surgeon came on stage to perform thoracoscopic surgery.

To put it simply, it means that the operation cannot be performed from the trachea, so a hole is drilled through the chest wall, from the outside of the lung, under the bronchoscope spot of the anesthesiologist (that is, me), find the location of the foreign body, and then open the lung and remove the foreign body , Ligation of the relevant lung bronchi.

This small pen was finally taken out, and the result was painful-part of the child's lung was removed, and the respiratory function was inevitably affected.

Closer to home, the anesthesiologist wants to say a lot about the airway in children.

Anatomy of the airway in children, a delicate flower child is fragile, especially the airway.

Due to not fully developed, children's head, face, throat, neck, chest and lungs are quite different from those of adults.

1.
Head and neck: The head is big and the neck is short, the neck muscles are not fully developed, and improper posture may cause the airway obstruction.

2.
Nose: The nostrils are relatively narrow, which are the main respiratory passages for children within 6 months, and are easily blocked by secretions, mucosal edema, and blood.

3.
Tongue and pharynx: The mouth and uvula are large, and the pharynx is relatively narrow and vertical.

The image of the maxillofacial image of young children, in order to show the characteristics, the model looks particularly ugly.
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Source: Internet 4.
Larynx: Newborns and babies have higher throats.

The baby's epiglottis is long and hard, in a "U" shape, and shifts forward, making the glottis difficult.

Because the throat cavity of children is narrow and funnel-shaped.

(The narrowest part is at the level of cricoid cartilage, that is, the subglottic area.

) Adults and children: the airway is different in children The narrowest part of the airway is very deep, at the level of cricoid cartilage 5.
Trachea: The length of the neonatal trachea increases with height.

The tracheal bifurcation position is higher.

The angles between the main bronchus and trachea on both sides of children under 3 years of age are basically the same.
When a foreign body enters, the probability of entering the left or right main bronchus is close.

6.
Lung: The development of lung tissue in children is not yet perfect, and the newborn's respiratory reserve is limited.

The lung interstitium is well-developed, with rich vascular tissue, less air and more blood, so it is prone to infection, inflammation is easy to spread, and it is easy to cause interstitial inflammation, atelectasis and pneumonia.

Insufficient production or release of pulmonary surfactants in premature infants can cause widespread alveolar collapse and reduced lung compliance.

The airways of infants and young children are extremely prone to spread of inflammatory edema and small airway spasms.

Image source @The Nemours Foundation7.
Thoracic: The thoracic expansion force is small when inhaling, and breathing mainly depends on the up and down movement of the diaphragm, which is easily affected by factors such as abdominal distension.

(Especially children with congenital intestinal obstruction or blood system diseases, extreme abdominal distension often causes respiratory failure.

) In newborns with extreme abdominal distension, breathing is a big problem (oh, poor baby), source: Dr.
Ling Chumian 8.
Mediastinum: It occupies a large space in the chest cavity and limits the expansion of the lungs during inhalation, so the breathing reserve capacity is poor.
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The tissues around the mediastinum are soft, loose, and full of elasticity.
When there is a large amount of fluid in the chest cavity, pneumothorax and atelectasis, it is easy to cause the displacement of the organs (trachea, heart and large blood vessels) in the mediastinum.

Many of the above characteristics make the airway of children, especially newborns, the most common headache target for anesthesiologists.

Take the most common anesthesia intubation, for ordinary people intubation, only a few seconds, refreshing and refreshing in the field of vision, clear at a glance.

What about children? Laryngoscope view: The small hole in the middle is the opening of the airway.
Source: Various difficult airways in children in Dr.
Ling Chumian’s classic case.
Source: Internet Source: Dr.
Ling Chumian’s most terrifying situation: the field of vision is gray, real The opening of the airway is just as small as the aperture.
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and for children, breathing is the most important matter of life and death.

Children's poor oxygen reserve and the nervous system need more oxygen supply, resulting in children's difficulty to tolerate hypoxia, heart rate and blood pressure and other vital signs are extremely sensitive to hypoxia.

For anesthesiologists, on the one hand, it is a very short operating time window (half a minute is up to the sky), on the other hand, it is difficult to operate like embroidering with a tongs.
Intubation/airway treatment of children requires a large The heart, a pair of eagle eyes, and a pair of stable hands are a big test to test the skills of an anesthesiologist.

What’s even more difficult is that the child’s airway often has only one chance for doctors to try.

Remember the case at the beginning? Children’s airways will quickly become swollen after being stimulated by surgical instruments.
The swollen connective tissue and spasm of the bronchi will make the narrow airways more contracture, the airway secretions will also increase rapidly, and a lot of slimy sputum/saliva It will cover the entire airway and greatly affect the operation.

From the outside, the sound of wheezing/wheezing (chicken croaking/wheezing as the common people say), the child’s face is more purple, and the breathing rate is faster.

Picture source: In principle, because the airway resistance is inversely proportional to the fourth power of the airway inner diameter, a slight narrowing of the airway will increase the resistance and make breathing more laborious.

In general, the important characteristics of the airway in children are: 1.
The airway in children is more sensitive, more irritable, and more likely to be blocked by small-caliber foreign bodies to the depths.

2.
After children's airway is stimulated, complications such as severe coughing, increased secretions, laryngospasm, and bronchospasm are likely to occur.

Therefore, for children with airway foreign bodies (not limited to solid foreign bodies, but also refluxed stomach contents, choking milk, and blocked sputum after infection), keeping the airway unobstructed is an absolute STEP ONE! On-site first aid-what to do To what? The field of emergency medicine has the concept of golden 4 minutes, which means that the nervous system will be irreversibly traumatized after 4 minutes of hypoxia/circulation stops.

