Foreign body entry stage: severe coughing, extreme dyspnea (impacted in the glottis) or slight coughing/holding of breath (entering the bronchus)

Quiet phase: only mild symptoms (such as cough, mild dyspnea) or no symptoms at all. Irritation/inflammatory phase: cough, atelectasis, emphysema

Complication period: mild cases include bronchitis and pneumonia; severe cases include lung abscess and empyema

Foreign bodies in the trachea: severe coughing and vomiting occur immediately, accompanied by flushed face and ears, suffocation, and difficulty breathing. Large foreign bodies can cause immediate suffocation; common signs include asthma, wheezing, and tracheal slapping sounds (foreign bodies hit the subglottic area upwards with the airflow).

Bronchial foreign body: early symptoms are similar to tracheal foreign body, but once it enters the bronchus, the coughing symptoms are alleviated; the foreign body blocks the bronchial cavity → dyspnea and chest discomfort; the foreign body is plant-based → obvious bronchitis; the foreign body is still mobile → highly spastic. Choking and coughing

Chest X-ray/lateral cervical X-ray; including direct signs and indirect signs (obstructive emphysema, obstructive atelectasis)

Mediastinal swing: seen in obstructive emphysema; when exhaling, air cannot be discharged, the intrapulmonary pressure on the affected side is greater than the unaffected side, and the heart and mediastinum are pushed to the unaffected side; when inhaling, the pressure within the unaffected lung increases, and the heart and mediastinum move to the affected side

Diagnosis, differential diagnosis, treatment

Acute laryngitis, bronchopneumonia, tuberculosis

① Diagnose in time and remove foreign bodies as soon as possible; ② Keep the respiratory tract open to prevent heart failure caused by dyspnea and hypoxia

Foreign bodies in the trachea: The "wait and wait" method can be used to remove them under direct laryngoscopy; for those who fail, they can be removed under bronchoscopy.

Bronchial foreign bodies: rigid tube bronchoscopy; direct method can be used in adults, indirect method is often used in children

Fiberoptic bronchoscope: suitable for small foreign bodies that are difficult to see with rigid tube bronchoscope

Tracheotomy and thoracotomy to remove foreign bodies

Complications: heart failure, severe pneumothorax, infection

Dysphagia: The degree is related to the shape and size of the foreign body, and whether there is secondary infection; in severe cases, symptoms such as salivation, nausea, and regurgitation may occur

Painful swallowing: The degree is related to the shape and size of the foreign body, and whether there is secondary infection; when the foreign body is located at the entrance of the esophagus, the pain is mostly localized in the middle/side of the neck; when the foreign body is located in the upper part of the esophagus, the pain is mostly located at the base of the neck/suprasternal fossa; foreign body When it is located in the thoracic esophagus, the pain is usually located behind the sternum and can radiate to the back.

Respiratory symptoms: difficulty breathing, choking

Limited neck movement: sharp foreign body at the esophageal entrance, periesophageal inflammation → neck muscle spasm → nuchal ankylosis

Fever: indicates secondary inflammation

Neck examination: There is tingling when the front edge of the sternocleidomastoid muscle compresses the esophagus medially or there is pain when moving the trachea → it indicates a sharp irritant

Subcutaneous emphysema: indicates possible esophageal perforation

X-ray examination: has decisive diagnostic significance for radiopaque foreign bodies (such as metallic foreign bodies); esophageal barium examination can be used for those who cannot be visualized by

Esophagoscopy: the final basis for diagnosis; visible foreign bodies are more common at the entrance of the esophagus, followed by the second stricture; not suitable for patients with esophageal perforation, periesophageal inflammation, and periesophageal abscesses

Esophageal perforation: cervical subcutaneous emphysema, pneumomediastinum esophagitis

Periesophagitis: most common complication

Mediastinitis and abscess: seen with esophageal perforation; purulent mediastinitis is the most common serious complication

Large blood vessel rupture: Aortic arch perforation is the most common

Tracheoesophageal fistula, esophageal stenosis

lower respiratory tract infection

acute phase

Remission period: If no complications occur, the pain gradually disappears, swallowing function recovers, wounds gradually heal, food intake increases, and subjective symptoms are relieved.

Scar stenosis stage: generally occurs 3 to 4 weeks after injury; when the lesions involve the muscle layer, scars will appear, and then esophageal stenosis will occur, swallowing dysfunction will reappear, and gradually worsen

Throat examination: Oropharyngeal mucosa is congested and swollen, pseudomembrane is formed after epithelial shedding, and appears erosive when secondary infection occurs; mucosal edema at the epiglottis and arytenoid cartilage can be seen in laryngeal involvement.

Imaging: especially if complications are suspected

Esophagoscopy: usually performed about 2 weeks after injury

Systemic: Symptoms of systemic poisoning may occur

Local: bleeding, esophageal perforation and mediastinitis, gastric burns/gastric perforation/peritonitis, laryngeal edema/aspiration pneumonia/pulmonary abscess/bronchiectasis, esophageal scar stenosis (unavoidable complications)

Neutralizer: Suitable for those who seek medical treatment within 1 to 2 hours after injury; note that sodium bicarbonate is prohibited for acid burns

antibiotic

Glucocorticoids: anti-shock, eliminate edema, and inhibit scar formation; but are contraindicated when the esophageal damage is extremely severe, local necrosis, or perforation is suspected.

Supportive therapy: rehydration, maintenance of water, electrolyte and acid-base balance, nutritional support

Tracheotomy: when symptoms of laryngeal obstruction are obvious

Endoscopy: performed after systemic symptoms are relieved to understand the extent of esophageal damage

Choose antibiotics and glucocorticoids for treatment according to the severity of the condition, and gradually reduce the dosage until they are discontinued; those with suspected esophageal stenosis should have a gastric tube/nutritional tube for nasogastric feeding as soon as possible

Esophagoscope bougie dilation (the disease is mild and localized), linear dilation, retrograde dilation (the disease is serious and extensive), memory titanium alloy stent implantation in the esophagus, surgery