Treatment and first aid for extravasation - getting under the skin. The amount of intervention depends on the stage of extravasation, the solution administered and specific antidotes. The treatment regimen for injuries of the 3rd-4th stage has not been developed. In the absence of randomized controlled trials, some organizations have published treatment protocols based on their own experience, case series and single hard data.
1. In all cases of extravasation - getting drugs under the skin do the following:
a. Immediately stop intravenous infusion.
b. Remove compressive bandages that can act as a tourniquet (for example, when fixing a limb).
in. Give the limb an elevated position to reduce swelling.
d. Local use of warming and cooling packs, which is debatable. Under the action of heat, local vasodilation occurs, which promotes the reabsorption of infiltrated solutions. However, according to the literature, moist warming packs can cause skin maceration.
2. Extravasation 1st and 2nd stage:
a. Remove the intravenous catheter.
b. Choose an antidote.
3. Extravasation 3rd and 4th stage:
a. Leave the IV catheter in place and aspirate as much of the injected fluid as possible using a 1 ml syringe.
b. The catheter is removed unless an antidote is needed.
in. Decide whether to use hyaluronidase or an antidote.
d. Method of multiple punctures. After extravasation with acidic or hyperosmolar solutions, tense edema develops with blanching of the skin over the site of infiltration. The use of the stylet after aseptic precautions allows the infiltrated solution to flow freely, while reducing swelling and the likelihood of necrosis. Then apply a dressing moistened with saline to improve drainage.
e. Flushing with saline. Some authors recommend using the method of washing with saline solution of subcutaneous tissues. After treatment and infiltration of the area with 1% lidocaine, 500-1000 units of hyaluronidase are injected subcutaneously. Then four small incisions are made with a scalpel along the periphery of the infiltration site. Washing is carried out. Physiological saline is injected through a catheter installed subcutaneously in one of the incisions, the liquid is poured out through another incision. The resulting swelling is squeezed out towards the incision with massaging movements to facilitate the removal of substances that have poured out of the vessel.
e. Hyaluronidase. Dispersants are effective in extravasation of calcium preparations, parenteral nutrition solutions, antibiotics, sodium bicarbonate, etc. According to some practice guidelines, hyaluronidase is not recommended for the treatment of damage resulting from the extravasation of vasopressors. However, there are also publications on the successful treatment of such extravasation by the use of hyaluronidase in combination with saline irrigation:
(1) Mechanism of action. The destruction of hyaluronic acid, interstitial substance or intercellular compounds contributes to an increase in the dispersion and reabsorption of fluid that has gone beyond the vascular bed, respectively, reduces tissue damage by mechanical means.
(2) Administration is most effective within an hour, may be administered up to 12 noon.
(3) Inject 1 ml (150 U/ml; 5 separate injections of 0.2 ml) around the site of extravasation with 25 or 26 gauge needles.
(4) Side effects. Cases of complications in newborns are not described in the literature, there are reports of rare cases of hypersensitivity reactions in adults.
4. Specific drug antidotes:
a. Phentolamine:
(1) Used in the treatment of injuries resulting from the extravasation of vasopressors such as dopamine and adrenaline, which cause tissue damage through intense vasoconstriction and ischemia.
(2) The effect develops almost immediately. Most effective within an hour, but can be administered up to 12 hours. The biological half-life of phentolamine when administered subcutaneously is less than 20 minutes.
(3) Mechanism of action: competitive blockade of α-adrenergic receptors, resulting in relaxation of smooth muscle cells and hyperemia.
(4) Doses have not been established for neonates. They depend on the size of the damage and the body weight of the newborn.
(5) Recommended doses range from 0.01 mg/kg per administration to 5 ml of a 1 mg/ml solution.
(6) The solution at a concentration of 0.5-1.0 mg/ml is injected subcutaneously into the infiltrated area after the removal of the intravenous catheter.
(7) Precautions. Hypotension, tachycardia, and rhythm disturbances may occur; should be administered with extreme caution in preterm infants; re-introduce in small doses.
b. Nitroglycerine locally:
(1) Effective in treating damage caused by dopamine extravasation.
(2) Mechanism of action: relaxation of vascular smooth muscle.
(3) Application: 2% nitroglycerin ointment at 4 mm/kg per affected area, may be reapplied every 8 hours if tissue perfusion does not improve.
