aerodigestive-benda asing kuliah5

8/9/2019 Aerodigestive-benda Asing Kuliah5

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Caustic Ingestion andForeign Bodies of theAerodigestive Tract

Dr Dony Hartanto SpTHT MKes


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Caustic Ingestion Esophagus, pharyn, !aryn

Bases Drain c!eaners

E!ectric dish"asher soap

Hair re!aant

Acids

B!eaches


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Caustic Ingestion #,$$$ !ye ingestions in chi!dren % #

years

Most in &itchen

High fa'i!y stress

Suicide atte'pts in adu!ts


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Caustic Ingestion A!&a!is ( pH ) *

+iuefaction necrosis

Acids ( pH % * Coagu!ation necrosis

B!eaches ( pH - * Irritants


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Caustic Ingestion A'ount

Type

Concentration Ti'e of contact

Acute phase

+atent period

Stricturefor'ation


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Caustic Ingestion Initia! 'anage'ent reuires

diagnosis

History

./tain container

0oison contro!

E'esis1


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Caustic Ingestion +aryngea! in2ury1

Hoarseness, stridor, dyspnea

Severe in2ury1 .dynophagia, droo!ing, refusa! of food

0erforation1 Chest pain, a/do'ina! pain, rigidity


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Caustic Ingestion 3eigh/oring in2ury

Ea'ination of !ips, chin, hands,

chest, c!othing .ropharyn

Suction, !ighting, restraint

+aryn4hypopharyn F!ei/!e 5/eroptic scope, 'irror


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Caustic Ingestion 6adio!ogic ea'

Chest 7 nec& radiographs

Bariu' s"a!!o" 8i!! not revea! 9stand :nddegree

in2uries


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Caustic Ingestion Esophagoscopy in virtua!!y a!! patients at

:; ?ei/!e de/ata/!e

Endoscopy to upper !i'it of severe /urn


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Caustic Ingestion @rade 9 < super5cia! in2ury

@rade : ( trans'ucosa! in2ury

@rade ( trans'ura! in2ury

Circu'ferentia! vs> !oca!ied in2ury


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Caustic Ingestion B!each ingestion

#


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Caustic Ingestion @oa!

0reventing per'anent

in2ury or stricture in

esophagus


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Caustic Ingestion Di!ution

8ater or 'i!&

3eutra!iing su/stancescontraindicated Eother'ic reaction

Ana!gesics


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Caustic Ingestion Anti/iotics 0ro

Decrease /acteria! counts 6eduction in granu!ation

Con In?u of gra' negatives Mas& infection 3o reduction in strictures

A'pici!!in ( #$ 'g4&g4day


16/61

Caustic Ingestion Steroids

Meti! 0redniso!one ( : 'g4&g4day :9 days then taper

Most eective for grade : in2uries

Strictures easier to 'anage Anderson ( no /ene5t


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Caustic Ingestion 0revention of acid re?u

H: /!oc&ers

0roton pu'p inhi/itors


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Caustic Ingestion +athyrogens

0revent cova!ent cross


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Caustic Ingestion 3asogastric tu/e

Esophagea! stent

0revent adherence of anterior andposterior "a!!s of esophagus


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Caustic Ingestion Strictures deve!op in 9$


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Caustic Ingestion 0rograde di!ation

ac&son si!&


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Caustic Ingestion 6etrograde di!ation

Safer1Tuc&er di!ators


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Caustic Ingestion @runtig /a!!oon catheter

6adia! direction of di!ation


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Caustic Ingestion


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Caustic Ingestion Esophagea! rep!ace'ent

Co!onic interposition

e2una! interposition

@astric pu!!


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Caustic Ingestion Esophagea! carcino'a

9,$$$ increased ris&

9 to *9 years after in2ury

Better prognosis than usua!esophagea! cancer


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Caustic Ingestion


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Foreign Bodies Foreign /ody ingestion

Foreign /ody aspiration

Todd!ers .ra! ep!oration

+ac& posterior dentition

Easy distracti/i!ity

Cognitive deve!op'ent Gedi/!e1


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Foreign Body Ingestion Coins ( *#

Meat

egeta/!e 'atter

+ess than :; hours in 'ost


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Foreign Body Ingestion 0arenta! suspicion

Sy'pto's Cho&ing, coughing, dysphagia,

odynophagia

0hysica! ea' Droo!ing, refuses p>o>, fussy chi!d

6espiratory co'pro'ise


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Foreign Body Ingestion Co''on !ocations

Cricopharyngeus

Aorta4!eft 'ainste' /ronchus @astroesophagea! 2unction


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Foreign Body Ingestion 6adiopaue

Coins

Carti!age4/ones

6adio!ucent Hot dogs

Bariu' s"a!!o"


