Diagnosis and treatment of plastic pen cap foreign

2022-08-06
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Diagnosis and treatment of foreign bodies with plastic pen caps in children's respiratory tract

the reason is that when the volume of the two lungs is not much different, the suction of the left lung is longer due to the thin left bronchus, and the suction is greater than the short and thick right bronchus. Moreover, the plastic pen cap is relatively light, and enters the left bronchus with the side with large suction. Panzimin (1980) believed that the right bronchus was thick and short, the pen cap was not easy to be embedded, and moved in series with the air flow; The left bronchus is thin and long, which is similar to the thickness of the pen cap. The plastic pen cap is easy to be embedded in the pen cap. It is a foreign body in the respiratory tract that is difficult to take out. The medical staff should pay enough attention to it. First, make a clear diagnosis, determine the nature, shape, size and position of the foreign body in the trachea. For those complicated with pneumonia, intrapulmonary infection and atelectasis, it should be fully anti-inflammatory, reduce the swelling of bronchial mucosa, and facilitate the removal of the foreign body. Tracheotomy should be carried out before operation, The size of the foreign body should be determined according to the specific situation at that time. Before operation, the appropriate bronchoscope should be selected according to the size of the child. If possible, the bronchoscope with a slightly thicker length should be selected as far as possible. The selection of foreign body forceps is mainly dense tooth forceps and reverse tension forceps. The instruments for tracheotomy are prepared for the rescue of children with laryngeal spasm and asphyxia. General anesthesia is a necessary condition for successful operation. It is not easy to master the depth of anesthesia for children around 10 years old. The anesthesia is shallow. The children are restless. For laryngospasm, the matching correction action should be performed after the connecting stick/head fall. The foreign body is easy to fall off in the glottis; The end face of the anesthesia pressure needle has a certain extension length L relative to the pressure foot plane. The child is drunk. The child has no spontaneous breathing, and the blood oxygen saturation decreases. It is impossible to remove the foreign body. From our experience, it is better to give an appropriate amount of muscle relaxant. The glottis is loose and open. The foreign body is easy to be removed. The foreign body in the pen cap should be operated by an experienced doctor. After inserting the bronchoscope, remove the secretion, carefully check the position of the foreign body and the embedment with the bronchial wall. If there is a small amount of granulation on the surface of the foreign body, it can be removed by forceps; If the bronchus is full of granulation and no foreign body can be seen at all, the granulation can not be taken out blindly to prevent complications such as pneumothorax. When the pen cap is clamped with reverse tension forceps or dense tooth forceps, it cannot be forcibly pulled outward to prevent damage to the bronchus and serious complications such as pneumothorax. Because the pen cap is embedded in the bronchus, causing atelectasis, the foreign body is firmly absorbed by the negative pressure, and it is very difficult to take it out. Some people use the drilling method to relieve the current negative pressure; Or the electrocoagulation method is commonly used in clinical practice to clamp the pen cap to rotate or pry, first remove the negative pressure at the far end of the pen cap, pull the pen cap as close to the bronchoscope lip as possible, make the pen cap and the mirror body in a straight line, and withdraw the bronchoscope together with the pen cap. When the pen cap is removed by forceps, it is often encountered that the pen cap falls off at the glottis, and a displaced foreign body is formed in the healthy lung. Since the atelectasis of the side lung was blocked by foreign bodies, the two lungs could not exchange gas, and the children would suffer asphyxia and the blood oxygen saturation would decrease. This is a very dangerous situation. Many reported cases of collision death. The second ed* quick rescue is to intubate the trachea, pressurize oxygen, tap the atelectasis side lung with a fist, and try to take a pen when the blood oxygen saturation is close to normal to prevent the foreign bodies from falling off and entering the other side of the bronchus to suffocate, In the anesthesia department of our hospital, a fine ventilation catheter under the healthy side bronchus was injected with oxygen, and the pen cap fell off without asphyxia. The author encountered a case in which the cylindrical pen cap with a diameter of 1.2cm and a length of 1.5cm fell off at the glottis to the opposite side, and the child was asphyxiated. The blood oxygen saturation was reduced to 30. Emergency endotracheal intubation was performed, pressurized oxygen was given, and the left lung was knocked at the same time. The blood oxygen saturation gradually increased to 95. Under complete anesthesia, the endotracheal intubation was pulled out, and the foreign body was removed under bronchoscope, Only 2min is allowed, otherwise the blood oxygen saturation will drop below 50. After 3 repetitions, the foreign body is finally removed. Under general anesthesia, the breathing completely disappears, the double vocal cords are in cadaveric position, the glottis is large and the resistance is small, so it is easy to take out the large foreign body in the final analysis. However, at this time, the anesthesia risk is great. Before the blood oxygen saturation decreases, the foreign body must be taken out, otherwise it is necessary to re intubate, pressurize oxygen, maintain breathing. For those who can not find the foreign body due to the long embedding time of the pen cap and the granulation completely wrapping the foreign body, we will ask the thoracic surgery to open the chest and take out the pen cap, There were 4 cases in this group. We thought that the pen cap was wrapped, the inflammatory granulation in the bronchus grew, the structure was unclear, bleeding, pneumothorax and other serious complications were easy to occur, and it was inappropriate to forcep the foreign body blindly

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