(4) Transdermal patches are also used.
(5) Precautions. Absorption through the skin may lead to hypotension.
in. Terbutaline:
(1) Effective in the treatment of peripheral ischemia due to extravasation of vasopressors in adults and older children; there are no publications on its use in neonatological practice.
(2) Mechanism of action: Peripheral vasodilation due to activation of beta2-adrenergic receptors.
(3) Administer subcutaneously at a concentration of 0.5-1.0 mg/ml; doses in adults range from 0.5 to 1 mg.
5. Treatment of a wound after extravasation - getting the drug under the skin:
Purpose of neonatal wound care with partial or complete loss of the skin is to achieve healing by primary or secondary intention without the formation of scars, contractures and surgical intervention. Different treatment regimens are used in different medical institutions.
a. Wash the injured area with sterile saline.
b. Apply sulfadiazine ointment to the affected area and change the bandages every 8 hours, carefully cleaning the wound surface, re-apply the ointment. Sulfonamides increase the risk of kernicterus, therefore, they are contraindicated in newborns in the first 30 days of life.
in. Water-based amorphous gels containing carboxymethyl cellulose polymer, propylene glycol and water keep the wound moist and facilitate healing. They are produced in the form of gels and films that can be applied directly to the wound surface and left in place for repeated dressings. The gel is easily removed with saline and changed every 3 days. More frequent change of dressings is carried out with excessive exudation.
d. Wet-dry dressings with saline and povidone-iodine dressings are also effective. Massive application of povidone-iodine to an open wound is not recommended in very low birth weight neonates because iodine absorption may depress thyroid function.
e. The effectiveness of the use of antibacterial ointments has not been proven.
e. Wound healing is assessed every day. Healing takes 7 days to 3 months.
and. If the wound is on the flexion surface, perform passive exercises within physiological volume with each dressing change in order to prevent contractures.
6. Plastic surgeon's consultation:
a. Carried out with damage to the entire thickness of the skin and significant areas of individual damage due to extravasation.
b. Enzymatic or surgical debridement or skin grafting may be required.
A foreign body in the respiratory tract can appear during hasty consumption of food or during games in children. This is accompanied by signs of respiratory failure, and if the victim is not quickly treated, then suffocation is possible. Such a person cannot breathe air, so he grabs it with his mouth like a fish. The ability to speak is also impaired. Many people do not know how to help, so intensive taps on the back are used. But you need to understand that such actions can only aggravate the situation.
How a foreign object can enter the respiratory tract
A foreign body in the upper respiratory tract can be for two reasons:
- A person actively talks and laughs while eating. It is in this case that most often pieces of poorly chewed food enter the respiratory tract and block it. Food on the go can also lead to blockage of the bronchi, when a person is in a hurry, hastily trying to chew the pieces. That is why doctors recommend eating in silence, without being distracted by talking and watching TV.
- A small child may have some small object from toys, as well as beads, balls and seeds in the respiratory tract. This happens during games, when the baby, out of curiosity, pulls everything into his mouth or even worse, puts it in the nasal passages, and then when breathing, the foreign body gradually descends into the bronchi.
Most often, in adults and children, foreign objects linger in the larynx, not descending into the trachea further. This is due to the fact that the larynx narrows in the area of the vocal cords, being, as it were, a natural barrier and preventing the passage of foreign objects further.
To prevent such accidents, it is necessary to give small children toys that do not contain small parts. Each toy should be checked for how tightly the eyes and nose are held.
Types of foreign objects
Depending on the form, all foreign objects can be conditionally divided into three groups. This is necessary in order to understand the danger of the situation in each case and quickly decide on the method of providing emergency assistance.
- Coin-shaped bodies - this includes coins, buttons, flat batteries, as well as any objects that have a flat, rounded shape.
- Spherical bodies - these can be beads, small sweets like Montpensier, vitamins, as well as pieces of poorly chewed apples and sausages. Such products, as a rule, do not have sharp corners, so they can easily fall through.
- Bodies resembling a rocker. This is the most dangerous case. Such foreign objects include pieces of dense meat, mainly pork, beef or lamb. Most often they choke on pieces of barbecue, which are interconnected by a thin but strong film.
When choosing an option for emergency assistance, it is necessary to take into account what the person choked on. It should be said that removing pieces of meat from the respiratory tract is the most problematic. Here you have to resort to emergency medical care.