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Foreign Body Ingestion Bariu' S"a!!o"


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Foreign Body Ingestion ./servation

6ecent ingestion

B!unt o/2ect Endoscopy

Co'p!ete o/struction Air"ay co'pro'ise

I'pacted Caustics Ano'a!ies


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Foreign Body Ingestion

6e'ova! @enera! anesthesia

Intu/ated

Esophagoscopy Ea'ine for u!ceration4perforation


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Foreign Body Ingestion Disc /atteries

E'ergency

3a.H, K.H, 'ercury 9 hour ( 'ucosa! da'age : to ; hours ( 'uscu!ar !ayers = to 9: hours ( perforation

Esophagoscopy ./servation for gastric !ocation for ;


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Foreign Body Ingestion 0ostoperative 'anage'ent

30. for ;


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Foreign Body Ingestion Ba!!oon Catheter Etraction

Eective in J$

Endoscopy for fai!ures Co'p!ications

E'esis EpistaisTrachea! p!ace'ent +aryngospas' Air"ay co'pro'ise


39/61

Foreign Body Aspiration Freuent!y resu!ted in death prior to :$th

century

@ross /ronchoto'y in a!! casesL Ki!!ian ( 9=J* ( 9st/ronchoscopic

re'ova! of foreign /ody Ear!y 9J$$s ( dista! i!!u'ination ac&son ( revo!utionied 5e!d of

/ronchoesophago!ogy 9J*$s ( rod !ens te!escopes


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Foreign Body Aspiration egeta/!e 'atter in *$


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Foreign Body Aspiration Bronchi ( =$


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Foreign Body Aspiration History

Cho&ing @agging 8heeing Hoarseness Dysphonia

Can 'i'ic asth'a, croup, pneu'onia

A positive history 'ust never /eignored, "hi!e a negative history 'ay /e'is!eadingL


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Foreign Body Aspiration Cho&ing episode "ith coughing, gagging

or "heeing Asy'pto'atic interva!

:$


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Foreign Body Aspiration 0hysica! ea'

+aryn4cervica! trachea Inspiratory or /iphasic stridor

Intrathoracic trachea 0ro!onged epiratory "heee

Bronchi neua! /reath sounds Diagnostic triad < %#$

ni!atera! "heee Cough Ipsi!atera!!y di'inished /reath sounds

Fi/eroptic !aryngoscopy


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Foreign Body Aspiration 6adiography

0A 7 !atera! vie"s of chest 7 nec&

Inspiration 7 epiration +atera! decu/itus vie"s

Air"ay ?uoroscopy

:# have nor'a! radiography


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Foreign Body Aspiration


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Foreign Body Aspiration@oa!

0ro'pt endoscopic re'ova! underconditions of 'ai'a! safety and'ini'a! trau'a


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Foreign Body Aspiration Co'p!ete air"ay o/struction

6espiratory distress

Ina/i!ity to spea& or cough 0artia! air"ay o/struction

Coughing

@agging

Throat c!earing

Bac& /!o"s4pro/ing hypopharyn notreco''ended


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Foreign Body Aspiration Co'p!ete air"ay o/struction

% one year Bac& /!o"s

) one year @ent!e a/do'ina! thrusts "hi!e supine

.!der chi!dren4adu!ts Hei'!ich 'aneuver


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Foreign Body Aspiration sua!!y 3.T A DI6E EME6@E3CN

Trained personne!

Instru'ents asse'/!ed and chec&ed A"ait for e'ptying of sto'ach

Find dup!icate FB to test instru'ents

and techniues


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Foreign Body Aspiration @enera! anesthesia

Spontaneous venti!ation

+aryngoscopes Bronchoscopes

Suction

Forceps

6od


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Foreign Body Aspiration 6eady to assu'e air"ay during

induction

+aryngoscopy Ea'ination of upper air"ay Atrau'atic insertion of /ronchoscope

Topica! anesthesia Bronchoscopy

Attached to venti!ating circuit


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Foreign Body Aspiration Bronchoscopy

Suction opposite /ronchus

Advance to foreign /ody Atrau'atica!!y grasp foreign /ody

6epeat /ronchoscopy Suction /ronchus

Mu!tip!e foreign /odies in #


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S!ipped foreign /ody 0ush /ac& into /ronchus

Sharp foreign /ody Advance /ronchoscope over FB


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Co'p!ications 0neu'onia

Anti/iotics, physiotherapy Ate!ectasis

Epectant 'anage'ent, physiotherapy

0neu'othora 0neu'o'ediastinu'


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0ostoperative Care Chest physiotherapy for retained

secretions Anti/iotics

3ot routine!y used

Steroids 3ot routine!y usedTrau'atic insertion or re'ova!

aerodigestive-benda asing kuliah5

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