Comparison of extraction devices for the removal of supraglottic foreign bodies

Evaluation and Management of Airway Foreign Bodies in the Emergency Department Setting

BACKGROUND

Airway foreign body can be a life-threatening issue in pediatric and adult patients, and the majority of these patients will first present to the emergency department.

OBJECTIVE

This article provides a narrative review of the diagnosis and management of airway foreign bodies for the emergency clinician.

DISCUSSION

Foreign bodies in the upper and lower airways are potentially life threatening. This affects all age groups but is more common in pediatric patients. A history of a witnessed ingestion or aspiration event should raise the clinical suspicion for an aspirated foreign body. Patients with upper-airway foreign bodies are more likely to present in respiratory distress when compared with lower-airway foreign bodies, which often present with more subtle signs. Stridor, drooling, and wheezing suggest respiratory distress, but the presenting clinical picture is often unclear and may only include a cough. Immediate intervention is required in the patient with hemodynamic instability or respiratory distress. Airway management including laryngoscopy, fiberoptic bronchoscopy, and cricothyrotomy may be needed in these patients, with the emphasis on removing the obstructing foreign body and securing the airway. Specialist consultation can assist in retrieving the foreign body and managing the airway. If the patient is stable, imaging and specialist consultation for potential operating room intervention should be considered.

CONCLUSIONS

An understanding of the presentation, evaluation, and management of the patient with an airway foreign body is essential for emergency clinicians.

Evaluation of Paraclinical Methods in diagnosis of Foreign Body and its complications compared to operating room findings in patients with oral, pharyngeal and esophageal symptoms in Amir A’lam Hospital

Foreign Body (FB) swallowing is one of the most common medical emergencies in the world. This injury can cause mortality and morbidity in all age groups. This study aimed to evaluate the paraclinical methods in diagnosis of foreign body and its complications compared to operating room findings in patients with oral, pharyngeal and esophageal symptoms. This was a retrospective study. All patients referred to the ENT (Ear, Nose, Throat) department of Amir A’lam hospital with complaints of foreign body swallowing admitted in the operating room were studied. The patients’ information including demographic information, type of swallowed body, paraclinical information and operating room findings were extracted from the patients’ records. This study was performed on 219 patients admitted to ENT clinic. The mean age of the patients was 45.10±20.61 years. The highest and the lowest frequencies for foreign body type were chicken bone in 61 cases (28.31%) and disk battery in 1 case (0.5%). The most and the least frequency of complaints after foreign body type were dysphagia in 129 cases (58.9%) and neck tenderness in 7 cases (3.19%). Computerized Tomography (CT) scan findings and operative findings were almost same except in two cases. Kappa agreement for lateral neck and observation in the operating room was 50.5% (P <0.001) and WBC count was significantly higher in patients with complications (P=0.010).

Ex vivo ovine model for pediatric flexible endoscopy training

OBJECTIVES

Medical students and residents in training have limited opportunities to develop pediatric endoscopy skills and would benefit from a realistic simulation model. We sought to develop such a model for flexible endoscopy using fresh head and neck tissue from young sheep.

METHODS

Tissue was collected from pre-pubescent sheep (n=5; mean age: 4 months; mean mass: 28kg) following humane euthanasia at the end of an in vivo protocol. No live animals were used in this study. The head and neck of the sheep were disarticulated 4-6cm above the sternal notch and stored at 5°C for 1-5 days. With the preparation was supported in supine position, flexible nasopharyngolaryngoscopy and transnasal endoscopic intubation were performed with video recording.

RESULTS

Five sheep were studied. Endoscopy was performed by a medical student under direct supervision by a pediatric otolaryngologist. Differences between ovine and human pediatric airway anatomy were defined.

CONCLUSIONS

Despite variations in proportion and structure, the experience of passing a flexible nasopharyngoscope through a sheep's airway is remarkably similar to pediatric endoscopy. The nasal anatomy is elongated, but very much like a child's in terms of anatomy, color and texture. The tactile feedback is nearly identical. Annoying secretions and their associated "whiteout" phenomena nicely simulate these challenges in pediatric endoscopy. When performing transnasal intubation, navigating to the larynx and advancing an endotracheal tube under guidance have the look and feel of the pediatric procedure. Issues of cost, availability, risk of zoonotic infection, and ethics are discussed.

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.

Nasal trumpet orthosis to maintain nares opening during a melolabial interpolation flap

BACKGROUND

The nasal trumpet has been used in emergency resuscitation, anesthesia, and facial burns to maintain nares openings. The dermatologic surgery literature is not as familiar with this device to improve respiratory function during the postoperative period after reconstruction of large defects on the nose.

OBJECTIVE

To present a novel way of using a modified nasal trumpet orthosis to maintain nasal valve patency and improve nasal valve respiratory function postoperatively following a melolabial interpolation flap.

MATERIALS

A sterile nasal trumpet orthosis.

CONCLUSION

We present a novel way of using a modified nasal trumpet orthosis after a melolabial interpolation flap procedure. For large defects involving the nares and/or nasal valve of the nose, the nasal trumpet is well tolerated by the patient and can lead to increased postoperative respiratory function while acting as a "bolster" for the closure.