You need to understand that even the smallest object with sharp edges that gets into the respiratory tract can be fatal for a person.
Clinical picture
The main symptoms of a foreign body entering the respiratory tract include the following conditions:
- intense coughing. In this way, the body tries to free the airways and get rid of the cause of irritation;
- breathing is very difficult, and in many cases the victim is not able to breathe at all. This is due to the fact that the lumen of the larynx is greatly narrowed or completely blocked;
- speech is impaired, most often when a foreign body enters the larynx, a person cannot speak clearly. If a foreign object affects the vocal cords, then any torture to say something ends with a strong cough;
- there is severe tearing of the eyes;
- the face and neck become very red, and in some cases become bluish in color. This is due to a lack of oxygen, and also due to the fact that you have to put in too much effort to breathe;
- breathing can be severely impaired or completely absent. In the latter case, the person loses consciousness.
If, under such conditions, a person is not provided with timely assistance, then there is a high probability that everything will end in death.
Sometimes others think that the person is joking and start laughing. However, the victim is not at all laughing, since suffocation can occur in just a few minutes.
First aid when a foreign body enters the respiratory tract
Most often, when foreign bodies enter the respiratory tract, there are only a few minutes during which help can be provided. Sometimes the life of a choking person depends on the quickness and awareness of the people who surround him. After all, when the count goes on for minutes, you can not wait for doctors.
If a person chokes on food, others try to pat him on the back with a palm to remove a piece of unchewed food from the respiratory tract. This method of assisting can also be effective, but only if the technique is performed correctly. It is necessary to beat the victim not haphazardly on the back, namely between the shoulder blades, in the projection of the respiratory tract. This should be done with the palm, which is folded like a boat. In this case, the cotton is stronger, it leads to the fluctuation of the airways and the foreign object. The result is a cough and the elimination of a piece of food.
This method of extracting foreign bodies is permissible only in cases where a person chokes on something small, and this is manifested only by coughing and reddening of the face. If the victim shows signs of suffocation and the expression on his face has taken on a frightened look, you should resort to other types of assistance:
- The person providing assistance stands behind the victim and tightly clasps his chest with his hands, while palms should be clasped in the lock. Next, the victim is given a command to make a short and sharp exhalation. At this time, the chest is strongly squeezed by the hands, and the victim is tilted forward. Such manipulations should be done until the airways are free from a foreign object.
- If a small child chokes, then to extract a piece of food or small objects from the respiratory tract, it is lifted upside down and tapped on the back. If a piece of food is not stuck very far, then such actions are quite enough to extract it. But here it is necessary to measure your strength and not to coward the child by the legs.
- There is another emergency method that will help remove a foreign body. It can be applied to both adults and children. To do this, the person providing assistance stands on the floor, on one knee, and lays the victim on the second so that the lower part of the body is slightly tilted forward. After this, it is necessary to make several blows between the shoulder blades towards the head. Blows are made with the base of the palm.
When providing first aid, it is important not to overdo it so as not to break the victim's ribs and damage the soft tissues.
Sometimes foreign bodies enter the trachea and then move to the bronchi, blocking the lumen. If the foreign object is too small, then it can move along the bronchial tree under the influence of the air flow and then get into the lungs. This is accompanied by shortness of breath, severe coughing and discomfort in the chest. In this case, it is impossible to provide assistance at home, the patient should be taken to a hospital, where a foreign object from the respiratory tract will be removed using a bronchoscope.
If a person is unconscious and has no breath, then it is necessary to dissect the tracheal membrane, but only a doctor can do such a manipulation correctly.
If the foreign body is not removed in a timely manner from the lower respiratory tract, a severe inflammatory process will develop with all the ensuing consequences.
How to help yourself
It happens that a person chokes on food at a time when there is no one at home, and there is nowhere to wait for help. In this case, you can try to help yourself by following these rules:
- The first thing to do is to stop panicking. Panic makes it difficult to correctly assess the situation and make the right decision;
- you need to try to make a few sharp exhalations. To enhance the effect, they clasp the chest with their hands and, on exhalations, make sharp bends forward;
- you need to raise both hands up and try to cough. In this position, the airways expand, and removal of the foreign body will not be difficult.
If such methods do not bring relief, you should contact your neighbors as soon as possible or go outside where passers-by can help.
