"You said the blockage is not in the throat?" Zhang Huayao asked Xie Wanying while observing carefully.
Blockages generally do not fall into the trachea immediately, which is why foreign bodies in the airway are common, but suffocation from falling into the trachea is not a very common occurrence. The physiological reactions and structures of the human body are effective in preventing the accidental swallowing of foreign bodies in daily life.
The most common physiological reaction is the pharyngeal reflex, which means that touching the back wall of the pharynx with a tongue depressor will cause nausea and vomiting.
The most important anatomical structure in our human body to prevent foreign bodies from entering the trachea is the epiglottis. We have already talked about this place in the last fiberoptic bronchoscopy. Now let’s talk about this: if there is a foreign body, due to the physiological defense function of the epiglottis, most of the foreign bodies will be rejected and stuck around the epiglottis.
An experienced emergency physician encountering a patient with foreign body obstruction would focus his examination on this area.
Based on her previous observations in the child's mouth and the initial judgment formed by the brain, Xie Wanying said: "No foreign body was found in the tonsils and oropharynx on both sides. No foreign body was found at the junction of the tongue root and epiglottis. There was no abnormality in the piriform sinuses on both sides of the throat entrance, which is often mentioned in textbooks as a place where foreign bodies are retained. Therefore, the obstruction should have fallen into the trachea, and it is expected to be in the tracheal bifurcation. The trachea of a five-year-old child is about five centimeters long, so it can be tried to remove it with laryngeal foreign body forceps."
As expected of an excellent medical student, every point she mentioned was a key point, leaving the teacher with nothing to criticize. As she said, 20 to 30 percent of foreign bodies will fall into the tonsils and oropharynx on both sides. Most will fall into the root of the tongue and epiglottis. As for the place where foreign bodies are retained as written in the textbook, the pyriform sinus is rare.
Zhang Huayao carefully checked these places and found no foreign body. This is certainly not a good thing for the child. As long as the doctor does not find the foreign body, the patient will be in danger of death. Now we can only hope that the foreign body has fallen into the trachea instead of the bronchus. As long as a direct laryngoscope can be found here, there is a chance to use the direct laryngoscope and foreign body forceps to remove the foreign body.
Boom boom boom, Lin Liqiong ran back again, running until she was almost out of breath. This time, after opening the small blue box she brought in, she finally brought out the direct laryngoscope as expected.
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"Do you have foreign body forceps?" Zhang Huayao asked.
"Yes." Lin Liqiong panted and touched the pocket of her white coat. Maybe she was too anxious, and her hands were shaking uncontrollably.
Xie Wanying reached out and held her hand to help her stop the trembling.
"Thank you." Lin Liqiong whispered, calming herself down and taking something out of her pocket, "This is all I can find."
Zhang Huayao took the instrument she found and looked at it carefully, and said, "No."
"This is a tracheal tube forceps." Cao Yong looked at it and knew it was wrong, so he said.
Medical devices are classified very carefully. Although doctors often have to use inappropriate medical devices to treat patients in emergencies, some of them are really not universal.
For example, the head of this tracheal intubation forceps is round and the cross section is relatively large. It is difficult to insert it into a child's trachea, but it can be inserted into the esophagus to remove foreign objects. The anteroposterior diameter of the trachea of a five-year-old child is about eight millimeters. The reason for the anteroposterior diameter is that the trachea is not a perfect cylinder, but a flat one. The anteroposterior diameter and the transverse diameter are different, and the transverse diameter is larger than the anteroposterior diameter. Both the anteroposterior diameter and the transverse diameter of children are much smaller than those of adults.
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