Mechanical asphyxia– is a complete or partial blockage respiratory tract, leading to disruption in vital organs due to oxygen starvation. Asphyxia can lead to death if the cause of its occurrence is not eliminated in time. Frequent victims of asphyxia may be infants, elderly people, patients with epilepsy, persons in alcohol intoxication.
Asphyxia is an emergency condition and requires urgent measures to eliminate it. Knowing some general rules, such as examining the oral cavity for the presence of a foreign body, tilting the head to the side to avoid tongue retraction, and mouth-to-mouth artificial respiration can save a person’s life.
Interesting Facts
- The most sensitive organ during oxygen starvation is the brain.
- The average time of death with asphyxia is 4–6 minutes.
- Game with asphyxiation - children's way receiving euphoria as a result in various ways by briefly introducing the body into a state of oxygen starvation.
- During asphyxia, involuntary urination and defecation are possible.
- Most common symptom asphyxia - convulsive painful cough.
- Asphyxia is diagnosed in 10% of newborn children.
What are the mechanisms of asphyxia?
To understand the mechanisms of development of asphyxia, it is necessary to consider in detail the human respiratory system. Breathing is a physiological process necessary for normal human functioning. During breathing, when you inhale, oxygen enters the body, and when you exhale, carbon dioxide is released. This process is called gas exchange. The respiratory system provides all organs and tissues with oxygen, which is necessary for the functioning of absolutely all cells of the body.
Structure of the respiratory tract:
- upper respiratory tract;
- lower respiratory tract.
Upper respiratory tract
The upper respiratory tract includes nasal cavity, oral cavity, as well as the nasal and oral parts of the pharynx. Passing through the nose and nasopharynx, the air is warmed, moistened, and cleansed of dust particles and microorganisms. The temperature of the inhaled air increases due to its contact with the capillaries ( the smallest vessels ) in the nasal cavity. The mucous membrane helps to humidify the inhaled air. The cough and sneeze reflex helps prevent various irritating compounds from entering the lungs. Some substances located on the surface of the nasopharyngeal mucosa, such as lysozyme, have antibacterial effect and are capable of neutralizing pathogenic microorganisms.Thus, passing through the nasal cavity, the air is purified and prepared for further entry into the lower respiratory tract.
From the nasal and oral cavities, air enters the pharynx. The pharynx is simultaneously part of the digestive and respiratory system, being a connecting link. It is from here that food can enter not into the esophagus, but into the respiratory tract and, as a result, become the cause of asphyxia.
Lower respiratory tract
The lower respiratory tract is the final section of the respiratory system. It is here, or more precisely in the lungs, that the process of gas exchange occurs.The lower respiratory tract includes:
- Larynx. The larynx is an extension of the pharynx. Below, the larynx borders the trachea. The hard skeleton of the larynx is the cartilaginous frame. There are paired and unpaired cartilages, which are connected to each other by ligaments and membranes. The thyroid cartilage is the largest cartilage of the larynx. It consists of two plates articulated at different angles. So, in men this angle is 90 degrees and is clearly visible on the neck, while in women this angle is 120 degrees and it is extremely difficult to notice the thyroid cartilage. Important role plays the epiglottic cartilage. It is a kind of valve that prevents food from entering the lower respiratory tract from the pharynx. The larynx also includes the vocal apparatus. The formation of sounds occurs due to changes in the shape of the glottis, as well as when the vocal cords are stretched.
- Trachea. The trachea, or windpipe, consists of arched tracheal cartilages. The number of cartilages is 16 - 20 pieces. The length of the trachea varies from 9 to 15 cm. The mucous membrane of the trachea contains many glands that produce secretions that can destroy harmful microorganisms. The trachea divides and passes below into the two main bronchi.
- Bronchi. The bronchi are a continuation of the trachea. The right main bronchus is larger than the left, thicker and more vertical. Just like the trachea, the bronchi consist of arcuate cartilage. The place where the main bronchi enter the lungs is called the hilum of the lungs. After this, the bronchi branch repeatedly into smaller ones. The smallest of them are called bronchioles. The entire network of bronchi of various sizes is called the bronchial tree.
- Lungs. The lungs are a paired respiratory organ. Each lung consists of lobes, with right lung there are 3 lobes, and in the left - 2. Each lung is penetrated by an extensive network bronchial tree. Each bronchiole ends ( smallest bronchus) transition to the alveoli ( hemispherical sac surrounded by blood vessels). This is where the process of gas exchange occurs - oxygen from the inhaled air penetrates into circulatory system, and carbon dioxide, one of the end products of metabolism, is released with exhalation.
Asphyxia process
The process of asphyxia consists of several successive phases. Each phase has its own duration and specific characteristics. In the last phase of asphyxia, a complete cessation of breathing is observed.There are 5 phases in the process of asphyxia:
- Pre-asphyxial phase. This phase is characterized by a short cessation of breathing for 10–15 seconds. Erratic activity is common.
- Dyspnea phase. At the beginning of this phase, breathing becomes more frequent and the depth of breathing increases. After a minute, exhalation movements come to the fore. At the end of this phase, convulsions, involuntary bowel movements and urination occur.
- Brief cessation of breathing. During this period, there is no breathing, as well as pain sensitivity. The duration of the phase does not exceed one minute. During a period of short-term respiratory arrest, you can only determine the work of the heart by feeling the pulse.
- Terminal breathing. Trying to take one last deep breath of air. The victim opens his mouth wide and tries to catch air. In this phase, all reflexes weaken. If by the end of the phase foreign object does not leave the airways, then complete cessation of breathing occurs.
- The phase of complete cessation of breathing. The phase is characterized by the complete inability of the respiratory center to maintain the act of breathing. Persistent paralysis of the respiratory center develops.
When a foreign object enters the respiratory system, a cough occurs reflexively. The first stage of the cough reflex involves taking a shallow breath. If a foreign object only partially closes the lumen of the respiratory tract, then a large share most likely it will be pushed out during a forced cough. If there is a complete blockage, then a shallow breath can aggravate the course of asphyxia.
Oxygen starvation
As a result of complete closure of the airway, mechanical asphyxia leads to respiratory arrest. As a result, oxygen starvation occurs in the body. The blood, which is enriched with oxygen in the alveoli at the level of the lungs, contains extremely small reserves of oxygen due to the cessation of breathing. Oxygen is essential for most enzymatic reactions in the body. In its absence, metabolic products accumulate in cells, which can damage the cell wall. In case of hypoxia ( oxygen starvation), the energy reserves of the cell are also sharply reduced. Without energy, a cell is unable to perform its functions for a long time. Different tissues respond differently to oxygen deprivation. Thus, the brain is the most sensitive, and Bone marrow– least sensitive to hypoxia.
Disorders of the cardiovascular system
After a few minutes, hypoxemia ( low oxygen levels in the blood) leads to significant disturbances in the cardiovascular system. The heart rate decreases and blood pressure drops sharply. Disturbances in heart rhythm are observed. This causes an overflow venous blood, rich in carbon dioxide, of all organs and tissues. There is a bluish complexion – cyanosis. The cyanotic hue occurs due to the accumulation in the tissues of a large amount of protein that transports carbon dioxide. In the case of serious vascular diseases, cardiac arrest can occur at any phase of the asphyxial state.
Damage to the nervous system
The next link in the mechanism of asphyxia is damage to the central nervous system ( central nervous system). Consciousness is lost at the beginning of the second minute. If the flow of oxygen-rich blood does not resume within 4 to 6 minutes, the nerve cells begin to die. For normal functioning The brain should consume approximately 20 - 25% of the total oxygen received during breathing. Hypoxia will lead to death in case of extensive damage to the nerve cells of the brain. In this case, there is a rapid oppression of all vital important functions body. This is why changes in the central nervous system are so destructive. If asphyxia develops gradually, the following manifestations are possible: impaired hearing, vision, and spatial perception.
Involuntary acts of urination and defecation often occur with mechanical asphyxia. Due to oxygen starvation, the excitability of the soft muscles of the intestinal wall and bladder increases, and the sphincters ( orbicularis muscles that act as valves) relax.
Highlight the following types mechanical asphyxia:
- Dislocation. Occurs as a result of closure of the airway lumen by displaced damaged organs ( language, lower jaw, epiglottis, submandibular bone).
- Strangulation. Occurs as a result of strangulation with hands or a noose. This type of asphyxia is characterized by extremely strong compression of the trachea, nerves and vessels of the neck.