In an emergency, many people get lost and forget about the skills they have. That is why you should set aside panic and try to help the victim as quickly as possible. In many cases, the life of a person depends on the correctness of its provision.
The pharynx, esophagus and respiratory tract often get food fish and meat bones during meals, as well as pins, buttons, small nails and other objects that are taken into the mouth during work. This can cause pain, difficulty breathing, coughing, and even suffocation.
Attempts to cause the passage of a foreign body through the esophagus into the stomach by eating crusts of bread, porridge, potatoes in most cases do not give success, therefore, in any case, be sure to contact a medical institution.
In those cases when, during mechanical ventilation, when trying to inflate the lungs under positive pressure, an obstacle is encountered, despite the fact that the patient's head is thrown back, the lower jaw is pushed forward, and the mouth is open, a foreign body in the upper respiratory tract can be suspected. If there is no effect, the victim is laid on the table, the head is sharply bent back and the larynx area is examined through the open mouth (Fig. 2.5).
Fig.2.5. Foreign bodies of the respiratory tract:
When a foreign body is detected, it is captured with tweezers, fingers and removed. The victim should be taken to a medical facility.
Three tricks are used to quickly open the mouth:
A - reception with the help of crossed fingers with a moderately relaxed lower jaw. Insert your index finger into the corner of the victim's mouth and press it in the direction opposite to the upper teeth. Then the thumb is placed against the index finger along the line of the upper teeth and the mouth is opened;
B - "finger behind the teeth" technique for a fixed jaw. An index finger is inserted between the cheeks and teeth of the victim and the tip is wedged behind the last molar;
B - the technique of "lifting the tongue and jaw" for a sufficiently relaxed lower jaw. The thumb is inserted into the mouth and throat of the patient and at the same time the root of the tongue is lifted with its tip. With other fingers, they grab the lower jaw in the chin area and push it forward.
After successful extraction of a foreign object and in the absence of breathing, it is necessary to continue the ventilation procedure.
At entry of a foreign body into the respiratory tract The first aid to the victim is as follows: the victim is laid on his stomach and bent knee, his head is lowered down as low as possible and the chest is shaken with hand blows on the back, while squeezing the epigastric region.
If the cough persists, a combination of gravity and patting should be tried. To do this, help the victim bend down so that his head is lower than his lungs, and sharply slam his palm between his shoulder blades. If necessary, you can do this three more times. Look into the mouth and if a foreign body pops up, remove it. If not, try to push it out with air pressure, which is created by sharp thrusts in the stomach. To do this, if the victim is conscious and able to stand, stand behind him and wrap your arms around his waist. Clench one hand into a fist and press it to the stomach with the side where the thumb is. Make sure that the fist is between the navel and the lower edge of the sternum. Place your other hand on your fist and press sharply up and into your abdomen (Figure 2.6).
Do this, if necessary, up to four times. Pause after each press and be prepared to quickly remove anything that might fly out of the windpipe. If the cough does not stop, alternate four slaps on the back and four pressures on the abdomen until the foreign body can be removed. If the cough persists, alternate hand thrusts into the victim's stomach with a slap on the back.
Rice. 2.6. Removal of a foreign body from the respiratory tract
If the victim is unconscious, then in order to press his stomach, turn him over on his back. Get on your knees so that he is between your legs, put your hand between your navel and sternum, and the other hand on the first. Make four clicks as described above. If the interference persists and the patient has stopped breathing, it is necessary to start artificial respiration and heart massage.
With complete closure of the airways, developed asphyxia and the inability to remove a foreign body, the only measure of salvation is an emergency tracheotomy. The victim should be immediately transported to a medical facility.
Most often, foreign bodies of the respiratory tract are observed in children. If the child has inhaled some small object, ask him to cough sharper, harder - sometimes, in this way, it is possible to push the foreign body out of the larynx. Or put the baby upside down on your lap and pat on the back. Try to take a small child firmly by the legs and lower it upside down, also patting on the back (Fig. 2.7).
Fig.2.7. Removal of a foreign body from the respiratory tract of a child
If this does not help, urgent medical care is needed, since a foreign body can also get into the bronchi, which is very dangerous. Special emergency measures are needed to extract it.
