異物講座課件

ForeignBodiesForeignbodyingestionForeignbodyaspirationToddlersOralexplorationLackposteriordentitionEasydistractibilityCognitivedevelopment(edible?)2021/5/71ForeignBodyIngestionCoins–75%Bones(mainlyfishbone)MeatVegetablematterFalseteethLessthan24hoursinmost2021/5/72ForeignBodyIngestionParentalsuspicionSymptomsChoking,coughing,dysphagia,odynophagiaPhysicalexamDrooling,refusesp.o.,fussychildRespiratorycompromise2021/5/73ForeignBodyIngestionCommonlocationsTonsilsValleculaepiglotticaPyriformsinusesCricopharyngeusAorta/leftmainstembronchusGastroesophagealjunction2021/5/74ForeignBodyIngestionRadiopaqueCoinsCartilage/bonesRadiolucentHotdogsBariumswallow2021/5/75ForeignBodyIngestionBariumSwallow2021/5/76ForeignBodyIngestionObservationRecentingestionBluntobject EndoscopyCompleteobstructionAirwaycompromiseImpactedCausticsAnomalies2021/5/77ForeignBodyIngestionRemovalGeneralanesthesiaIntubatedEsophagoscopyExamineforulceration/perforation2021/5/78ForeignBodyIngestionDiscbatteriesEmergencyNaOH,KOH,mercury1hour–mucosaldamage2to4hours–muscularlayers8to12hours–perforationEsophagoscopyObservationforgastriclocationfor4-7daysLaparotomyforbowelperforation2021/5/79ForeignBodyIngestionComplicationPerforationofesophagusSubcutaneous/mediastinalemphysemaMediastinalabscessBreakoftheaortaEsophagealfistula/stricture2021/5/7109、人的價值，在招收誘惑的一瞬間被決定。2023/2/32023/2/3Friday,February3,202310、低頭要有勇氣，抬頭要有低氣。2023/2/32023/2/32023/2/32/3/20234:56:45PM11、人總是珍惜為得到。2023/2/32023/2/32023/2/3Feb-2303-Feb-2312、人亂于心，不寬余請。2023/2/32023/2/32023/2/3Friday,February3,202313、生氣是拿別人做錯的事來懲罰自己。2023/2/32023/2/32023/2/32023/2/32/3/202314、抱最大的希望，作最大的努力。03二月20232023/2/32023/2/32023/2/315、一個人炫耀什么，說明他內(nèi)心缺少什么。。二月232023/2/32023/2/32023/2/32/3/202316、業(yè)余生活要有意義，不要越軌。2023/2/32023/2/303February202317、一個人即使已登上頂峰，也仍要自強(qiáng)不息。2023/2/32023/2/32023/2/32023/2/32021/5/711PerforationTachycardiaTachypneaFeverChestpain2021/5/712ForeignBodyIngestionBalloonCatheterExtractionEffectivein90%EndoscopyforfailuresComplicationsEmesisEpistaxisLaryngospasmAirwaycompromise2021/5/713ForeignBodyIngestionPostoperativemanagement

Fasting>7dforperforation2021/5/714ForeignBodyAspirationVegetablematterin70-80%Peanuts&othernuts(35%)Carrotpieces,beans,sunflower&watermelonseedsMetallicobjectsPlasticobjects2021/5/715ForeignBodyAspirationBronchi–80-90%RightmainstemmostcommonCarinaLessdivergentangleGreaterdiameterTracheaLarynxLargerobjects,irregularedgesConformingobjects2021/5/716ForeignBodyAspirationHistoryChokingGaggingWheezingHoarsenessDysphoniaCanmimicasthma,croup,pneumonia“Apositivehistorymustneverbeignored,whileanegativehistorymaybemisleading”2021/5/717ForeignBodyAspirationChokingepisodewithcoughing,gaggingorwheezingAsymptomaticinterval20-50%notdetectedforoneweekInflammationandComplicationsCoughEmphysemaObstructiveatelectasisHemoptysisPneumoniaLungabscessFever2021/5/718ForeignBodyAspirationPhysicalexamLarynx/cervicaltracheaInspiratoryorbiphasicstridorIntrathoracictracheaProlongedexpiratorywheezeBronchiUnequalbreathsoundsDiagnostictriad-<50%UnilateralwheezeCoughIpsilaterallydiminishedbreathsoundsFiberopticlaryngoscopy2021/5/719ForeignBodyAspirationRadiographyPA&lateralviewsofchest&neckInspiration&expirationLateraldecubitusviewsAirwayfluoroscopy25%havenormalradiography2021/5/72002021/5/721ForeignBodyAspiration2021/5/722ForeignBodyAspiration2021/5/723ForeignBodyAspiration2021/5/724ForeignBodyAspiration2021/5/725ForeignBodyAspirationGoaloftreatmentPromptendoscopicremovalunderconditionsofmaximalsafetyandminimaltrauma2021/5/726ForeignBodyAspirationUsuallyNOTADIREEMERGENCYTrainedpersonnelInstrumentsassembledandcheckedAwaitforemptyingofstomachFindduplicateFBtotestinstrumentsandtechniques2021/5/727ForeignBodyAspirationGeneralanesthesiaSpontaneousventilationLaryngoscopesBronchoscopesSuctionForcepsRod-lenstelescopes2021/5/728ForeignBodyAspirationReadytoassumeairwayduringinductionLaryngoscopyTopicalanesthesiaExaminationofupperairwayAtraumaticinsertionofbronchoscopeBronchoscopyAttachedtoventilatingcircuit2021/5/729ForeignBodyAspirationBronchoscopySuctionoppositebronchusAdvancetoforeignbodyAtraumaticallygraspforeignbodyRepeatbronchoscopySuctionbronchusMultipleforeignbodiesin5-19%RemovegranulationtissueTopicalvasoconstrictorsforbleeding2021/5/730ForeignBodyAspirationSlippedforeignbodyPushbackintobronchusSharpforeignbodyAdvancebronchoscopeoverFB2021/5/731ForeignBodyAspirationComplicationsPneumoniaAntibiotics,physiotherapyAtelectasisExpectantmanagement,physiotherapyPneumothoraxPneumomediastinum2021/5/732CausticIngestion5,000lyeingestionsinchildren<5yearsMostinkitchenHighfamilystressSuicideattemptsinadults2021/5/733CausticIngestionAlkalis–pH>7LiquefactionnecrosisAcids–pH<7CoagulationnecrosisBleaches–pH=7Irritants2021/5/734CausticIngestionAmountTypeConcentrationTimeofcontact2021/5/735CausticIngestionGrade1-superficialinjuryGrade2–transmucosalinjuryGrade3–transmuralinjuryCircumferentialvs.localizedinjury2021/5/736CausticIngestionAcutephase(1-2w)LocalGeneralLatentperiod(1-2w)Strictureformation2021/5/737CausticIngestionInitialmanagementrequiresdiagnosisHistoryObtaincontainerPoisoncontrolEmesis?2021/5/738CausticIngestionLaryngealinjury?Hoarseness,stridor,dyspneaSevereinjury?Odynophagia,drooling,refusaloffoodPerforation?Chestpain,abdominalpain,rigidity2021/5/739CausticIngestionNeighboringinjuryExaminationoflips,chin,hands,chest,clothingOropharynxSuction,lighting,restraintLarynx/hypopharynxFlexiblefiberopticscope,mirror2021/5/740CausticIngestionRadiologicexamChest&neckradiographsBariumswallowWillnotreveal1stand2nddegreeinjuries2021/5/741CausticIngestionEsophagoscopyinvirtuallyallpatientsat24-48hourspost-ingestion<24hours–underestimationofinjury>48-72hourswithriskofiatrogenicperforation–bariumswallowRigidvs.flexibledebatableEndoscopytoupperlimitofsevereburn2021/5/742CausticIngestionBleachingestion5-6%sodiumhypochloriteProduceulcerationNormaloropharynx–bariumswallowBurnedoropharynx-esophagoscopy2021/5/743CausticIngestionGoaloftreatmentPreventingpermanentinjuryorstrictureinesophagus2021/5/744CausticIngestionDilutionWaterormilkNeutralizingsubstancescontraindicatedExothermicreactionAnalgesics2021/5/745CausticIngestionAntibioticsProDecreasebacterialcountsReductioningranulationConInfluxofgramnegativesMaskinfectionNoreductioninstricturesAmpicillin–50mg/kg/day2021/5/746CausticIngestionSteroidsPrednisone–2mg/kg/dayx21daysthentaperMosteffectiveforgrade2injuriesStrictureseasiertomanage2021/5/747CausticIngestionPreventionofacidrefluxH2blockersProtonpumpinhibitors2021/5/748CausticIngestionNasogastrictubeEsophagealstentPreventadherenceofanteriorandposteriorwallsofesophagus2021/5/749CausticIngestionStricturesdevelopin10-15%DilationProgradeRetrogradeBallooncathetersEsophagealreplacement2021/5/750CausticIngestionProgradedilationJacksonsilk-wovenbougiesHurstdilatorsMaloneydilators2021/5/751CausticIngestionRetrogradedilationSa