Strana tijela disajnih puteva

Traheobronhoskopija
Profesor dr Šekib Umihanić

sekib.umihanic@gmail.com
Respiratorna insuficijencija
Akutna

Hronična

Parcijalna (snižene vrijednosti O2, normalne CO2)

Globalna (snižene vrijednosti O2, povišene CO2)

-Kompenzovana pH 7,35-7,45

-Dekompenzovana Ispod 7,35 ili preko 7,45

KLINIČKA SLIKA

STADIJ EKSCITACIJE

Započinje napadom kašlja, apnejom i cijanozom. Tipično je da traje 5 do 10

minuta.

Kašalj je posljedica nadražaja ogranaka vagusa, a apneja i cijanoza posljedica su

bronhospazma ili laringospazma.
STADIJ LATENCIJE
Nakon aspiracije stranog tijela simptomi se ubrzo smire i slijedi razdoblje bez simptoma.

Napadi kašlja, apneje i cijanoze mogu se javiti u različitim vremenskim razdobljima,

kada se strano tijelo pomakne.

Karakterističan znak stranog tijela u dušniku je tzv. balotman. Čuje se udarac pri udisaju,
jer strano tijelo udari u bifurkaciju dušnika, te pri izdisaju, jer ono udari u glasnice, pri
čemu se one refleksno adduciraju.
STADIJ KOMPLIKACIJA

simptomi stranog tijela mogu se pogoršavati, npr zbog bubrenja vegetabilnog stranog
tijela ili zbog popratne upale okolnog zida.

Može se javiti spastični bronhitis, recidivirajuće pneumonije, bronhiektazije i plućni

apsces.
SUMNJA NA STRANO TIJELO U DISAJNIM PUTEVIMA
(MKB: J-70)
Strana tijela se prema porijeklu dijele na organska i neorganska.

Organska strana tijela dijele se na vegetabilna i nevegetabilna.

Vegetabilna strana tijela, npr. grah, grašak, imaju sposobnost da

bubre, mogu dati simptome kasnije.
Instrumentarij za bronhoskopiju
 Indications for bronchoscopy

-history of aspiration of a foreign body,

- undefinite history followed by coughing or choking or dyspnea,

-indication from pediatrician

Period Total (No.) Per year (No.) Positivie findings Mortality (%)
N %

1954-1968 56* - 56 - 3.57**

1971-1985 204 14.57 128 62.7 0.70

1987-1998 230 19.01 136 59.1 0.87

1999-2004 172 28.60 85 49.4 0.00

* Minimal possible number of bronchoscopies,

** Maximal percentage of mortality (there is no data about total number of performed bronchoscopy).

From 1954. to 2004. the six children (0.9%) died during bronchoscopy at ORL Clinic Tuzla.
 Age: 9 months to 14 years

- 65.2% occurred within the first 3 years

Type 1954-1968 1971-1985 1987-1998 1999-2004

Organic 94.6 95.7 83.8 78.1

Non-organic 5.4 4.3 8.8 15.6

Indefinite nature - - 7.4 6.3

Foreign body 1954-1968 1971-1985 1987-1998 1999-2004

Peanut --- 15.0 18.4 37.5

Walnut --- 5.7 9.2 12.5

Bean 46 29.2 14.6 9.4

Pumpkin seed 12.5 8.5 6.8 3.1

Grain of coffee --- 8.5 8.8 6.3

 Larynx 0.2%

Trachea 14.4%

Left bronchus
Right bronchus
29.5%
53.0%
1.
TURBAN PIN ASPIRATION SYNDROM
Turban pin aspiration has gradualy increased in last 20 years.

Newly distinguished foreign body (turban pin) aspiration has been encountered among
adolescent girls, especially in Islamic countries.
The history is the same in all cases: they have aspirated these pins while talking, laughing, deep
breathing and coughing during these manoeuvres
2.
 STATUS POST LARYNGECTOMIAM TOTALEM
VOICE RESTAURATION

1. Oesophageal voice
2. Voice prothesis
3. Electrolarynx
VOICE PROTHESIS
Đ.O. 75 y.

DG: Status post laryngectomiam totalem et irradiationem

-Aspiration improvisation "voice prosthesis"
3.
DG: Status post laryngectomiam totalem et irradiationem

-Aspiration improvisation "voice prosthesis"

4.
A 41-year - old man with history of schizophrenia,
The patient aspirated a larger piece of a spoon in order to commit
suicide.
Vital observations were normal.
The chest X-ray revealed a metal FB a 11-cm-long foreign object in
distal part of trachea and right main bronchus.
The patient was scheduled promptly for rigid bronchoscopy under general
anaesthesia, without endotracheal intubation. In case of a failure through
endoscopy, the tracheotomy and the extraction of a FB with
tracheostoma as a backup plan.

A findings were normal in larynx. A metal FB reaching to the right main

bronchus was present in distal parts of trachea, engaged with a curved tip
directing to the front.

The attempt was to remove the FB with a bronchoscope no. 9 but it was a
failure due to the diameter of a foreign body which was larger than the
diameter of an instrument. Than the trachea was entered in parallel with
pincers and the instrument no. 7.
The dimensions of the FB are 11cm x 1 cm (curved end) representing the
handle of the metal spoon.
After the successful extraction of the FB, the control check of the bronchial
tree was performed, and the findings were normal.
After the procedure, the patient was in a good condition and the next day
he was leave from hospital.