This can happen to anyone. Everyone experienced that unpleasant moment when a lot of people are sitting at the table, and food or drink got “in the wrong throat”. Most often, to stop this incident, it is enough to clear your throat.
But what to do if within a few minutes it does not get better, neither inhalation nor exhalation is possible, the face changes color? Surrounding people rush to help with the desire to pat on the back.
Now let's imagine: the victim is sitting at the table, the position of the torso is almost vertical, the foreign body is stuck in the airways. Where does it go with pats on the back? That's right - down the airways. Such actions are dangerous, can aggravate the situation and even lead to death.
What is the right way to act in such situations? Opinions are contradictory. Let's turn to the textbook on first aid.
In the section on the ingress of a foreign body into the respiratory tract, recommendations are given: put the victim on the stomach through the knee of the person providing first aid, strike on the back.
And not a word about the Heimlich method, which is described in many articles as the only effective one when food has entered the respiratory tract. Western cinematography also actively advertises this technique to us.
The question arises, what method should a first aid person turn to when every lost second can lead the victim to death?
For help with clarification, go to emergency doctor .
- If a person chokes, in what cases do they use blows to the back, and in what cases do they use the Heimlich maneuver?
- In some cases, taking a tap on the back can provoke the dislocation of the foreign body even lower into the airways. The lower it is from the vocal cords, the more pronounced the degree of asphyxia (suffocation). Ambulance workers are invited in such a situation to act in accordance with the normative act, which clearly regulates the manipulations with the victim.
1. We start with tapping (patting, hitting between the shoulder blades). Only you need to perform it correctly so as not to harm: give the body of the victim a position with an inclination forward and inflict 5 blows between the shoulder blades. The mechanism of this technique is due to the fact that we cause stimulation and enhancement of the cough reflex, which increases the expiratory pressure in the airways. This is necessary for self-removal of a foreign body from the respiratory tract.
2. The second stage, if the pat is ineffective, is the execution Heimlich maneuver. The victim must be tilted forward, stand behind him, put his hand folded into a fist in the area between the navel and the sternum, grab it with the other hand and make 5 sharp pushes inward and upward.
3. If it doesn’t help, start all over again: 5 blows to the back in the correct position of the body, then the Heimlich maneuver.
The Heimlich maneuver is different for pregnant women, children, and unconscious people.
Pregnant produce shocks in the chest area.
If the person has lost consciousness , you need to put it on your back, make sure that your head is not turned to the side. It is more convenient to sit on top of him and in the area between the navel and the xiphoid process of the sternum, make the same shocks as if the rescuer was standing behind, in this case, use your weight.
If a child is choking, do not hesitate.
In children, the mucosa is very tender, and edema quickly increases. In a matter of minutes, edema from 1 degree turns into 4 and hypoxic coma. You need to immediately call an ambulance or go to the nearest hospital on your own. While waiting for an ambulance, you can not do nothing. Provide maximum air flow, clean the oral cavity and nasal passages from mucus with a rubber can (syringe) or a syringe with a dropper tube. Since there may be reflex vomiting, it is necessary to give a stable lateral position. In children's practice, it is not always advised to start with tapping. If you do it incorrectly, it can lead to a rupture of the lungs or to the dislocation of a foreign body.
However, it is no coincidence that the order for ambulance workers prescribes a sequence of actions, starting with blows to the back. This is due to high efficiency when done correctly. I can say that if you decide to strike a child in the interscapular region, you need to be careful.
The child is given the following position:
If these actions are ineffective, turn the child on his back, head below the body. Make 5 pushes inward and towards the chest in the area below the nipples by one finger. You can do this with one or two hands.
If there was no one around who would help, you can independently help yourself with a modified Heimlich technique. The point is that the victim independently reproduces the above-described tremors in the epigastric region (a). Or he uses improvised means: the back of a chair, the corner of a table, etc. (b)
Be careful, try not to rush and not be distracted by conversations at the table. Stay calm and follow the steps clearly if you or someone close to you is choking.
In the respiratory tract (trachea, larynx, bronchi, nasal cavity, pharynx), most often by accident, sometimes food and small objects, which are called foreign bodies in medicine, get into. More often there are foreign objects in the larynx, as it is quite narrow and does not let them pass further. When any object enters the respiratory tract, a person begins to cough violently. If even with the help of coughing it is not possible to get rid of a piece of food or another object, you should contact a specialist who will correctly and immediately provide first aid.
