Airway foreign body obstruction: An emergency guide to protect your breathing

Author: Chen Hui, head nurse of the First Affiliated Hospital of Naval Medical University

Reviewer: Wang Qin, deputy chief nurse, First Affiliated Hospital of Naval Medical University

Huang Haidong, deputy chief physician, the First Affiliated Hospital of Naval Medical University

A few friends get together for dinner, chatting and laughing, drinking beer, eating crayfish, this "best CP" storm swept our taste buds, not to mention how cool it is! But sometimes, by chance, someone tells a joke, and you laugh while licking the food, but you didn't expect that this laugh would suck the whole crayfish into your throat! At first, you may think that it's no big deal, and you may think that the crayfish has been swallowed into the esophagus. However, when your chest starts to feel stuffy and you have difficulty breathing, you realize that the situation is not good!

This is not a fictional story. Every day, the emergency room of the hospital receives countless patients with various tracheal foreign bodies. From food to small toys, any small object may become a fatal hidden danger.

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1. What is airway foreign body obstruction?

The airway, also known as the respiratory tract, is the channel for the human body to exchange gases. When the airway is blocked by some foreign matter, it is called airway foreign body obstruction. This is an emergency. If not treated in time, it may lead to suffocation or even death within minutes.

2. What are the common airway foreign bodies?

1. Endogenous foreign bodies: mainly refer to substances that originate from the human body and enter the airway due to certain reasons (such as vomiting, airway secretions, etc.), also including bronchial stones.

2. Animal foreign bodies: such as teeth, bones, fish bones, etc. These foreign bodies usually enter the airway due to accidental ingestion or accident. For example, a fish bone may get stuck in the throat or enter the airway while eating.

3. Plant foreign bodies: such as peanuts, melon seeds, nuts, etc. These foreign bodies often enter the airway due to accidental inhalation or swallowing by children or the elderly.

4. Mineral foreign bodies: such as metal products, stones, glass, etc. These foreign bodies usually cause mild irritation and reaction to the airway mucosa. They may enter the airway accidentally or intentionally (such as self-harm).

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3. What are the common causes of airway foreign body obstruction?

1. Children’s teeth are underdeveloped and their laryngeal reflex function is poor.

2. Not concentrating while eating (laughing, crying, talking).

3. Bad habits, such as children putting small objects in their mouths, and workers putting nails, screws, etc. in their mouths due to professional habits.

4. When a person is unconscious, drunk or anesthetized, food, dentures, etc. may accidentally enter the trachea.

5. People who attempt suicide or are mentally ill may intentionally place foreign objects into their mouths and into their airways.

6. Iatrogenic airway obstruction, such as accidental insertion of instruments, dressings or tissues into the mouth, nose or throat during examination, surgery or treatment.

4. Where do foreign bodies in the airway usually stay?

The location where foreign bodies stay in the airway is related to the nature, size, shape, and anatomical characteristics of the airway.

1. Sharp and irregular foreign objects are prone to stay in the glottis (larynx).

2. Large foreign bodies with unusual shapes are more likely to remain in the trachea.

3. Small foreign objects can easily become lodged in the bronchi.

5. What are the symptoms of airway foreign body obstruction?

1. Incomplete obstruction

(1) Severe coughing: When the airway is partially obstructed, the patient can cough hard, resulting in severe coughing.

(2) Wheezing: When the coughing stops, you may hear a wheezing sound.

(3) Dyspnea: There is mild dyspnea and foreign body sensation in the airway.

(4) Changes in complexion and skin: The complexion may appear bluish purple, and the skin, nail beds, and oral mucosa may also turn bluish purple. This is caused by lack of oxygen.

2. Complete obstruction

(1) Dyspnea: The patient will experience obvious dyspnea, manifested as inability to speak and cough.

(2) Painful expression: The patient may pinch his or her neck with his or her hands, making a "V" shape.

(3) Severe cyanosis of the face and skin: Prolonged breathing difficulties can cause severe cyanosis of the face and skin, especially blue lips.

(4) Loss of consciousness and coma: If the obstruction cannot be relieved in time, the patient will soon lose consciousness and fall into a coma due to lack of oxygen.

3. Other common manifestations

(1) Choking and coughing: When foreign objects block the airway, they will irritate the tracheal mucosa, cause bronchial smooth muscle spasm, and induce choking and coughing.

(2) Anxiety: When foreign objects block the airway for a long time, it will affect the mood and manifest as anxiety.

In addition, patients with airway foreign body obstruction may also experience sudden and severe choking, reflex vomiting, hoarseness, etc.

6. How to prevent airway foreign body obstruction?

1. Pay attention to food safety: eat chopped food and avoid swallowing large pieces of difficult-to-swallow food; chew food slowly; avoid talking or laughing while eating; avoid excessive drinking.

2. Special supervision of children: Cultivate the habit of children sitting in a dining chair to eat, teach them to eat quietly, and avoid running, laughing or other activities that may distract their attention while eating. Prevent children from walking, running or playing with food in their mouths to prevent food from entering the airway when they fall. Properly store foreign objects that are easy to be accidentally inhaled, such as small toys, coins, nuts, etc., to ensure that children cannot get them.

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3. Oral hygiene maintenance: brush your teeth and rinse your mouth regularly. Good oral hygiene habits can help reduce bacteria and food residues in the mouth and reduce the risk of airway foreign body obstruction.

