Bronchial foreign body: should bronchoscopy be performed in all patients with a choking crisis?

The aspiration of a bronchial foreign body (FB) remains a common pediatric problem with serious and sometimes fatal sequelae. The diagnosis is often delayed or overlooked. With the aim of determining a reliable clinical and/or radiologic finding to indicate the requirement for bronchoscopy, 100 patients admitted to our hospital because of FB aspiration who underwent rigid bronchoscopy were retrospectively studied. The clinical and radiologic data were compared with the bronchoscopy findings, which revealed that the history of a choking crisis was the clinical parameter that showed the highest sensitivity (97%) with high specificity (63%), and that other symptoms and radiology, even those with high sensitivity (88% and 85%, respectively), had low specificity (9%). We conclude that bronchoscopy should be performed in all patients with a history of a choking crisis even if they have normal radiologic findings and few symptoms.     

Relationships between pre-hospital characteristics and outcome in victims of foreign body airway obstruction during meals

ObjectiveThe purpose of this study is to determine the outcome of foreign body airway obstruction according to the initial actions taken for choking victims during meals.MethodsOur subjects were patients who became unresponsive or unconscious because of foreign body airway obstruction (FBAO) during meals in the presence of bystander witnesses. We investigated the associations between outcome and the following factors: age, gender, type of foreign body, chest compressions after the patient became unresponsive or unconscious, episode of cardiac arrest, efforts by a bystander to remove the foreign body, eating-related activities of daily living, time elapsed from the 119 call to arrival of emergency medical technicians (EMTs), and time elapsed from the 119 call to hospital arrival (primary endpoint).ResultsOf the 138 patients enrolled during the study period, 35 (25.4%) received chest compressions by bystanders after becoming unresponsive or unconscious and 69 (50.0%) suffered cardiac pulmonary arrest. Chest compressions by a bystander after the victim became unresponsive or unconscious (p < 0.0001) and no CPA (p < 0.0001) were significantly related to good outcome. Chest compressions by a bystander were both associated with good neurological outcome (odds ratio, 10.57; 95% CI, 2.472–65.059, p < 0.0001). No CPA after FBAO was another independent predictor (odds ratio, 50.512; 95% CI, 13.45–284.41; p < 0.0001), but efforts to remove the foreign body before the arrival of EMTs did not affect outcome.ConclusionChest compressions by a bystander, a support received by only 25% of the patients, proved to be essential for improved outcome for choking victims who became unresponsive or unconscious. Education for lay-rescuer response to choking might further improve overall outcome.     

精神病噎食患者的临床分析与护理对策

目的分析精神科患者噎食的原因并提出护理对策。方法选取我院2010年至2012年成功抢救的15例精神科噎食患者作为研究对象,分析患者的临床资料,总结护理对策。结果导致精神病噎食的原因主要抗精神病药物所致的锥体外系反应,精神病患者由于智力衰退、病症发作等原因没有自控能力。通过对患者采取有效的护理措施后,大大减少患者噎食的发生。结论分析精神病噎食的原因并采取相应的护理措施可减少噎食的发生。     

The course of the terminal phase in patients with amyotrophic lateral sclerosis

The fear of “choking to death” is on the mind of most patients suffering from amyotrophic lateral sclerosis (ALS). So far, however, there have been no systematic surveys concerning the dying phase in a general ALS population. We therefore performed a structured telephone interview with the relatives of 121 patients who died from ALS and were followed by the Motor Neuron Outpatient Clinic of the Department of Neurology, University of Munich, Germany. These data are compared with those obtained by a retrospective analysis of medical records of 50 ALS patients who were followed by the Wisdom Hospice, Rochester, UK. The data show that most ALS patients (Germany 88 %, UK 98 %) died peacefully, and no patient “choked to death”. The symptoms most frequently reported for the last 24 hours were dyspnoea, coughing, anxiety and restlessness. Around half (G 55 %, UK 52 %) of the patients died at home. The main palliative measures in place during the terminal phase were: home mechanical ventilation (G 21 %, UK 0 %), percutaneous endoscopic gastrostomy (G 27 %, UK 14 %), morphine (G 27 %, UK 82 %) and benzodiazepines (G 32 %, UK 64 %). The use of these palliative measures was judged to be beneficial by almost all relatives. These data support the hypothesis of a peaceful death process in ALS and should be communicated to patients and their relatives, at the latest after the onset of dyspnoea, to relieve unwarranted fears. Received: 17 October 2000 / Received in revised form: 12 January 2001 / Accepted: 30 January 2001     

Preventing choking and suffocation in children

Choking, suffocation and strangulation cause serious unintentional injuries in children and are leading causes of unintentional death in infants and toddlers. Nearly all choking, suffocation and strangulation deaths and injuries are preventable. The present statement reviews definitions, epidemiology and effective prevention strategies for these injuries. Recommendations that combine approaches for improving safety, including research, surveillance, legislation and standards, product design and education, are made. Paediatric health care providers should be encouraging parents and other caregivers to learn cardiopulmonary resuscitation (CPR) and choking first aid, as well as offering anticipatory, age-appropriate guidance to prevent these injuries at regular health visits.     