Types of foreign bodies entering the respiratory tract
Depending on the shape and parameters, all alien objects are divided into 3 main groups. The first group includes bodies with a spherical shape: balls, tablets, capsules, soft pieces of food. These bodies are characterized by non-sharp edges and can penetrate into the trachea. Doctors remove such foreign objects, if possible, using the “Pinocchio effect” (it is necessary to turn upside down and hit with an open palm between the shoulder blades).
The second group includes bodies with a flat and wide surface, which are somewhat similar to coins. These items include buttons, coins, plates, body jewelry, rings, artificial nails, and others. Foreign bodies of the second group easily penetrate the glottis, but it is almost impossible to remove them in a natural way. To slightly reduce the pain of a person when a coin enters the respiratory tract, a strong tapping of the palm between the shoulder blades can. This is done so that the foreign body changes its place of localization and the person can breathe.
The third group of foreign bodies includes objects whose shape resembles a rocker. The most dangerous objects that can disrupt a person's breathing and get into the larynx are pieces of meat with a strong film. Pork or lamb meat becomes a rubber stopper that prevents a person from inhaling and exhaling.
The only chance to extract a piece of meat from the respiratory tract is a strong blow made just below the diaphragm or an instant cricothyrotomy (conicotomy). Dissection of the larynx can only be carried out by a medical professional who is trained in the technique of the procedure and can really save a person's life.
Symptoms when a foreign body enters the respiratory tract
The first symptom that appears when there is a foreign object in the respiratory tract is a strong cough to redness of the face, then vomiting, tears in the eyes and suffocation. If symptoms occur, it is recommended to exhale sharply so that the object blocking the larynx comes out under air pressure.
If a person cannot get rid of a foreign body, then along with a cough, stridor breathing appears with characteristic wheezing when inhaling. With each new breath, the object moves further, irritation of the mucous membrane of the trachea or larynx occurs. Due to the irritating factor, the airways begin to swell, mucus is abundantly secreted and accumulates. The most dangerous is the spasm of the glottis and swelling of the vocal folds.
When strangulated, the red color of the skin of the neck and face begins to change to blue, and the cough becomes more frequent. Then apathy and adynamia appear, the choking person loses consciousness. After losing consciousness of the patient, you need to monitor his pulse and send him to the hospital for medical care. If this is not done, a coma may occur.
The onset of coma (blue asphyxia) is evidenced by:
- lack of consciousness;
- blue skin of the neck, face, lips;
- an increase in blood vessels in the neck;
- vulture and retraction of the supraclavicular and subclavian cavities during inspiration;
- weak pulse on the carotid artery.
After blue strangulation, after 5-10 minutes pale asphyxia begins. Pale suffocation is accompanied by pallor of the skin, the reaction of the pupils to light disappears, and the pulse is not felt.
When foreign objects enter the respiratory tract, a person has a few minutes before the onset of an attack and the appearance of clinical symptoms, so people around him should provide the correct first aid and take appropriate measures. The following two mistakes should not be made when saving a person: additionally examine the oral cavity (significant loss of time), try to remove food with a finger or other objects (part of the food or a foreign body can come off and enter the trachea, resulting in suffocation).
"Pinocchio effect" when a foreign body enters
When removing spherical bodies, you should use the "Pinocchio effect". If the baby chokes on, for example, peas, you need to turn it over so that the head is down, then hit the palm between the shoulder blades 3-4 times. In case the food did not fall on the floor, you need to proceed to other methods. The basic technique is the “Pinocchio effect”: we turn over the choking one on the stomach, then we throw it over our thigh or the back of the chair, and only then we hit the palm of our hand several times between two shoulder blades. This method is used to extract foreign bodies from children, adolescents and adult men and women.
You can save the injured baby using this technique: we put the baby on our own forearm, insert 2 fingers into the oral cavity (if there is a piece of paper from a candy or a bag in the mouth, it should be carefully removed), then lightly beat the baby on the back until a foreign object falls out ( strong blows can injure the spinal cord and lead to disability, so their strength must be monitored). It is forbidden to shake or hold the legs upside down, as children have a very weak spine.
If after 15-30 seconds the food does not fall out of the throat, you need to change tactics. If the foreign object looks like a coin or plate, this technique will not be effective. Doctors recommend that if the method is ineffective, use the "American police method" (see below).