- Compression. Compression of the chest by various heavy objects. In this case, due to the weight of the object squeezing the chest and abdomen, it is impossible to perform breathing movements.
- Aspiration. Penetration into the respiratory system by inhalation of various foreign bodies. Common causes of aspiration are vomit, blood, and stomach contents. Usually, this process occurs when a person is unconscious.
- Obstructive. There are two types of obstructive asphyxia. First type – asphyxia of the lumen of the respiratory tract, when foreign objects can enter the respiratory tract ( food, dentures, small objects). Second type - asphyxia from covering the mouth and nose with various soft objects.
Highlight following types obstructive asphyxia:
- closing the mouth and nose;
- closing the airway.
Closing the mouth and nose
Closing of the mouth and nose is possible due to an accident. So, if a person falls face first onto a soft object during an epileptic seizure, this can lead to death. Another example of an accident is if, while breastfeeding, the mother unknowingly closes the baby's nasal cavity with her mammary gland. With this type of asphyxia you can find following signs: flattening of the nose, a pale part of the face that was adjacent to a soft object, a bluish tint to the face.Closure of the airway
Closure of the airway lumen is observed when a foreign body enters it. Also, the cause of this type of asphyxia can be various diseases. A foreign body can close the airway during fear, screaming, laughing or coughing.Obstruction by small objects usually occurs in small children. Therefore, you need to carefully ensure that the child does not have access to them. Elderly people are characterized by asphyxia caused by the entry of a denture into the lumen of the respiratory tract. Also, the absence of teeth and, as a result, poorly chewed food can lead to obstructive asphyxia. Alcohol intoxication is also one of the most common causes of asphyxia.
The course of asphyxia may be affected by the following: individual characteristics body:
- Floor. To determine the reserve capabilities of the respiratory system, the concept of vital capacity ( vital capacity). vital capacity includes the following indicators: tidal lung volume, inspiratory reserve volume and expiratory reserve volume. It has been proven that women have vital capacity 20–25% less than men. It follows that male body better tolerates the state of oxygen starvation.
- Age. The vital capacity parameter is not a constant value. This indicator varies throughout life. It reaches its maximum by the age of 18, and after 40 years it gradually begins to decline.
- Susceptibility to oxygen starvation. Regular exercise helps increase lung capacity. Such sports include swimming, athletics, boxing, cycling, mountaineering, and rowing. In some cases, the vital capacity of athletes exceeds the average of untrained people by 30% or more.
- Presence of concomitant diseases. Some diseases can lead to a decrease in the number of functioning alveoli ( bronchiectasis, pulmonary atelectasis, pneumosclerosis). Another group of diseases can limit breathing movements, affecting the respiratory muscles or nerves of the respiratory system ( traumatic rupture of the phrenic nerve, trauma to the dome of the diaphragm, intercostal neuralgia).
Causes of asphyxia
The causes of asphyxia can be varied and, as a rule, depend on age, psycho-emotional state, the presence of respiratory diseases, diseases digestive system or associated with the entry of small objects into the respiratory tract. Causes of asphyxia:
- diseases of the nervous system;
- diseases of the respiratory system;
- diseases of the digestive system;
- aspiration of food or vomit in children;
- weakened infants;
- psycho-emotional states;
- alcohol intoxication;
- talking while eating;
- haste in eating;
- lack of teeth;
- dentures;
- entry of small objects into the respiratory tract.
Nervous system diseases
Some diseases of the nervous system can affect the airway. One of the causes of asphyxia may be epilepsy. Epilepsy is a chronic human neurological disease characterized by sudden occurrence convulsive seizures. During these seizures, a person may lose consciousness for several minutes. If a person falls on his back, his tongue may roll back. This condition can lead to partial or complete closure of the airways and, as a result, asphyxia.Another type of nervous system disease leading to asphyxia is damage to the respiratory center. The respiratory center is understood as a limited area medulla oblongata, responsible for the formation of the respiratory impulse. This impulse coordinates all respiratory movements. As a result of traumatic brain injury or swelling of the brain, damage to the nerve cells of the respiratory center may occur, which can lead to apnea ( cessation of breathing movements). If paralysis of the respiratory center occurs during a meal, this inevitably leads to asphyxia.
Neuritis can lead to difficulty swallowing and possible blockage of the airways. vagus nerve. This pathology is characterized by hoarseness and impaired swallowing. Due to unilateral damage to the vagus nerve, paresis may occur vocal cord (weakening of voluntary movements). Also, the soft palate cannot be maintained in its original position, and it descends. With bilateral damage, the act of swallowing is sharply disrupted, and the pharyngeal reflex is absent ( swallowing, coughing or gag reflexes when irritated, the pharynx is impossible).
Respiratory system diseases
There are a number of diseases of the respiratory system that lead to blockage of the airways and cause asphyxia. Conventionally, these diseases can be divided into infectious and oncological.The following diseases can cause asphyxia:
- Abscess of the epiglottis. This pathology leads to swelling of the epiglottic cartilage, an increase in its size and a decrease in its mobility. During food intake, the epiglottis is not able to perform its functions as a valve that closes the lumen of the larynx during the act of swallowing. This inevitably leads to food entering the respiratory tract.
- Quinsy. Phlegmonous tonsillitis or acute paratonsillitis is a purulent-inflammatory disease of the tonsils. Occurs as a complication lacunar tonsillitis. This pathology leads to swelling soft palate and the formation of a cavity containing pus. Depending on the location of the purulent cavity, blockage of the respiratory tract is possible.
- Diphtheria. Diphtheria is an infectious disease that usually affects the oral part of the pharynx. In this case, the occurrence of croup, a condition in which the airways are blocked by diphtheria film, poses a particular danger. The airway can also be blocked if there is extensive swelling of the pharynx.
- Tumor of the larynx. A malignant tumor of the larynx leads to the destruction of surrounding tissues. The degree of destruction determines the size of food that can penetrate from the pharynx into the larynx. Also, the tumor itself can cause asphyxia if it partially or completely blocks the lumen of the larynx.
- Tracheal tumor. Depending on the shape, the tumor can protrude into the lumen of the trachea itself. In this case, stenosis is observed ( narrowing) lumen of the larynx. This will significantly complicate breathing and subsequently lead to mechanical asphyxia.
Digestive system diseases
Diseases of the digestive system can lead to food entering the respiratory tract. Asphyxia can also be caused by aspiration of stomach contents. Swallowing disorders can be a consequence of burns of the mouth and pharynx, as well as in the presence of defects in the anatomy of the oral cavity.The following diseases can cause asphyxia:
- Cancer of the upper esophagus. A tumor of the esophagus, growing, can exert significant pressure on adjacent organs - the larynx and trachea. Increasing in size, it can partially or completely compress the respiratory organs and, thereby, lead to mechanical asphyxia.
- Gastroesophageal reflux. This pathology is characterized by the entry of stomach contents into the esophagus. In some cases, the contents of the stomach can penetrate into the oral cavity, and when inhaled, enter the respiratory tract ( aspiration process).
- Tongue abscess. An abscess is a purulent-inflammatory disease with the formation of a cavity containing pus. The following picture is typical for a tongue abscess: the tongue is enlarged in volume, inactive and does not fit in the mouth. The voice is hoarse, breathing is difficult, there is profuse salivation. With a tongue abscess, a purulent cavity may be located in the root zone and prevent air from entering the larynx. Also, increased size of the tongue can cause asphyxia.
Aspiration of food or vomit in children
Aspiration is the process of various foreign materials entering the respiratory system through inhalation. As a rule, vomit, blood, and stomach contents can be aspirated.Aspiration is quite common among newborns. It can occur if the mammary gland fits tightly into the baby's nasal passages and makes breathing difficult. The child, trying to breathe, inhales the contents of his mouth. Another reason may be the baby's incorrect position during feeding. If the baby's head is tilted back, the epiglottis is not able to completely block the lumen of the larynx from milk entering it.
Aspiration of regurgitated masses during vomiting is also possible. Developmental defects may be the cause digestive tract (esophageal atresia, tracheoesophageal fistula).
Birth trauma, toxicosis during pregnancy ( complication of pregnancy, manifested by edema, increased blood pressure and protein loss in urine), various malformations of the esophagus significantly increase the chance of asphyxia due to aspiration.
