Upper respiratory tract obstruction_engl.ppt
Transcript
Upper respiratory tract obstruction recognition and Corrective Actions Josip Lesko, dr. med. Obstruction of upper respiratory tract - most common causes and manifestations Anatomy Nasal skeleton - Pyramid nasal bones cartilage quadrangular triangular alar Obstruction of upper respiratory trac...
Upper respiratory tract obstruction recognition and Corrective Actions Josip Lesko, dr. med. Obstruction of upper respiratory tract - most common causes and manifestations Anatomy Nasal skeleton - Pyramid nasal bones cartilage quadrangular triangular alar Obstruction of upper respiratory tract - most common causes and manifestations The air flow mechanism through the nose Obstruction of upper respiratory tract - most common causes and manifestations The air flow mechanism through the nose Laminar Turbulent In the case of normal airflow disturbance, the nasal obstruction is the result Upper Airway Obstruction Noisy Breathing Noise during INSPIRATION Noise during EXPIRATION Difficulty breathing IN Difficulty breathing OUT Proximal to Thoracic Inlet Distal to Thoracic Inlet Nose, pharynx, larynx Trachea, bronchi, peripheral airways Obstruction of upper respiratory tract - most common causes and manifestations The causes of nasal obstruction Structural •changes in tissue •trauma •congenital malformation Systemic •physiological changes •pathological Obstruction of upper respiratory tract - most common causes and manifestations Structural changes Septal changes - Deviation - Perforation - Abscess or hematoma Collapsing nose valves Nasal shell hypertrophy Adenoid hypertrophy Nasal polyps Neoplasms Choanal atresion Obstruction of upper respiratory tract - most common causes and manifestations Systemic changes - Physiological changes The nasal cycle Positional obstruction - Pathological changes Metabolic and endocrine changes Rhinitis Allergic, infectious, atrophic, medicamentosa, vasomotor, chronic rhinosinusitis Foreign bodies of the nose Obstruction of upper respiratory tract - most common causes and manifestations Normal septum Septal deviation Obstruction of upper respiratory tract - most common causes and manifestations Nose fracture Obstruction of upper respiratory tract - most common causes and manifestations Trauma of the nose sport, accident, game, traffic accident Difficult or impossible breathing on the nose due to obstruction due to: edema deformation of the septum hematoma Obstruction of upper respiratory tract - most common causes and manifestations Nose trauma - nasal bone fracture X-ray, CT Obstruction of upper respiratory tract - most common causes and manifestations • Septal perforation Possible causes of septal perforation TRAUMA INFECTIONS/INFLAMMATION Local trauma Syphilis Surgery (septum) Lepra Cautery (el, kem) TBC Septal abscess Wegener's granulomatosis Cocain necrosis Lupus eritematodes Polychondritis Heavy metal poisoning TUMOR IDIOPATSKI Obstruction of upper respiratory tract - most common causes and manifestations Nasal valve collapse Obstruction of upper respiratory tract - most common causes and manifestations • Nasal concha hypertrophy Obstruction of upper respiratory tract - most common causes and manifestations Adenoid hypertrophy Obstruction of upper respiratory tract - most common causes and manifestations • Nasal polyps Obstruction of upper respiratory tract - most common causes and manifestations Nasal polyps – Choanal polyp Obstruction of upper respiratory tract - most common causes and manifestations Neoplasm Inverted papilloma Juvenile angiofibroma Sarcomas Squamous cell carcinoma Obstruction of upper respiratory tract - most common causes and manifestations • Choanal atresion Obstruction of upper respiratory tract - most common causes and manifestations RHINITIS • • • • • • Allergic Infectious Atrophic Medicamentosa Vasomotor Chronic rhinosinusitis Obstruction of upper respiratory tract - most common causes and manifestations Medicamentous rhinitis Obstruction of upper respiratory tract - most common causes and manifestations Nasal cavity foreign bodies Obstruction of upper respiratory tract - most common causes and manifestations Diagnostics • • • • • Inspection of the nose Rhinoscopy Fiberendoscopy CT, MR Ultrasound Dyspnoea • Stenosis location: Pharynx Larynx Trachea and bronchi Pharynx • Abscess (peritonsillar, retropharyngeal, base of tongue) • Angioedema • OSA • Tumors Pharynx • Abscess (peritonsillar, retropharyngeal, base of tongue) Pharynx • Angioedema Pharynx • OSA Pharynx • Tumors Larynx • • • • • • • Congenital stridor Epiglottitis and epiglottis abscess paralysis of the vocal cords Laryngeal spasm Foreign bodies Tumors Trauma Larynx • Congenital stridor Larynx • Epiglottitis and epiglottis abscess Larynx • paralysis of the vocal cords Larynx • Laryngeal spasm Larynx • Tumors Larynx • Trauma Larynx • Foreign bodies Heimlich maneuver Trachea and bronchi • Tracheitis and bronchitis with stenosis and chondritis • Foreign bodies • External compression (struma) • Tracheomalacia • Scar tissue stenosis • Trauma • Tumor Trachea and bronchi • Tracheitis and bronchitis with stenosis and chondritis Trachea and bronchi • Foreign bodies Trachea and bronchi • External compression (struma) Trachea and bronchi • Tracheomalacia Trachea and bronchi • Scar tissue stenosis Trachea and bronchi • Tumor Diagnostics • Anamnesis • Examionation with spatula • Indirect laryngoscopy • Direct laringotraheobronhoscopy • X-ray Treatment • Intubation • Tracheotomy • Conicotomy Intubation Coniotomy Foreign bodies • Hypopharynx and esophagus • Larynx, trachea and bronchi • Nose • Ear Hypopharynx and esophagus • Fish bone, bones, toothpicks... • Smaller - tonsills, root of tongue, vallecula • Toys, coins, flat bones, dental prostheses • Bigger - pyriform sinus, 1st or 2nd constriction Symptoms • Dysphagia • Odinophagia • Mediastinitis Larynx, trachea and bronchi • 80% between 1st and 3rd year of life • Peanuts, nuts, pins, coins, buttons, beans, toy pieces... • The episodes of coughing, intermittent or permanent dyspnea with cyanosis, pain and occasional hoarseness • Right Bronch 63% Corpus alienum Bronchoscopy and esophagoscopy Unconsciousness