4. Avoid dangerous activities: Do not do dangerous actions such as swallowing balloons or chewing large pieces of food to avoid increasing the risk of airway foreign body obstruction.

5. Learn first aid skills: Understand and master correct first aid skills, such as the Heimlich maneuver, which is essential for dealing with airway foreign body obstruction.

6. Regular physical examinations: help detect potential health problems, such as oral diseases, respiratory diseases, etc., which may increase the risk of airway foreign body obstruction.

7. Use safe tableware: Choose safe tableware suitable for children, the elderly and other groups that are prone to making mistakes, such as spoons and chopsticks that are not easy to break, to reduce the possibility of accidentally swallowing foreign objects.

8. Implement first aid for choking: Master the correct first aid steps for choking, including abdominal impact and chest compression, and provide immediate rescue in an emergency.

9. Perform lung function exercises regularly: helps to strengthen respiratory muscle strength, improve gas exchange efficiency, and reduce the risk of airway foreign body obstruction.

10. Use ventilator-assisted ventilation: For those with sleep apnea or other breathing disorders, customized ventilator equipment should be used under the guidance of a physician to prevent food from entering the trachea due to weakened swallowing reflex during sleep.

7. How to provide first aid in case of airway foreign body obstruction?

1. Back tapping method: Suitable for patients with clear consciousness and severe airway obstruction. The rescuer stands to the side of the patient, slightly closer to the back of the patient, supports the patient's chest with one hand, lets the patient lean forward, and uses the base of the other hand to tap the patient's shoulder blades five times.

2. Abdominal impact method (Heimlich emergency method): The patient is standing or sitting, and the rescuer stands behind the patient, with his arms around the patient's waist, asking him to bend over and tilt his head forward; the rescuer holds a hollow fist with one hand, with the thumb side of the fist pressed tightly between the patient's xiphoid process and navel, and holds the fist with the other hand, and impacts inward and upward quickly with force. Repeat the impact 5 times. If the obstruction is not relieved, continue to perform 5 back percussions alternately.

3. Self-help method: The patient holds a hollow fist with one hand, and uses the thumb of the fist to press against the position of two horizontal fingers above the navel of the abdomen. With the other hand, hold the fist tightly and push upward and inward for 5 times. Repeat the operation several times until the foreign body in the airway is cleared.

4. First aid for special groups: For pregnant women or obese people, abdominal impact method should not be used. Chest impact method can be used. The technique is the same as abdominal impact method, but the thumb is placed in the middle of the sternum, and be careful to avoid the rib margin and xiphoid process.

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If airway obstruction occurs, you must remain calm and take correct emergency measures. If the measures are ineffective, go to the hospital emergency department immediately and use respiratory endoscopic interventional treatment to promptly relieve airway obstruction.

8. What is respiratory endoscopic interventional treatment for airway foreign body obstruction?

Interventional therapy is a minimally invasive treatment method that allows for local biopsy and treatment of lesions under the guidance of imaging equipment, without exposing the lesions through surgery, through tiny channels on the skin, or existing channels in the human body. In the case of airway foreign body obstruction, interventional therapy mainly enters the airway through natural cavities (such as the nasal cavity and oral cavity) to directly treat the foreign body.

1. Methods of respiratory endoscopic interventional therapy

(1) Bronchoscopy for foreign body removal

√ Principle of operation: Directly observe and remove foreign bodies in the airway through bronchoscope.

√ Applicable situations: Used to diagnose and treat difficult-to-locate or complex airway foreign body obstruction situations.

√Advantage: The location of foreign matter can be directly observed and removed accurately.

(2) Rigid bronchoscopy technique

√Operation principle: The operation is performed using a rigid bronchoscope, which can be combined with a variety of techniques (such as freeze-thaw, cryosection, high-frequency snare, high-frequency electrosurgical unit, argon gas knife, etc.) to perform foreign body resection or removal.

√ Applicable situations: Applicable to complex situations such as airway neoplasm obstruction and tumors.

√Advantages: Flexible operation, able to handle various complex airway obstruction situations.

(3) Airway stent implantation

√ Operating principle: A stent is implanted in the airway to support the narrowed or obstructed airway.

√ Applicable situations: Applicable to obstruction caused by airway stenosis, collapse, etc.

√Advantages: Can quickly restore airway patency and relieve patient symptoms.

2. Precautions after respiratory endoscopic interventional treatment

(1) Do not eat or drink for 2 hours after respiratory endoscopic interventional treatment. Eat warm and soft food and observe whether there is any discomfort such as choking.

(2) Observe breathing closely to check for symptoms such as dyspnea, chest tightness, or chest pain.

(3) Take antibiotics or other medications as prescribed by your doctor when necessary.

(4) Follow the doctor's advice and have a chest CT scan and electronic bronchoscopy performed one month later.

(5) Correct bad behavior and eating habits promptly, and do not talk or play while eating.

3. Effect of respiratory endoscopic interventional therapy

Respiratory endoscopic interventional therapy is very effective in the treatment of airway foreign body obstruction, which can quickly relieve the obstruction and restore the patient's respiratory function. At the same time, respiratory endoscopic interventional therapy has the advantages of less trauma and faster recovery, which is of great significance for improving the quality of life of patients.