Weakened infants
In weakened or premature newborns, the swallowing reflex is usually impaired. This occurs due to damage to the central nervous system. Various infectious diseases that the mother of the child suffers during pregnancy, toxicosis or intracranial birth injury may disrupt the swallowing process. Aspiration breast milk or vomit can cause mechanical asphyxia.Psycho-emotional states
During food intake, various psycho-emotional states can affect the swallowing act. Sudden laughter, screaming, fright or crying can lead to the throwing of a bolus of food from the pharynx into the upper respiratory tract. This is explained by the fact that during psycho-emotional manifestations, air must be exhaled from the larynx to create certain sound vibrations. In this case, food from the oral part of the pharynx can be accidentally sucked into the larynx during the next inhalation.Alcohol intoxication
Alcohol intoxication is a common cause of asphyxia in the adult population. During sleep, aspiration of vomit may occur as a result of impaired gag reflex. Due to inhibition of the functions of the central nervous system, a person is unable to perceive the contents of the oral cavity. As a result, vomit can enter the respiratory tract and cause mechanical asphyxia. Another reason may be the separation of swallowing and respiratory processes. This condition is typical for severe alcohol intoxication. In this case, food and liquid can easily penetrate the respiratory system.Talking while eating
Food particles can be inhaled when talking while eating. Most often, food ends up in the larynx. In this case, a person coughs reflexively. During a cough, pieces of food can usually easily escape into the upper respiratory tract without causing harm to health. If a foreign object was able to fall lower - into the trachea or bronchi, then the cough will not have an effect and partial or complete asphyxia will occur.Haste while eating
Hasty consumption of food not only leads to diseases of the gastrointestinal tract, but can also cause mechanical asphyxia. With insufficient chewing of food, large, poorly processed pieces of food can close the lumen of the oropharynx. If the oral cavity contains a large number of poorly chewed pieces of food, problems with swallowing may occur. If the bolus of food does not release the oropharynx within a few seconds, inhalation will be impossible. Air simply will not be able to penetrate this food bolus and, as a result, a person may choke. The protective mechanism in this case is the cough reflex. If the food bolus is too large and coughing does not lead to its release from the oral cavity, then blockage of the airways is possible.Missing teeth
Teeth serve several functions. Firstly, they mechanically process food to a uniform consistency. Grinded food is more easily processed further in the gastrointestinal tract. Secondly, teeth are involved in the process of speech formation. Thirdly, during the process of chewing food, a complex chain of mechanisms arises aimed at activating the work of the stomach and duodenum.Missing teeth can cause asphyxia. When food enters the oral cavity, it is not crushed enough. Poorly chewed food can get stuck in the mouth and become a foreign object. The large and small molars are responsible for grinding food. The absence of several of them can cause mechanical asphyxia.
Dentures
Dental prosthetics is an extremely popular procedure in dentistry. These services are most often used by older people. Average term The lifespan of dentures varies between 3 and 4 years. After this period, dentures may wear out or become loose. In some cases, they may be partially or completely destroyed. If a denture gets into the respiratory tract, it will irreversibly lead to asphyxia.Inhalation of small objects
Foreign objects can become needles, pins or pins if they are used for quick access to cleaning the oral cavity. Children are characterized by asphyxia, in which coins, balls, buttons and other small objects enter the respiratory tract. Also, small fragments of toys can get into the respiratory tract. Some foods can also cause closure of the airways. These include, for example, seeds, peas, beans, nuts, candies, and tough meat.Symptoms of asphyxia
During asphyxia, a person tries to clear the airways of a foreign object. There are a number of signs that will help you understand that we're talking about specifically about asphyxia.| Symptom | Manifestation | Photo |
| Cough | If a foreign object enters the larynx, a person will reflexively begin to cough. At the same time, the cough is convulsive, painful, and does not bring relief. |  |
| Excitation | A person instinctively grabs his throat, coughs, screams and tries to call for help. Small children are characterized by strangled crying, frightened eyes, wheezing and wheezing ( stridor). Less often, the crying is strangled and muffled. |  |
| Forced pose | Tilt of the head and torso forward allows you to increase the depth of inhalation. |  |
| Blue complexion | As a result of oxygen starvation, a large amount of blood containing carbon dioxide is concentrated in the tissues. A protein that is bound to carbon dioxide and gives skin bluish tint. |  |
| Loss of consciousness | The blood flowing to the brain does not contain enough oxygen. With hypoxia, the nerve cells in the brain cannot function normally, which leads to fainting. |  |
| Stopping breathing | Breathing stops within a few minutes. If the cause of asphyxia is not eliminated and the foreign body is not removed from the lumen of the respiratory tract, then after 4–6 minutes the person will die. |  |
| Adynamia | Decrease motor activity until its complete cessation. Adynamia occurs due to loss of consciousness. |  |
| Involuntary urination and defecation | Oxygen starvation leads to increased excitability of the soft muscles of the walls of the intestines and bladder, while the sphincters relax. |  |
First aid for mechanical asphyxia
Mechanical asphyxia is an emergency condition. The life of the victim depends on the correctness of first aid actions. Therefore, every person must know and be able to provide emergency assistance.Providing first aid in case of mechanical asphyxia:
- self-help;
- providing first aid to an adult;
- providing first aid to a child.
Self Help
Self-help can only be provided when consciousness is maintained. There are several methods that will help in case of asphyxia. Types of self-help for asphyxia:
- Perform 4 – 5 strong cough movements. If a foreign body enters the lumen of the respiratory tract, it is necessary to make 4–5 forced cough movements, while avoiding deep breaths. If a foreign object has cleared the airway, a deep breath can again lead to asphyxia or even worsen it. If a foreign object is located in the pharynx or larynx, then this method may prove to be effective.
- Apply 3 to 4 pressures in the upper abdomen. The method is as follows: place the fist of the right hand in the epigastric region ( top part abdomen, which is bounded above by the xiphoid process of the sternum, and on the right and left by the costal arches), with the open palm of your left hand, press your fist and with a quick sharp movement towards yourself and up, make 3-4 pushes. In this case, the fist, making a movement to the side internal organs, increases pressure inside the abdominal and thoracic cavity. Thus, air from the respiratory system rushes out and is able to push out the foreign body.
- Lean your upper abdomen against the back of a chair or armchair. As in the second method, the method increases intra-abdominal and intrathoracic pressure.
Providing first aid to an adult
Providing first aid to an adult is necessary if he is intoxicated, his body is weakened, in a number of certain diseases, or if he cannot help himself.The first thing to do in such cases is to call an ambulance. Next, you should use special first aid techniques for asphyxia.
Methods of providing first aid to an adult with asphyxia:
- Heimlich maneuver. It is necessary to stand from behind and clasp your arms around the victim’s torso just below the ribs. Place one hand in the epigastric region, clenching it into a fist. Place the palm of the second hand perpendicular to the first hand. With a quick jerking motion, press your fist into your stomach. In this case, all the force is concentrated at the point of contact of the abdomen with thumb hand clenched into a fist. The Heimlich maneuver should be repeated 4 to 5 times until breathing normalizes. This method is the most effective and is most likely to help push a foreign object out of the respiratory system.
- Perform 4–5 palm strikes on the back. Approach the victim from behind, using the open side of your palm to deliver 4 to 5 blows of medium force on the back between the shoulder blades. The blows must be directed along a tangential trajectory.
- A method for providing assistance if a person cannot be approached from behind or is unconscious. It is necessary to change the person's position and turn him on his back. Next, position yourself on the victim’s hips and place the open base of one hand in the epigastric region. With your second hand, press on the first and move deeper and upward. It is worth noting that the victim’s head should not be turned. This manipulation should be repeated 4 – 5 times.
Methods for providing artificial respiration:
- "Mouth to mouth." You must use any rag material ( handkerchief, gauze, piece of shirt) as a gasket. This will avoid contact with saliva or blood. Next, you need to take a position to the right of the victim and sit on your knees. Inspect the oral cavity for the presence of a foreign body. To do this, use the index and middle fingers of the left hand. If it was not possible to find a foreign object, proceed to the next steps. Cover the victim's mouth with a cloth. They tilt the victim's head back with their left hand, and with their right hand they pinch his nose. Make 10 - 15 air injections per minute or one exhalation every 4 - 6 seconds. It should be in close contact with the victim's mouth, otherwise all the inhaled air will not reach the victim's lungs. If the manipulation is performed correctly, you will notice movements of the chest.
