The slap of the foreign body impact can be heard in the trachea

Introduction At the end of exhalation, the slap sound of the foreign body impacting the tracheal wall and the subglottic area can be heard at the trachea. It is one of the symptoms of tracheal foreign body. The foreign body has just inhaled, mainly cough. Later, active foreign bodies move with the airflow, which can cause paroxysmal cough and difficulty breathing. The throat is rich in nerve distribution. When it is stimulated by foreign matter that is accidentally inserted by drowning, it produces a defensive cough, forcing foreign matter to escape and protecting the lower respiratory tract. Children with cough or itchy throat are more dangerous than adults.

Cause

(1) Children like to tease the small things, the teeth are not yet born, can not chew food, and the cough reflection is not perfect.

(2) The foreign body itself is smooth, small and light, such as melon seeds, peanuts, beans, small rubber caps, plastic tube caps, etc. are easily inhaled into the respiratory tract.

(3) Bad habits at work, such as shoemakers pinning needles, studs, buttons, etc. between the teeth, occasionally inadvertently, or suddenly speaking, inhaling foreign objects. In addition, it can also be caused by vomiting, anesthesia, poisoning, or suffering from a nervous system disease, so that throat reflex is inhibited. In the upper airway operation, the instrument parts are detached or the tissue is removed, and the instrument is occasionally inhaled during the treatment of the upper root canal.

an examination

Related inspection

Bronchography

When a foreign body enters the lower respiratory tract, there is a severe cough. It often has a long or short asymptomatic period, so it is easy to be misdiagnosed. Due to the nature of the foreign body, the location and shape of the foreign body, the symptoms are also different, which are described as follows:

(1) Throat foreign body

When a foreign body enters the throat, cough, shortness of breath, and reflexive throat occur immediately, causing inspiratory difficulty and wheezing. If the foreign body stays in the mouth of the throat, there is hoarseness or difficulty in swallowing. If a slightly larger foreign body is blocked in the glottis, it can be immediately suffocated to death.

(2) Tracheal foreign body

The foreign body has just been inhaled, and its symptoms are similar to those of the throat, and it is mainly cough. Later, the active foreign body moves with the airflow, which can cause paroxysmal cough and difficulty in breathing. At the end of exhalation, the foreign body can be heard at the trachea to impact the slap sound of the tracheal wall and the subglottic area. And under the thyroid cartilage, the foreign body can be touched and the shock is felt. Because the tracheal cavity is occupied by foreign bodies, or the edema under the glottis is narrow, it causes difficulty in breathing and can cause wheezing.

(three) bronchial foreign body

Early symptoms are similar to tracheal foreign bodies. Different symptoms can occur due to different types of foreign bodies. Botanical foreign bodies, such as peanuts and beans, contain free fatty acid and oleic acid, which are highly irritating to mucous membranes, and often have acute bronchitis symptoms such as high fever, cough, and purulent sputum. If it is a metal foreign body, it has less local irritation. If it does not block, it can remain in the bronchi for several months without symptoms. Later, due to the intrusion of foreign bodies into the bronchus, different degrees of obstruction occurred and different symptoms appeared.

1. The bronchus is not completely blocked. When inhaling, the trachea is enlarged, the air can enter, and when the exhalation is reduced due to bronchi, the exhaled breath is less, and the distal gas at the obstruction is continuously increased, forming obstructive emphysema. When checking, you can find:

1 The chest movement of the affected side is restricted when breathing.

2 The respiratory sounds of the affected side were reduced, the vocal fibrillation was weakened, and the percussion was drum sound.

The 3X fluoroscopy showed that the heart and mediastinum were displaced to the healthy side, and the transverse sac was flat. During the respiratory activity, the heart and mediastinum can be seen, that is, when the end of exhalation, the heart and mediastinum move to the healthy side. When inhaling, the heart and mediastinum move to the center due to increased pressure on the contralateral side. This phenomenon can be distinguished from obstructive atelectasis.

2. The bronchus is completely blocked. When the air is unable to pass during exhalation or inhalation, the distal air at the obstruction is gradually absorbed by the lungs, and finally obstructive atelectasis is formed. During the examination, it was found that the respiratory movement of the affected side was restricted, the chest of the affected side was flat, the breathing sound was weakened or completely disappeared, the vocal fibrillation was weakened, and the percussion of the affected side was dull. X-ray fluoroscopy shows that the heart and mediastinum shift to the affected side, do not move with the breathing, the lateral side of the affected side rises, the intercostal space is reduced, and the lung shadow is denser.

Differential diagnosis

Since the foreign body in the respiratory tract is mostly a child, when the foreign body is inhaled, the family member may not see it, and the child cannot complain of it. Can not ask the history of foreign body inhalation, children often because of wheezing, but were misdiagnosed as "asthmatic bronchitis", or misdiagnosed as "pertussis" due to paroxysmal cough, or misdiagnosis due to long-term respiratory infection "Pneumonia", "bronchodilation" and so on. Therefore, there are localized lesions in the lungs of children, long-term unhealed or good-time offenders. The so-called "three unlike" symptoms are neither lung tuberculosis nor typical bronchial pneumonia, nor other lung diseases. In all cases, the possibility of foreign bodies in the respiratory tract should be considered and should be taken seriously. A detailed physical examination and X-ray examination are important means for diagnosing foreign bodies.

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