For a child who has a foreign body stuck in his throat and suffocates, this time can be shortened to only about 2 minutes.

It is very difficult for professional medical staff to be there within 2 minutes.
Ordinary people present who master first aid knowledge are undoubtedly the best candidates to save lives in the first place.

Under this brief introduction.

First of all, it needs to be clear that the purpose of all that is done is to make the airway unobstructed in the shortest time.

At present, the best method is Heimlich's first aid method (as shown in the figure below) to stand up and rescue others.

Source: Relief on the Internet to rescue others.

Source: The network stands to help itself.

Source: Two pictures from the Internet: Rescue children.

Picture source: No matter what kind of position the network, the main point is: use the soft tissue area under the abdomen-diaphragm to generate upward pressure and compress the lower part of the lungs, thereby driving the remaining air in the lungs to produce impact airflow, and the airflow is directionally washed and stuck.
The foreign body until the foreign body is removed.

Advanced First Aid——The anesthesiologist revealed the professional points.
If the child cannot get rid of the foreign body for a long time, or the child is not completely blocked in the trachea and has certain respiratory function, but the medical staff is late, and the child's condition is getting worse, what should be done? You need some hard goods.

Next, I will use more professional knowledge and related teaching materials to explain the operation process in detail.

It is not difficult, just remember the ABCD order.

A: Airway: Observation: chest and abdomen breathing movement, listening to breathing sounds and airflow sounds, feeling the airflow in and out of the nose and mouth.

Operation: By adjusting the child's body position, "straighten" the airway to reduce the airway resistance.

When the child is in the supine position, due to the insufficient development of the neck curve and the relatively large head, the airway is actually compressed by the falling tongue, which often causes the airway to be more obstructed.

(See the watermark in the source of the picture) As shown in the picture, there is a pillow (or soft cushion, if you don’t have the condition to rest on your thigh).

The child can be placed in the "sniff position".

Note: The child's jaw is raised, and the neck is relatively "straightened" (see the watermark in the picture source).
How do you understand the action of "straightening"? (Not using brute force to pull the child's cervical spine, please pay attention!) The following uses the concept of "axial plane" in the head and neck of anesthesiology to demonstrate: O oral axis P throat axis T tracheal axis.

Source: The network can see that by raising the occiput and raising the head, the OPT three-axis angle is significantly reduced and the airway is more unobstructed.

B: Breathing: Observe: breathing rate, breathing effort, thoracic movement, breathing sounds of the respiratory tract and lungs.

Operation: Mask oxygen (best) or mouth-to-mouth artificial respiration.

Mask oxygen is undoubtedly the easiest way to maintain basic breathing when the artificial airway is not established.
It is limited in popularity and is not accessible to ordinary people.

(The practical ball and soft cushion/plastic mask can be quickly made out) The placement range of infant mask and the way of oxygen supply.
In the right picture, pressing the plane of the baby’s thyroid cartilage is to prevent excessive gas from entering the esophagus and causing flatulence.
Ordinary people who are professionally trained should not imitate.

Photo source: One-handed and two-handed mask lifting method for network professionals.

Source: See below for the explanation of network artificial respiration.
In short, ensuring the child's continuous Breathing is the key to this step.

C: Circulation: Observe: skin color, body temperature, heart rate, blood pressure, pulse, capillary filling time, etc.

Operation: chest compressions.

Here are a few pictures to quickly get the operation of chest compressions.

The above 5 pictures are all from the Internet.
Attention: In the field of emergency, the order of CAB is currently favored.
The purpose is to confirm the pulse first to prevent the patient's heart from being damaged by pressing it indiscriminately.

But here, the child who has been confirmed to be suffocating and causing cardiac arrest should still follow the steps of A to open the airway, B to ensure breathing, and C to press the chest.

Also, if you confirm that your child's heart really stops at this time through pulse and heartbeat, don't hesitate, press! It's gone if you don't press people! D: Disablility Nerve Function Test: The site mainly checks the children's state of consciousness, that is, whether they respond to sounds-whether they respond to painful stimuli.

The above ABCD steps, ordinary people have learned, can also save lives professionally.

Among them, keep in mind: the smoothness of the airway is the first! The last thing ordinary people need to do is all kinds of "indigenous remedies.
"
Whether it is vinegar, duck saliva, Chinese medicine or other magical secret recipes, they are all harmful to the elimination of airway foreign bodies.

According to ABCD in emergency situations, see a doctor as soon as possible in non-emergency situations, is the right way! As an anesthesiologist, we are familiar with the rescue in various emergencies.

As a portable doctor for politicians from all over the world, this profession has been underestimated and even vilified in China, and it is far from being respected that matches the profession.

As a young anesthesiologist, I hope that through popular science, more ordinary people will have first aid skills, and they will also understand us who are lonely with the god of death.

This article was originally published on the Zhihu platform and has been authorized by Dr.
Ling Chumian.

Author: Lingken, screen name "Ling Chu sleep", Union Hospital, Huazhong University of Science anesthesiologists.

During the epidemic, voluntarily signed up to join the Xiehe Anesthesia Intubation Commando and fought for 55 days in the new crown front line of Wuhan Xiehe West Hospital.

The team has accumulated more than 170 cases of intubation and participated in more than 20 rescue operations.

On behalf of the team, he has repeatedly appeared on various CCTV columns.

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Poke here, more predictable!