Categories: FOREIGN BODIES IN THE AIR AND FOOD PASSAGES
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery
The questions arising are:
I. Is a foreign body present?
2. Where is it located?
3. Is a peroral endoscopic procedure indicated?
4. Are there any contraindications to endoscopy?
In order to answer these questions the definite routine given below is
followed unvaryingly in the Bronchoscopic Clinic.
2. Complete physical examination, including mirror laryngoscopy.
3. Roentgenologic study.
The history should note the date of, and should delve into the details
of the accident; special note being made of the occurrence of
laryngeal spasm, wheezing respiration heard by the patient or others
(asthmatoid wheeze), fever, cough, pain, dyspnea, dysphagia,
odynphagia, regurgitation, etc. The amount, character and odor of
sputum are important. Increasing amounts of purulent, foul-odored,
sometimes blood-tinged sputum strongly suggest prolonged bronchial
foreign body sojourn. The mode of onset of the persisting symptoms,
whether immediately following the supposed accident or delayed in
their occurrence, is to be noted. Do attacks of sudden dyspnea and
cyanosis occur? What has been the previous treatment and what attempts
at removal have been made? The nature of the foreign body is to be
determined, and if possible a duplicate thereof obtained.
General physical examination should be complete including inspection
of the eyes, ears, nose, pharynx, and mirror inspection of the
naso-pharynx and larynx. Special attention is paid to the chest for
the localization of the object. In order to discover conditions
rendering endoscopy unusually hazardous, all parts of the body are to
be examined. Aneurysm of the aorta, excessive blood pressure, serious
cardiac and renal conditions, the presence of a hernia and the
existence of central nervous disease, as tabes dorsalis, should be at
least known before attempting any endoscopic procedure. Dysphagia
might result from the pressure of an unknown aneurysm, the symptoms
being attributed to a foreign body, and aortic aneurysm is a definite
contraindication to esophagoscopy unless there be foreign body present
also. There is no absolute contraindication to the endoscopic removal
of a foreign body, though many conditions may render it wise to
post-pone endoscopy. Laryngeal crises of tabes might, because of their
sudden onset, be thought due to foreign body.