- "Mouth to nose." The procedure is similar to the previous one, but has some differences. Exhale into the nose, which is previously covered with material. The number of blows remains the same - 10 - 15 exhalations per minute. It is worth noting that with each exhalation you need to close the victim’s mouth, and in the intervals between blowing air, open your mouth slightly ( this action simulates the passive exhalation of the victim).
Providing first aid to a child
Providing first aid to a child is extremely challenging task. If a child cannot breathe or speak, coughs convulsively, or his face turns bluish, an ambulance should be called immediately. Next, free him from restraining clothing ( blanket, diaper) and begin performing special first aid techniques for asphyxia. Methods of providing first aid to a child with asphyxia:
- Heimlich maneuver for children under 1 year. Place the child on your arm so that the face rests on the palm. It is good to fix the baby's head with your fingers. The legs should be different sides from the forearm. It is necessary to slightly tilt the child's body down. Perform 5–6 tangential pats on the child’s back. Patting is done with the palm of the hand in the area between the shoulder blades.
- Heimlich maneuver for children over 1 year of age. You should place the child on his back and sit on his knees at his feet. Place the index and middle fingers both hands. Apply moderate pressure in this area until the foreign body clears the airways. The technique must be performed on the floor or any other hard surface.
For children under 1 year of age, artificial respiration is performed using the “mouth-to-mouth and nose” method, and for children over 1 year of age, artificial respiration is performed using the “mouth-to-mouth” method. To begin, you should place the baby on his back. The surface on which the child should lie must be hard ( floor, board, table, ground). It is worth checking the oral cavity for the presence of foreign objects or vomit. Next, if a foreign object was not found, place a cushion from available materials under the head and begin blowing air into the child’s lungs. It is necessary to use rag material as a gasket. It should be remembered that exhalation is carried out only with the air that is in the mouth. The volume of a child's lungs is many times less than that of an adult. Forced inhalation can simply rupture the alveoli in the lungs. The number of exhalations for children under one year old should be 30 per 1 minute or one exhalation every 2 seconds, and for children over one year old - 20 per 1 minute. The correctness of this manipulation can be easily verified by the movement of the child’s chest while air is blown in. It is necessary to use this method until the ambulance team arrives or until the child’s breathing is restored.
Do I need to call an ambulance?
Mechanical asphyxia is an emergency condition. Asphyxial status directly threatens the life of the victim and can cause rapid death. Therefore, if signs of asphyxia are recognized in a person, it is necessary to immediately call an ambulance, and then begin to take measures to eliminate asphyxia. It is necessary to remember that only an ambulance team can provide high-quality and qualified assistance. If necessary, all necessary resuscitation measures will be performed - indirect massage heart, artificial respiration, oxygen therapy. Also, emergency doctors can resort to urgently- cricoconicotomy ( opening the laryngeal wall at the level of the cricoid cartilage and conical ligament). This procedure will allow you to insert a special tube into the hole made, and through it you can resume the act of breathing.
Prevention of mechanical asphyxia
Prevention of mechanical asphyxia is aimed at reducing and eliminating factors that can lead to closure of the airway. (applicable to children under one year of age):
- Prevention of aspiration during feeding. It should be remembered that during feeding the baby's head should be elevated. After feeding, it is necessary to ensure that the baby is in an upright position.
- Use of a feeding tube in case of feeding problems. It is not uncommon for a baby to have trouble breathing when bottle feeding. If holding your breath during feeding occurs frequently, then using a special feeding tube may be a way out.
- Prescribing special treatment for children prone to asphyxia. In case of repeated repetition of mechanical asphyxia, the following treatment regimen is recommended: injections of cordiamine, etimizol and caffeine. This regimen can only be used after consultation with your doctor.
- Restricting the child's access to solid foods. Any solid product in the kitchen can cause asphyxia. You need to try to prevent foods such as seeds, beans, nuts, peas, candies, and hard meat from falling into the child’s hands. You should avoid such foods for up to four years.
- Selecting and purchasing safe toys. The purchase of toys should be based on the age of the child. Each toy should be carefully inspected for any removable hard parts. You should not purchase construction sets for children under 3–4 years old.
- Right choice food. Nutrition for a child must strictly correspond to his age. Well-chopped and processed food is a necessity for children under three years of age.
- Keep small items in a safe place. It is worth keeping various office supplies such as pins, buttons, erasers, caps in a safe place.
- Teaching children to chew food thoroughly. Solid food should be chewed at least 30–40 times, and food with a soft consistency ( porridge, puree) – 10 – 20 times.
- Limit alcohol consumption. Drinking alcohol in large quantities can lead to disruption of chewing and swallowing and, as a result, increase the risk of mechanical asphyxia.
- Refusal to talk while eating. During a conversation, an involuntary combination of swallowing and breathing is possible.
- Be careful when eating fish products. Fish bones often get into the lumen of the respiratory tract, causing partial closure of the lumen of the respiratory tract. Also, the sharp part of a fish bone can penetrate the mucous membrane of one of the organs of the upper respiratory tract and lead to inflammation and swelling.
- Use pins, needles and hairpins for their intended purpose. For quick access, hairpins and pins can be placed in the mouth. During a conversation, these small objects can freely penetrate the respiratory tract and cause asphyxia.
Performing any procedure in the oral cavity carries the risk of aspiration: a foreign body. Endodontic instruments, dental rings for fixing rubber dam, standard metal crowns. Aspiration is usually, but not always, accompanied by coughing and choking. If acute respiratory failure develops with the appearance of cyanosis, conicotomy is indicated. If acute respiratory failure does not develop, the patient should be transferred to the emergency room as soon as possible for a chest x-ray and assessment by a general practitioner. If a foreign body in the chest is not detected, abdominal radiography is performed to determine its location in the stomach or intestines
The use of a rubber dam and a safety suture system helps reduce the incidence of aspiration of endodontic instruments.
2. Airborne emphysema is an accumulation under the skin and in the interfascial spaces of air that has entered there under pressure.
The appearance of emphysema may be associated with the use of an air gun to inject under high pressure air into the open cavity of the tooth.
Pressurized air may enter the root canal and exit into the soft tissue, or may directly spread under the soft tissue. Immediately after penetration under the soft tissue, air can spread along the cervical fascia, towards the sternum and follow the paratracheal or prevertebral fascia into the mediastinum. Upward air can be directed through the cheek to the temporal and orbital areas. Airborne emphysema is characterized by a severe clinical picture when infection and air embolism, often leading to death. Due to the abundant vascularization of the head and neck, air can enter into the vascular system through numerous venous anastomoses (eg, pterygoid plexus, facial veins, ophthalmic veins). The resulting emboli travel through the veins and reach the right atrium, which can lead to cardiac arrest.
Symptoms usually develop suddenly; in this case, the patient may complain of swelling in the face and neck, a feeling of heaviness and pressure behind the sternum, limited mouth opening, difficulty swallowing, or facial asymmetry. The most ominous symptoms are sudden blurred vision, acute attacks cough, difficulty breathing, loss of consciousness.
Clinical signs are facial asymmetry, soft tissue crepitus, significant depression of vital functions, increased breathing, cyanosis, arrhythmia or asystole.
Emergency treatment. If the process is superficial and the spread of air has stopped, this condition can stop on its own. It is necessary to begin therapy with broad-spectrum antibiotics and monitor the patient daily until symptoms are completely relieved. If air propagation continues after cessation of dental procedures and progresses to deeper tissues, or cardiovascular or respiratory symptoms, the patient must be urgently hospitalized in the department intensive care the nearest hospital to provide qualified care.
3. Cellulitis, abscesses, osteomyelitis of the jaw bones possible when exudate spreads from the apical periodontium into the surrounding tissues due to untimely treatment or improper treatment. Issues of treatment of acute odontogenic infection are described in detail in educational literature.
Tasks for independent work student
To independently study the topic, you need to familiarize yourself with the methodological recommendations, which outline the main points that you should pay attention to when studying the material presented in the list of references. On practical lesson the student must accept 1 patient with apical periodontitis: collect anamnesis, conduct clinical examination And additional methods research, make a diagnosis, choose a treatment method, carry out endodontic treatment and tooth restoration, and carry out preventive measures.
SITUATIONAL TASKS
Task 1. The child is 8 years old. He has no complaints of pain.
Status localis: in tooth 74 on the mesial-occlusal surface - deep carious cavity, communicating with the tooth cavity. Probing of the coronal pulp and percussion of the tooth are painless, the tooth does not respond to thermal stimuli. There is a fistula on the gum in the area of tooth 74. Referring to the fact that the tooth would soon change, the doctor suggested removing it if pain appeared. According to the doctor, it is not worth removing the tooth at the time of treatment, because it saves space for permanent tooth.
Do you agree with the doctor's position? What complications can this tactic lead to?
Task 2. Child 6 years. Complaints about: the appearance of an “abscess” on; gum to the area of tooth 54, sometimes aching pain appears in this tooth. From the anamnesis: a month ago the tooth was treated for chronic granulating periodontitis.
Status localis: tooth 54 is under a filling, percussion is painless, the gum mucosa in the area of tooth 54 is hyperemic, in the area of the projection of the root apexes there is a fistula with purulent discharge.
On the radiograph: palatal and mesial-buccal root canals obturated to the apical foramen, the distal buccal root is curved, and the root canal is sealed to the bend (by ½ length), in the area of the root apexes there is bone loss with unclear boundaries of 0.4x0.4 mm, bone loss in the area of the follicle of the permanent tooth, cortical the follicle plate is preserved. When compared with the initial radiograph, an increase in the focus of bone tissue loss is noted.
Make a diagnosis. Name possible reasons that led to progression pathological process.
Task 3. The child is 9 years old. Complaints about changes in the color of the tooth crown 11.
From the anamnesis: a year ago, while playing sports, I hit my teeth when I fell. After the impact, the tooth hurt for several days when biting, the pain stopped on its own, I did not see a doctor
Status localis: tooth 11 intact, crown: gray, on the gum in the area of root projection there is a fistula, percussion is painless. On the radiograph: the root is 2/3 formed, the root canal and apical foramen are wide, in the area of the apical foramen there is a rarefaction of bone tissue with unclear boundaries of 0.3x0.3 cm.
The doctor spent next treatment: trepanned the crown, performed instrumental and medicinal treatment of the root canal, after which the canal was sealed with gutta-percha pins, and the crown was restored.
Is the treatment method chosen correctly? Root formation forecast?
Task 4. The child is 13 years old. During endodontic treatment of tooth 46, a K-file was broken to the mesiobuccal canal.
What are the possible reasons for tool breakage? What's your tactic?
Task 5. The child is 9 years old. Complaints about elevated temperature body up to 38°, pain when biting on tooth 36, “swelling” of the left cheek.
From the anamnesis: a day ago, paroxysmal throbbing pain appeared in tooth 36 at night, and the gums in the area of tooth 36 became “swollen.” The pain in the tooth intensified from hot water. The tooth became ill for the first time, the child immediately went to the doctor. A devitalizing paste based on paraformaldehyde was applied to the exposed pulp for 7 days, along with a temporary filling.
Objective data: facial asymmetry due to swelling of the soft tissues of the left submandibular region, regional lymph nodes are enlarged and painful on palpation.
Status localis: tooth 36 under a temporary filling, percussion of the tooth is sharply painful, the mucous membrane of the gums in the area of teeth 75 and 36 is hyperemic, the transitional fold is smoothed, palpation is sharply painful. KPU+KPU = 3+6. On the radiograph: a deep carious cavity is determined on the occlusal surface, the roots are formed to 2/3 of the length, the root canals and the apical foramen are wide. In the area of the root apexes, foci of clearing with clear boundaries of 0.2x0.2 cm are identified.
Make a diagnosis. Was the treatment method chosen correctly? Name the reasons for the complication that has arisen.
LITERATURE
Main
1. Lecture material.
2. Pediatric dentistry / edited by Kolesov A. A. - M.: Medicine, WITH 156-168.
EDUCATIONAL MATERIAL
Errors and complications in the diagnosis and treatment of pulpitis in children in various age periods are associated with a number of circumstances:
1. Difficulties in making a diagnosis associated with the patient’s age, inability or complexity of psychological contact, the inability to fully collect anamnesis and identify complaints from parents and the child, features of the course of the pathological process in the pulp, anatomical features of the tooth, etc.
2. Wrong choice of treatment method.
3. Failure to comply with the indications and necessary conditions for the method of therapy.
4. Violation of the technique of performing the method.
| I. Errors and complications when carrying out conservative methods of treating pulpitis of primary teeth and permanent teeth with unfinished root formation. | |||
| No. | Nature of complications | Causes of complications | Remedies |
| Sharp pain during preparation of a carious cavity and, as a consequence, the inability to continue and complete treatment | Inadequate anesthesia. | Repeated pain relief. | |
| The appearance of paroxysmal spontaneous pain, as well as prolonged pain from various types of irritants, soon after treatment. | a) incorrect determination of indications for conservative methods; b) violation of the technique of performing the method. | Changing the treatment method - devital amputation or extirpation in temporary teeth, vital amputation - in permanent teeth. | |
| Pulp necrosis and, as a consequence, the development of acute or chronic periodontitis. | See previous complication | Endodontic treatment of root canal/canals or extraction - in temporary teeth, apexification method - in permanent teeth. | |
| Secondary caries, loss of filling. | a) poor-quality preparation of the walls of the carious cavity; b) violation of the filling technique; c) use of filling material not according to indications. | Treatment of caries with preserved lining or repeated treatment conservative method, adherence to filling placement techniques, use of filling material according to indications. | |
| P. Errors and complications in the treatment of pulpitis of primary teeth using the method of devital amputation. | |||
| Increased pain after applying devitalizing paste. | a) incorrect tactics of the doctor - treatment of acute purulent or chronic gangrenous pulpitis with phenomena acute periodontitis amputation method; b) application of paraformal-dehyde paste without opening the tooth cavity; c) excessive pressure of the dentin bandage; d) a temporary filling is not hermetically applied (in the gingival area). | Changing the treatment method requires vital pulp extirpation. removal of a temporary filling, opening of the tooth cavity, re-application of devitalizing paste in the required dose into a dry carious cavity; removal of the temporary filling, re-application of devitalizing paste and dentin dressing without pressure; re-application of devitalizing paste and dentin bandage without pressure, carefully maintaining the seal. | |
| Development of acute drug-induced periodontitis | a) exceeding the time limit for applying devitalizing pastes | Amputation and extirpation of the pulp, application of one of the antidotes to the apical opening, application of an antidote to the mouth of the canal/canals under a temporary filling, prescription of anti-inflammatory therapy according to indications, further treatment of periodontitis | |
| Necrosis of the gingival papilla. | a) seepage of devitalizing crust through a leaky closed carious cavity; b) application of devitalizing paste to the gingival papilla with an insufficiently prepared class II cavity | Removal of the temporary filling, preparation of the carious cavity, careful treatment of the gingival papilla with an antidote, antiseptic, enzyme, re-application of devitalizing paste (if necessary), maintaining a thorough seal of the dressing. | |
| Chemical burn oral mucosa | Contact of phenol- and formalin-containing drugs on the mucous membrane due to the carelessness of the doctor or leakage from a leaky closed carious cavity. | Treatment of the mucous membrane with an antidote, antiseptic, enzyme, or agent that accelerates epithelialization. | |
| Lack of effect of pulp devitalization (pain of the pulp upon probing after removal of the temporary dressing). | a) early loss of temporary filling; b) violation of the technique of applying devitalizing drugs; c) use of expired devitalizing agents; d) failure to comply with the rules for storing and working with paraformaldehyde. | Repeated application of the devitalizing agent in compliance with the technique and rules | |
| Insufficient effect of pulp devitalization (pain during amputation of the coronal pulp, or pulp in the area of the root canal orifices). | Incomplete necrotization of the pulp due to an insufficient amount of the devitalizing drug, or its short duration of action, or improper preparation and storage of paraformal-dehyde-containing pastes. | Applying cotton balls with a phenol-formalin mixture, formocresol over the mouth of the root canal/canals under a temporary filling or re-application of a devitalizing drug | |
| a) incorrectly chosen method of treatment (amputation if extirpation is necessary); b) insufficient pulp mummification due to a reduction in the time of application of the resorcinol-formalin mixture (or other mummifying agents); c) use of PTEO paste prepared not ex tempore, but in advance, non-compliance with the rules for storing paraformaldehyde; d) applying mummifying paste to the bottom of the tooth cavity, and not to the mouth of the root canals; e) incomplete opening of the tooth cavity. | Endodontic treatment of chronic periodontitis or tooth extraction. | ||