Emergency care in case of inhalation of coin-shaped bodies
When hit by objects that look like a coin, it is advisable to use a technique called the “piggy bank effect”. If a person swallowed a coin, you need to force the alien object to change its location. With strong blows in the chest area, it is likely that the foreign object will turn the other way and free the air passage or move to the bronchi (when the coin or button is in one bronchus, the victim will be able to breathe and have time to get to the ambulance).
The most common way to shake the chest is to tap on the back with the palm of your hand. The “method of American policemen” is also considered an effective procedure. Technique: you should stand behind the victim and take him by the shoulders, then move him away from you to outstretched arms and only then sharply hit him with his back against his own chest. This manipulation can be carried out 3-4 times. The technique is effective if the rescuer has a flat male chest.
Features of the "Heimlich method"
The "Heimlich method" is effective in removing foreign particles from the upper respiratory tract. The technique is considered one of the most risky and should be carried out exclusively by medical professionals. During a sharp blow just below the diaphragm, from 250 to 300 ml of air is pushed out of the lungs, and a foreign body flies out with the air. The risk is that with a sharp blow, reflex cardiac arrest, injury to internal organs, and bleeding can occur.
The "Heimlich method" is forbidden for babies who are not yet 3 years old. Even if the food came out with air, the victim should be taken to the hospital in an ambulance, because after such a radical method of removing a foreign body, internal organs and systems can be damaged. It is forbidden to learn this technique from each other, for this there are specialized courses and conferences.
Features of the implementation of the "Heimlich method": you need to stand behind a choking person and wrap your arms around him, folded into a castle. In this case, the lock should be between the lower ribs and the navel. Next, the rescuer must remove the victim from himself and with all his strength hit him with his back against his chest, and press the epigastric region with the brushes folded into the lock.
Cricothyrotomy
Only medical professionals are authorized to perform a cricothyrotomy, as this is a serious procedure that needs to be trained and mastered. During the manipulation, an incision is made between the cricoid and thyroid cartilages (the hole will be above the trachea and the victim will be able to breathe freely).
Surrounding people can help to carry out emergency manipulation, for this it is necessary: to fix the head of the choking person (it is advisable to hold it between both knees so that the medical worker makes an accurate cut), press the victim’s hands to the floor or ground, ask people for an object in the form of a tube (it will help let air in and out of the lungs).
Rules to help avoid getting a foreign body into the respiratory tract
To prevent food and other objects from getting into the trachea and larynx, you need to follow a few simple rules. First, you can’t eat on the street, because something can frighten a person and a piece of food will get into the respiratory tract. Secondly, you should not talk during the meal, because not only soft food, but also bones from meat or fish can end up in the throat. Thirdly, you should not keep metal objects and other foreign bodies between your teeth, which can inadvertently get into the trachea or larynx. Fourth, if a child holds a small toy near his face or licks it, you must immediately pick it up, since the actions of the baby are often unpredictable (it is advisable to give the child a soft large toy so that he does not get upset and start crying).
Serious mistakes when removing a foreign object
With incorrect (too strong and intense) blows to the back, a foreign particle can move forward and end up in the tracheobronchial tree, thereby blocking the airways. If a foreign object has entered the tracheobronchial tree, a tracheotomy should be performed immediately.
It is forbidden to turn the child upside down and shake, because the baby's body is still too weak and may not withstand such a load (there is a risk of dislocation and even fracture of the cervical vertebrae). The most serious mistake during a rescue operation is panic. The surrounding people and medical workers are no less afraid than the victim himself, so you need to gather your will into a fist and act according to the technique of extracting a foreign particle from the respiratory tract.
There are many techniques and methods that will help remove a foreign object from the larynx and other internal organs, but there are also ways of first self-help. Doctors recommend that when a foreign particle enters the respiratory tract, exhale sharply, throwing straight arms forward. Along with these movements, you need to quickly lean forward. If this event does not help and the actions of the surrounding people are not effective, you need to take the choking person to the hospital for surgical intervention.
Speciality: infectious disease specialist, gastroenterologist, pulmonologist.
General experience: 35 years .
Education:1975-1982, 1MMI, San-Gig, highest qualification, infectious diseases doctor.
Science degree: doctor of the highest category, candidate of medical sciences.
