"You said the blockage is not in the throat?" Zhang Huayao asked Xie Wanying while observing hard.
Blockages generally do not fall into the trachea immediately, which is why foreign bodies in the airway are common, but it is not uncommon for suffocation to fall into the trachea. The physiological reactions and structures of the human body are effective in preventing daily foreign bodies from being swallowed.
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The most common physiological reaction is the gag reflex, that is, touching the posterior wall of the pharynx with a tongue depressor will cause nausea and vomiting.
One of the most important anatomical structures in our human body to prevent foreign bodies from accidentally entering the trachea is the epiglottis. We have already talked about this place during the last fiberoptic bronchoscopy. So what I want to say now is that if there is a foreign body, due to the physiological defense function of the epiglottis,
Most foreign objects will be repelled and stuck around the epiglottis.
An experienced emergency physician who encounters a patient with foreign body obstruction will perform a focused examination in this area.
Based on her previous observations in the children's mouths and preliminary judgments of brain formation, Xie Wanying said: "No foreign bodies were found in the tonsils and oropharynx on both sides. No foreign bodies were found at the intersection of the tongue base and the epiglottis. Foreign bodies are often referred to in textbooks as retention.
There is no abnormality in the piriform fossae on both sides of the laryngeal entrance. Therefore, the blockage should have fallen into the trachea, probably at the tracheal bifurcation. The length of the trachea of a five-year-old child is about five centimeters. You can try using laryngeal foreign body forceps.
Come and get it.”
As expected of an excellent medical student, everything she said was critical, making the teacher blameless. As she said, 20 to 30% of foreign bodies will fall into the tonsils and oropharynx on both sides. Most of them will.
It falls into the base of the tongue and the epiglottis. As for the piriform fossa where foreign bodies are retained as written in textbooks, it is rare.
Zhang Huayao carefully inspected these places and found no foreign matter. This is certainly not a good thing for the child. As long as the doctor does not find the foreign matter, the patient will die. Now he can only hope that the foreign body fell into the trachea instead of the bronchi.
Go, as long as a direct laryngoscope can be found here, there is an opportunity to use the direct laryngoscope and foreign body forceps to remove the foreign body.
Dong Dong Dong Dong, Lin Liqiong ran back again, until she was almost out of breath. This time after opening the small blue box she brought in, she finally lived up to her expectations and got a direct laryngoscope.
"Do you have foreign body forceps?" Zhang Huayao asked.
"Yes." Lin Liqiong gasped while touching the pockets of her white coat. Maybe she was too anxious, and her hands could not stop shaking.
Xie Wanying stretched out her hand and held her hand to stop her trembling.
"Thank you." Lin Liqiong whispered, calming down and taking out the things in her pocket, "I can only find this."
Zhang Huayao took the equipment she found and looked at it carefully and said, "That's not right."
"This is the endotracheal intubation forceps." Cao Yong looked at it and knew something was wrong, so he said.
The classification of medical devices is very detailed. Although doctors often use inappropriate medical devices to treat patients in emergencies under forced circumstances, some of them are really incompatible.
For example, the current endotracheal intubation forceps have a round head and a relatively large cross-section, which is quite awkward when entering the child's trachea, but it can remove foreign objects from the feeding tube. The front-to-back diameter of a five-year-old child's trachea is about eight millimeters.
Taking the front-to-back diameter as an example, the reason is that the trachea is not a right cylinder, but a flat type. The front-to-back diameter and the transverse diameter are not the same, and the transverse diameter is larger than the front-to-back diameter. Both the front-to-back diameter and the transverse diameter are more than ten years larger in children than in adults.