| Perforation of the bottom of the tooth cavity | a) ignorance of the topography of the tooth cavity; b) narrowing of the tooth cavity due to calcification of the pulp, formation of denticles | Closing the perforation site with glass ionomer cement; if there is no effect, tooth extraction. | |
| III. Errors and complications in the treatment of pulpitis of primary teeth using formocresol-pulpotomy. | |||
| Sharp pain during preparation of a carious cavity, amputation of the pulp. | Inadequate anesthesia. | Repeated anesthesia (but intrapulpal!) | |
| The appearance of acute spontaneous pain, as well as long-term pain from various types of irritants in the immediate period after treatment. | a) incorrectly chosen treatment method; b) undiagnosed inflammation of the root pulp (bleeding was not controlled correctly); c) violation of the technique of carrying out the method at any stage; d) leakage of the restoration material | ||
| Perforation of the bottom or wall of the tooth cavity. | Ignorance of the topography of the tooth cavity. | Closing the perforation site with glass ionomer cement, but more often - tooth extraction. | |
| Development of root pulp necrosis and chronic periodontitis (in the long term after treatment), internal root resorption. | a) failure to comply with the indications for the method (incorrectly chosen treatment method); b) undiagnosed inflammation of the root pulp; c) violations in the technique of carrying out the method at any stage; d) leakage of the restoration material. | Endodontic treatment of root canal/canals or tooth extraction. | |
| Chemical burn of the oral mucosa. | a) contact of formocresol with the mucous membrane due to the carelessness of the doctor due to insufficient isolation surgical field. | Treatment of the mucous membrane with an antidote (sodium bicarbonate), an antiseptic, an enzyme, and an agent that accelerates epithelialization. | |
| IV. Errors and complications in the treatment of pulpitis of primary teeth using ferrous sulfate. | |||
| Not currently defined, but apparently similar to those of formocresol pulpotomy, except for the possibility of burning the oral mucosa. The tactics are similar. | |||
| V. Errors and complications when carrying out the devital extirpation method in the treatment of pulpitis of temporary teeth and permanent teeth with incomplete root formation. | |||
| Insufficient effect of pulp devitalization (pain during amputation of the coronal pulp, or pulp in the area of the root canal orifices, or root pulp). | Incomplete necrotization of the pulp due to an insufficient amount of the devitalizing drug, or its short duration of action, or improper preparation and storage. | Repeated application of a devitalizing drug or vital extirpation. | |
| Necrosis of the gingival papilla | a) leakage of devitalizing paste through a leaky closed carious cavity; b) application of devitalizing paste to the gingival papilla with an insufficiently prepared class II cavity | Removal of the temporary filling, preparation of the carious cavity, careful treatment of the gingival papilla with an antidote, antiseptic, enzyme, re-application of the devitalizing paste, careful sealing of the bandage. | |
| Burn of the oral mucosa. | Contact of phenol-formalin, resorcinol-formalin mixture on the mucous membrane due to the negligence of the doctor or leakage from a leaky closed carious cavity. | Treatment of mucus and membranes with an antidote, antiseptic, enzyme, or agent that accelerates epithelialization. | |
| Acute toxic periodontitis | a) exceeding the time limit for applying devitalizing pastes; c) use of prohibited arsenic-containing pastes. | Amputation and extirpation of the pulp, application of one of the antidotes to the apical opening, application of an antidote to the mouth of the canal/canals under a temporary filling, prescription of anti-inflammatory therapy according to indications, further treatment of periodontitis | |
| The occurrence of acute periodontitis | a) violation of the principles of endodontic preparation and obturation of the root canal/canals (lack of diagnostic radiographs before treatment; incorrect determination of the working length; periodontal trauma in the apex area, etc.) b) removal of the filling material beyond the apical foramen. | Physiotherapy, anti-inflammatory therapy according to indications, unfilling of canals to ensure the outflow of exudate with repeated endodontic treatment or tooth extraction. Physiotherapy, anti-inflammatory therapy, periostotomy as indicated. | |
| Exacerbation of chronic periodontitis | Application of devitalizing paste for undiagnosed chronic periodontitis. | Providing emergency care and further treatment of periodontitis or tooth extraction. | |
| Development of chronic periodontitis (in the long term). | a) incomplete extirpation of the pulp; b) poor-quality filling of the root canal/canals; c) violation of the principles of endodontic preparation of the root canal / canals. | Repeated endodontic treatment or tooth extraction. | |
| Bleeding from the canal/canals after pulp extirpation. | a) incomplete extirpation; b) trauma to periodontal tissue. | Correct determination of the working length of instruments, use of hemostatic agents; complete removal of the pulp. | |
| Perforation of the root wall | Violation of the principles of endodontic root canal preparation. | Removal of a tooth. | |
| VI. Errors and complications when performing vital pulpotomy in permanent teeth with incomplete root formation. | |||
| Insufficient analgesic effect. | Inadequate anesthesia. | Repeated anesthesia but not intrapulpal! | |
| The occurrence of acute spontaneous pain, prolonged pain from thermal and mechanical stimuli after treatment. | a) violations in the technique of carrying out the method at any stage; b) leakage of the restoration material; c) “rough” amputation; d) loss of filling. | Performing deep amputation. | |
| Necrosis of the root pulp and, as a consequence, death of the growth zone with the development of periodontitis. | See previous paragraph. | Performing the apexification method. | |
| Obliteration of root canals. | For the purpose of prevention this complication a number of authors recommend performing final filling of the root canals of the tooth after completion of root formation. |
When treating pulpitis, accidents may occur - aspiration of small endodontic instruments, burs into the respiratory tract or their ingestion. In such cases, it is necessary to urgently call emergency assistance and transport the patient to a hospital for specialized care. Prevention - careful and Attentive attitude to treatment, the use of retaining rings and chains for endodontic instruments, isolation of the surgical field with a rubber dam.
The development of an allergic reaction to anesthetic drugs is another serious complication of pulpotherapy. The doctor must provide emergency care and the patient must be hospitalized. Prevention: careful collection of allergy history.
Assignment for student independent work:
After analyzing the theoretical part of the lesson, the student must accept 1 - 2 patients on the topic of the lesson. If there is a patient (patients) with a complication after previously performed pulpotherapy, a complete dental examination of the patient is carried out, data is entered into the medical history, complaints and anamnesis are identified. Next, it is necessary to carry out probing, percussion of the causative tooth, evaluate its color and stability, the condition of the surrounding gums, thermal tests, EDI, send for radiography and interpret the radiograph. Analyzing previous treatments and data objective research At the moment, it is necessary to determine the causes of complications in the treatment of pulpitis, make a diagnosis, draw up a treatment plan and provide necessary help.
SITUATIONAL TASKS
Task 1. The child is 8 years old. Complains about long aching pain in tooth 75 when eating cold food. The tooth began to bother me a few days after filling. From the medical history: tooth 75 was treated biological method regarding chronic fibrous pulpitis 6 days ago. Objectively: The child is restless and has a negative attitude towards treatment. CPUS+ CPUS = 10, there is a filling on the mesial-occlusal surface of tooth 75, the seal is not broken, the tooth is stable, percussion is painless, a long-term positive reaction to the cold thermal test. Name the possible causes of the complication, draw up a treatment plan, and provide emergency care.
Task 2. The child is six years old. Complaints of paroxysmal, spontaneous, aching pain in tooth 84, aggravated by thermal irritants. From the medical history: 3 days ago, paraformaldehyde paste was placed in tooth 84 under a temporary filling for the treatment of chronic fibrous pulpitis. Objectively: tooth 84 is under a bandage, percussion is painless, the tooth is stable. After removing the bandage, there is a deep carious cavity on the distal-occlusal surface of the tooth; no communication with the tooth cavity was found; probing the bottom is painful at one point. Name the causes of the complication, draw up a treatment plan, provide emergency care.
Task 3. The child is 7 years old. Complaints of pain when biting on tooth 55, which appeared 3 days ago. From the medical history: 2 months ago tooth 55 was treated for chronic gangrenous pulpitis using devital amputation (using paraformaldehyde). Objectively: tooth 55 is under a filling, the seal is not broken, percussion of the tooth is painful, tooth mobility is grade 1, the gums in the area of tooth 55 are hyperemic, swollen, painful on palpation. Name the possible causes of the complication, draw up a treatment plan, and provide emergency care.