精神科患者噎食发生原因及预防和应急处理

目的分析精神科患者噎食的发生原因,提出预防和应急处理策略。方法对精神科12例患者发生的13例次噎食事件进行回顾性分析。结果精神科患者发生噎食的主要风险因素是抗精神病药物不良反应,其次是暴饮暴食等精神症状;引起噎食的常见食物是馒头,噎食发生时段主要是午餐时。结论精神病患者发生噎食致窒息者较多,必须针对其风险因素进行动态风险评估,落实针对性干预措施,做好应急处理,以降低住院精神病患者噎食的发生率和死亡率。     

Comparison of GlideScope(®) versus Macintosh laryngoscope for the removal of a hypopharyngeal foreign body: A randomized cross-over cadaver study

Objective

This study aimed to evaluate whether GlideScope^® is an effective and acceptable method for the removal of a hypopharyngeal foreign body.

Methods

This was a prospective study conducted in 28 first year emergency residents with little prior airway management experience. Participants extracted hypopharyngeal foreign bodies using a Macintosh laryngoscope and GlideScope^® with Magill and Sponge forceps. The primary endpoints were extraction time and success rate with each device. Participant preferences were also assessed.

Results

The cumulative success rate in relation to time to extraction was significantly higher with the Macintosh laryngoscope than with the GlideScope^® (p < 0.001) regardless of the extraction device. Significantly fewer attempts were required for the first successful extraction with the Macintosh laryngoscope versus GlideScope^® with Magill forceps (p = <0.001) and Sponge forceps (p = <0.001). The time for successful foreign body extraction using GlideScope^® was significantly lower when using Magill (median 46 s, IQR 28–75 s) forceps than Sponge forceps (median 79 s, IQR 41–88 s).

Conclusions

In this cadaver model, the Macintosh laryngoscope appeared to be more efficient and preferred than GlideScope^® for extracting hypopharyngeal airway foreign bodies that are associated with fatal asphyxiation.     

胆心综合征诊治体会

目的:通过对胆心综合征发病机制及特征的研究,提高对胆心综合征的认识,减少误诊率。方法:总结2002年以来4例胆心综合征患者的诊疗经过及相关资料分析。结果:4例患者胆道疾病治愈后,心脏症状明显好转或消失。结论:提高对胆心综合征的认识,减少误诊率。     

Pediatric exposure to choking hazards is associated with parental knowledge of choking hazards

Objective

To evaluate parental knowledge regarding household food and non-food choking hazards.

Design

Cross Sectional Survey.

Setting

Tertiary Care Children's Hospital.

Participants

Parents presenting to a Pediatric Otolaryngology Clinic with a child <4 years old.

Methods

Parental survey asking which choking hazard foods (CHF) they allow their child to eat, previous instruction of CHF, knowledge of non-food choking hazards, and their knowledge sources. Statistics: adjusted odds ratios (AOR) and logistic regressions.

Results

492 respondents. Adjusted for significant covariates associations between correct knowledge of CHF and correct parents actions of disallowing CHF: fruit chunks (prior instruction = 42%; correct action = 25%; AOR = 3.51; P < 0.0001), hot dogs (59%; 28%; 1.75; 0.0178), raw vegetables (41%; 47%; 1.28; 0.198) popcorn (67%; 49% 2.64; <0.0001), whole grapes (68%; 51%; 2.2; <0.0001), nuts (73%; 66%; 2.47; <0.0001), chunks of peanut butter (45%; 79%; 2.55; 0.0003), sticky candy (79%; 80%; 2.16; <0.0033), gum (72%; 84%; 1.75; 0.028), seeds (65%; 87%; 1.4; 0.247), 76% always supervise meals, 57% always cut food, 62% know CPR.

Knowledge of non-food hazards

Coins (97%), marbles (94%), small batteries (93%), small toy parts (93%), dice (92%), pen caps (92%), safety pins (85%), balloons (84%), syringes (40%). Sources of choking hazard knowledge: physicians (67%), family/friends (52%), books/magazines (40%), and the Internet (25%).

Conclusions

Parental knowledge of CHF is incomplete. The consumption of CHF in children under 4 is significantly associated with decreased parental knowledge. Therefore, more parental education is needed.