Task 4. The child is 7.5 years old. Complaints of swelling right cheek, which appeared a day ago, inability to chew food on the right side. From the medical history: 5 months ago, tooth 84 was treated for exacerbation of chronic gangrenous pulpitis using the extirpation method; the root canals were filled with zinc oxide eugenol paste. X-ray quality control of the filling was not carried out. Objectively: facial asymmetry due to slight swelling of the cheek on the right, submandibular lymph nodes on the right are enlarged and painful on palpation. In the oral cavity - the transitional fold in the area of teeth 85,84 is swollen, hyperemic, smoothed, tooth 85 is intact, tooth 84 is under a filling, percussion of tooth 84 is sharply painful, tooth 84 is mobile - 1st degree. Name the possible causes of the complication, draw up a treatment plan, and provide emergency care.
Task 5. Child 8 children. Complains of prolonged aching pain in tooth 46 when eating cold food. The tooth began to bother me a few days after the filling; on the last night the patient woke up with pain in the tooth. From the medical history: tooth 46 was treated in two visits for chronic fibrous pulpitis using a biological method 10 days ago. An antibiotic paste with a corticosteroid is placed under the permanent filling. From the life history: often sick colds. Objectively: There is a filling on the chewing surface of tooth 46, percussion of the tooth is painless, the gums are without pathological changes, there is a long-term painful reaction to cold. EOD of a tooth is 46-55 µA, a tooth is 36-25 µA. CGZ + cpuz = 8. Name the possible causes of the complication, draw up a treatment plan, provide emergency care.
Task 6. The child is 9 years old. Complaints of pain from thermal irritants in tooth 11 within a week after previous treatment. From the medical history: Tooth 11 was treated for chronic fibrous pulpitis using the method of vital amputation with coating of the pulp stump with the drug "Calcimol" (Voco) and subsequent filling with a compomer. Objectively: 11 under the filling, percussion is painless, the surrounding gums and transitional fold are without visible pathology. Name the possible causes of the complication, draw up a treatment plan, and provide emergency care.
Task 7. The child is 11 years old. Came with a purpose preventive examination, no complaints of pain. From the medical history: tooth 16 was treated by vital pulpotomy 3 years ago; the patient is being monitored at the dispensary. Objectively: tooth 16 is under a sound filling, percussion is painless, the surrounding gums and transitional fold are without visible pathology. On the radiograph: the carious cavity and the tooth cavity are filled with filling material, the roots of tooth 16 are fully formed, marks are noted throughout the canals sharp narrowing lumen. Name the possible causes of the complication, draw up a treatment plan, and provide the necessary assistance.
Task 8. The child is 6 years old. There are no complaints about pain. The child’s mother noticed the presence of a “formation” with purulent discharge on the gum in the area of tooth 75. From the medical history: a year ago, tooth 75 was treated for chronic fibrous pulpitis using the method of devital pulpotomy using paraformaldehyde paste. Objectively: tooth 75 is under a sound filling, percussion is painless, there is a fistula with purulent discharge on the gum mucosa in the area of the projection of the furcation of the roots. On the radiograph: destruction of bone tissue with unclear outlines in the area of bifurcation of the roots of tooth 75, the cortical plate of the tooth germ 35 is preserved. Name the possible causes of the complication, draw up a treatment plan, and provide the necessary assistance. What will be your tactics if an X-ray reveals destruction of the cortical plate of tooth germ 35?
Task 9. The child is 5 years old. Complaints of “discomfort” when biting in the area of tooth 84. No complaints of pain. The child’s mother noticed the presence of a “formation” on the gum in the area of tooth 84. From the medical history: 9 months ago, tooth 84 was treated for chronic fibrous pulpitis using devital pulpotomy using paraformaldehyde paste. Objectively: tooth 84 is under a high-quality filling, percussion is slightly painful, there is a fistula with purulent discharge on the gum mucosa in the area of the projection of the apexes of the roots. On the radiograph: destruction of bone tissue with unclear outlines in the area of the apex of the roots of tooth 84, the cortical plate of the tooth germ 44 is preserved. Name the possible causes of the complication, draw up a treatment plan, and provide the necessary assistance.
LITERATURE
Main:
1. Lecture material.
2. Pediatric dentistry / edited by A.A. Kolesov, - Moscow, "Medishna", 1991.-P. 152-155.
Additional:
1. Barer G.M., Ovchinnikova I.A. Formaldehyde preparations in endodontics // Clinical dentistry. - 1997. - No. 4. -P.64-66.
2. Ivanov V.S., Urbanovich L.I., Berezhnoy V.Z. Inflammation of the dental pulp. - Moscow, "Medicine", 1990. p. 192 - 204.
3. Maksimova O. P. Advanced course “KS” // Clinical dentistry. -1997, - No. 4. -P.92-102.
4. Chopin F. Calcium hydroxide in dentistry // Clinical dentistry. - 1997. - No. 4. -P.20-24.
5. Yakovleva V.I., Trofimova E.K., Davidovich T.P., Prosveryak G.P. Diagnosis, treatment and prevention of dental diseases. - Minsk, "Higher School", 1994.-P. 179-185.
Causes and consequences
The most common reasons for children - small objects and candies, and for adults - pieces of food. Defensive reaction is a cough. Complete obstruction of the respiratory tract leads to asphyxia, after 10–20 seconds to loss of consciousness, and within 3–4 minutes to circulatory arrest. A small foreign body or piece of food can enter the trachea or bronchus without causing complete obstruction respiratory tract and asphyxia; if it remains in the bronchus, it can lead to atelectasis of the lung, its lobe or segment, and can cause recurrent pneumonia.
Figure 23.3-1. Algorithm of actions for asphyxia (based on ERC recommendations)
1. Noisy breathing and ability to speak(point to partial obstruction upper respiratory tract) → ask the patient to cough vigorously and observe.
2. The patient is unable to make sounds(complete obstruction) but conscious → act immediately. Stand to the left of the patient (if you are left-handed, then to the right) and slightly behind → . Place your left hand in front of the middle of his chest, and with your right lean him forward. Vigorously strike the proximal part (closer to the wrist) of the palm into the interscapular area and check whether a fragment of food (foreign body) has appeared in the oral cavity; if not, repeat max. up to 5 times. If there is no result → stand from behind, wrap your arms around the patient under the armpits, place your left hand, clenched into a fist, slightly below the xiphoid process, grab it with your right hand and vigorously press towards yourself and up so that, by pressing the diaphragm, increase the pressure in the chest cage → . If a woman in late pregnancy or a significantly obese person is injured → place your hands on bottom part sternum, as during resuscitation. If necessary, repeat max. up to 5 times, alternating with 5 blows to the back area.
Figure 23.3-2. Impacts to the interscapular area
Figure 23.3-3. Pressing on the epigastric area - Heimlich maneuver
3. The patient is unconscious→ call an ambulance medical care, place the patient on his back, perform rhythmic chest compressions in the middle part of the sternum to a depth of 5–6 cm with a frequency of 100–120/min. After 30 sternum compressions, tilt the patient's head back and check to see if a piece of food (foreign body) has moved into the mouth or throat. If this happens, remove it carefully so as not to push it deeper. Do not be afraid that the victim will bite you - an unconscious patient does not have enough muscle tone to harm you. Continue chest compressions and attempts to remove the foreign body. Alternative way- place the patient in a fixed position on his side → and press from above on the lateral surface of the chest.
4. Age of the child<1 года → place it on your forearm, tilting your head down, holding your jaw with your thumb and forefinger (not your neck! →); With the wrist of your other hand, hit the interscapular area and check whether the foreign body has come out of the respiratory tract. If after 5 blows there is no result, lay the child on his back and press vigorously with two fingers on the middle of the sternum → with a frequency of 100–120/min to a depth of ≈1/3 of the anteroposterior dimension of the chest, do up to 5 compressions, check whether the foreign object has come out body; repeat the sequence of manipulations if there is no improvement.
Figure 23.3-4. Impacts to the interscapular area of an infant
Figure 23.3-5. Chest compressions in an infant
Foreign bodies enter the respiratory system through the oral cavity when inhaled. They are very dangerous as they can block the access of air to the respiratory tract. In this case, it is necessary to provide first aid and call a doctor. If a small object is retained in the bronchi, an inflammatory process and a focus of suppuration will occur near it.
Causes
Foreign bodies in the larynx, trachea or bronchi are observed mainly in babies who put small objects in their mouth and can inhale them. In this case, a reflex spasm of the muscles of the trachea and bronchi may occur, which significantly worsens the condition. The entry of foreign objects into a child's bronchi requires the help of a doctor.
In adults, cases of the disease are associated with talking or laughing while eating, as well as with vomit entering the bronchi during poisoning, for example, during alcohol intoxication. In the latter case, severe pneumonia may develop.
Symptoms
A foreign object stopping in the larynx is accompanied by the following symptoms:
- difficulty breathing;
- lack of air;
- cyanosis around the nose and mouth;
- strong coughing tremors;
- in children - vomiting, lacrimation;
- short cessation of breathing.
These signs may disappear and return again. Often the voice becomes hoarse or disappears completely. If the foreign body is small, shortness of breath appears with exertion with noisy inhalation, retraction of the areas under and above the collarbones, and the spaces between the ribs. In infants, these symptoms intensify when feeding or crying.
If a large object enters the larynx, signs of narrowing of the airways occur in a calm state, accompanied by cyanosis and agitation of the victim. If the bluish coloration of the skin during movements spreads to the torso and limbs, there is rapid breathing in a calm state, lethargy or motor agitation appears, this indicates a danger to life. Without help, a person loses consciousness, has convulsions, and stops breathing.
Signs of narrowing of the tracheal lumen: paroxysmal cough, vomiting and cyanosis of the face. When coughing, you can often hear popping sounds that occur when a foreign object is displaced. When the trachea is completely obstructed or a foreign object gets stuck in the vocal cords, suffocation occurs.
Small foreign bodies can quickly enter one of the bronchi with inhaled air. Often, the victim does not make any complaints at first. Then a purulent process develops in the bronchi. If the parents did not notice that the child inhaled a small object, he develops chronic inflammation of the bronchi, which cannot be treated.
Urgent Care
The victim needs to be hospitalized immediately. A hospital examination should be performed, including a chest x-ray. Fiberglass bronchoscopy is often necessary - examination of the trachea and bronchi using a flexible thin tube equipped with a video camera and miniature instruments. Using this procedure, the foreign object is removed.
An adult may try to cough out a foreign object before help arrives. First you need to take a deep breath, which happens when the vocal cords are closed. When you exhale, a powerful air flow can push out a foreign object. If you can’t take a deep breath, you need to cough up the remaining air in your lungs.
If coughing is ineffective, sharp pressure is applied with fists to the area under the sternum. Another way is to quickly lean over the back of a chair.
In more severe cases, with severe shortness of breath, retraction of the subclavian fossa, increasing cyanosis, the victim should be helped by another person. You can do the following:
- Approach the victim from the back and with the lower part of your palm make several sharp pushes on the back at the level of the upper edge of the shoulder blades.
- If this does not help, wrap your arms around the victim, place your fist on the upper abdomen, cover the fist with the other hand and quickly press upward.
If life-threatening signs appear in a child, first aid is as follows:
- The baby is turned upside down for a short time, tapping him on the back.
- Place the child with his stomach on the adult’s left thigh, press his legs with one hand, and clap his back with the other hand.
- The baby can be placed on the left forearm, holding it by the shoulders, and patted on the back.
If there is no threat to life, the victim can breathe; it is not recommended to perform all of the listed techniques, as this can lead to the movement of a foreign object and getting it stuck in the area of the vocal cords.
If the patient is unconscious and not breathing, artificial respiration must be performed. The chest should begin to expand. If this does not happen, it means that the foreign body has completely blocked the air supply. In this case, the patient needs to be turned over on his side with his chest facing him, held in this position and applied several blows in the interscapular area. Then he should be turned on his back and the oral cavity examined.
If the foreign object is not removed, both hands are placed on the upper abdomen and sharp pushes are made in the direction from bottom to top. Any foreign body in the mouth is removed and artificial respiration is continued until consciousness is restored. If there is no pulse, begin chest compressions, which should last at least 30 minutes or until the victim’s condition improves.
Pediatrician E. O. Komarovsky talks about a foreign body in the respiratory tract:
Assisting a patient with aspiration of a foreign body into the respiratory tract:
When a foreign body enters the respiratory tract, a cough immediately appears, which is an effective and safe means of removing the foreign body and an attempt to stimulate it - a first aid remedy.
In the absence of cough and its ineffectiveness with complete obstruction of the respiratory tract, asphyxia quickly develops and urgent measures are required to evacuate the foreign body.
Main symptoms ITDP:
- Sudden asphyxia.
- “Unreasonable”, sudden cough, often paroxysmal.
- Cough that occurs while eating.
- With a foreign body in the upper respiratory tract, shortness of breath is inspiratory, with a foreign body in the bronchi - expiratory.
- Wheezing.
- Possible hemoptysis due to damage to the mucous membrane of the respiratory tract by a foreign body.
- When auscultating the lungs, there is a weakening of breathing sounds on one or both sides.
Attempts to remove foreign bodies from the respiratory tract are made only in patients with progressive ARF that poses a threat to their life.
- Foreign body in the throat- perform manipulation with your finger or forceps to remove the foreign body from the pharynx. If there is no positive effect, perform subdiaphragmatic-abdominal thrusts.
- Foreign body in the larynx, trachea, bronchus - perform subdiaphragmatic-abdominal thrusts.
2.1. The victim is conscious.
- Victim in a sitting or standing position: stand behind the victim and place your foot between his feet. Wrap your arms around his waist. Make a fist with one hand and press it with your thumb against the victim’s abdomen on the midline just above the umbilical fossa and well below the end of the xiphoid process. Grasp the hand clenched into a fist with the hand of the other hand and, with a quick jerk-like movement directed upward, press on the victim’s stomach. The thrusts must be performed separately and distinctly until the foreign body is removed, or until the victim is unable to breathe and speak, or until the victim loses consciousness.
- Slap on the baby's back: Support the baby face down horizontally or with the head end slightly lowered on the left hand placed on a hard surface, such as the thigh, using the middle and thumb to support the baby's mouth slightly open. Apply up to five fairly strong pats to the baby's back with an open hand between the shoulder blades. The claps must be strong enough. The less time has passed since the foreign body was aspirated, the easier it is to remove it.
- Thrusts to the chest. If five back slaps do not remove the foreign body, try chest thrusts, which are performed as follows: turn the baby face up. Support the baby or his back on your left arm. Determine the point at which chest compressions are performed for VMS, that is, approximately a finger's width above the base of the xiphoid process. Give up to five sharp pushes to this point.
- Thrusts into the epigastric region - the Heimlich maneuver - can be performed on a child over 2-3 years old, when the parenchymal organs (liver, spleen) are reliably hidden by the costal frame. Place the heel of your hand in the hypochondrium between the xiphoid process and the navel and press inward and upward.
The release of a foreign body will be indicated by a whistling/hissing sound of air leaving the lungs and the appearance of a cough.
If the victim has lost consciousness, perform the following manipulation.
2.2. The victim is unconscious.
Lay the victim on his back, place one hand with the heel of the palm on his stomach along the midline, just above the umbilical fossa, far enough from the end of the xiphoid process. Place the other hand on top and press on the stomach with sharp jerking movements directed towards the head, 5 times with an interval of 1-2 seconds. Check ABC (airway, breathing, circulation). If there is no effect from subdiaphragmatic-abdominal thrusts, proceed to conicotomy.
Conicotomy: Feel the thyroid cartilage and slide your finger down along the midline. The next protrusion is the cricoid cartilage, which is shaped like a wedding ring. The depression between these cartilages will be the conical ligament. Treat your neck with iodine or alcohol. Fix the thyroid cartilage with the fingers of your left hand (for left-handers, vice versa). With your right hand, insert the conicote through the skin and conical ligament into the tracheal lumen. Remove the conductor.
In children under 8 years of age, if the size of the conicotome is larger than the diameter of the trachea, then puncture conicotomy is used. Fix the thyroid cartilage with the fingers of your left hand (for left-handers, vice versa). With your right hand, insert the needle through the skin and conical ligament into the tracheal lumen. To increase the respiratory flow, several needles can be inserted in succession.
All children with ITDP must be hospitalized in a hospital where there is an intensive care unit and a thoracic surgery department or a pulmonology department and where bronchoscopy can be performed.
