Violation of patency respiratory tract

This is the most common cause of complications. Any respiratory
complication leads to hypoxia and hypercapnia. Beyond the signs
hypoxia and hypercapnia, the following is observed: 1) increased co-
contraction during inhalation of the respiratory muscles, the participation of auxiliary
ny muscles; 2) displacement of the trachea downwards with each attempt to inhale;

3) absence or decrease in the volume of inspiration; 4) whistling or
wheezing sounds when breathing. Most frequent violations pass-
airway dilations are associated with tongue retraction, laryn-
gospasm, bronchial spasm, airway obstruction.

tongue drop - frequent complication intravenous and
mask anesthesia. It can occur during the very
goat and after it when transporting a patient from the operating room to the hospital
lat. Proper retention of the lower jaw and insertion of air
hovoda prevents this complication.

Laryngospasm - partial or complete closure of the true
vocal cords, disrupting the free patency of the airways. In addition to the symptoms of hypoxia and hypercapnia for
spasm is characterized by sonorous high intermittent wheezing.

Causes: direct irritation of the mucous membrane
ki trachea and larynx with ether vapor, blood, mucus, emetic
masses, foreign bodies. Laryngospasm may occur
reflexively, if the operation, especially its traumatic moments
(protrusion of the intestine, reduction of dislocation, stretching of the sphincter
anus), are carried out with too superficial
goat.

Warning:

1) preparation with atropine, promedol and antihistamines
drugs reduces the risk of laryngospasm;

2) before induction anesthesia, the patient must breathe oxygen
by birth;

3) the concentration of drugs, especially ether, must be increased
vat gradually;

4) the air duct must not be inserted during anesthesia with barbiturates, without.
local anesthesia root of the tongue and pharynx with dikain;

5) if the operation is performed under anesthesia without muscle relaxants,
then in the most traumatic moments it is necessary to deepen anesthesia
or apply local anesthesia to the area of ​​operation.

1) increase the oxygen content in the inhaled mixture, you
move the lower jaw forward, hold an artificial
ventilation;

2) if laryngospasm is caused by ether, reduce its concentration
radio and again gradually increase it only after the liquidation
giving laryngospasm;

3) inject intravenously 1 ml of a 1% solution of promedol and 0.5 ml
0.1% atropine solution;

4) if laryngospasm persists, introduce relaxants and intubation
torment the patient;

5) if an attempt at intubation fails, you need to pierce the pain
sew with a needle the thyroid-ring-paired ligament and through this
inject oxygen with a needle;

6) if these measures do not eliminate laryngo-
spasm, a tracheostomy is needed.

Bronchiospasm - a sharp narrowing of the bronchioles, especially
when exhaling, leads to expansion of the lungs, acute emphysema, hy-
poxia and hypercapnia. When pressing on the breathing bag
very strong resistance is felt, and it is not possible to enter the lungs
introduce even a little oxygen.

Causes: In general, the same as with laryngospasm. To them
you can add the introduction of prozerin without atropine, adrenolytic drugs, cyclopropane anesthesia.

Warning: patients suffering from bronchial asthma,
premedication includes antihistamines. For
induction anesthesia do not use thiopental.

1) intravenously inject ephedrine, aminophylline, glucocorti-
coids;

2) inhalation of izadrin aerosols or fluorotano-
narcosis.

Blockage of the airways. Vomiting and regurgitation
tion - active in the first case and passive in the second
transferring the contents of the stomach into the oral cavity. These complications are dangerous.
the fact that vomit can get into the trachea and bronchi.

When aspiration occurs reflexes due to irritation
receptors of the respiratory tract by the acidic contents of the stomach (la-
ringo- and bronchospasm), bradycardia and cardiac arrest. After
operations occur atelectasis, pneumonia, Mendelso-syndrome
on (acute exudative pneumonitis), lung abscesses.

Warning:

1) insertion of the probe and suction of the contents from the stomach;

2) intubation in Fowler's position;

3) the rapid deepening of anesthesia eliminates vomiting reflex;

4) timely suction of contents from the oral cavity,
lowering and turning the head to the side when vomiting occurs
or regurgitation.

Treatment:

1) cleansing of the lungs (suction of contents with direct
laryngoscopy or after intubation through a tube), rinsing
trachea and bronchi saline or
0.5% solution of bicarbonate with the addition of antibiotic
ticks;

Violation of bronchial patency is a complex of symptoms, characterized by difficulty in the passage of air flow through the respiratory tract. This is due to narrowing or blockage small bronchi. This syndrome accompanies bronchial asthma, chronic and acute obstructive bronchitis, COPD.

Broncho-obstructive syndrome (BOS) according to the nature of origin is primary-asthmatic, infectious, allergic, obstructive and hemodynamic, arising from circulatory disorders in the lungs. Separately, there are such reasons for BOS:

• Neurogenic - they are provoked by a hysterical seizure, encephalitis, ChMP.
• Toxic - an overdose of histamine, acetylcholine, some radiopaque substances.

Depending on the duration of clinical symptoms, the following types of BOS are distinguished:

• Acute (lasting up to 10 days). Most often occurs in infectious and inflammatory diseases of the respiratory tract.
• Protracted (lasting more than 2 weeks). It is characterized by a blurring of the clinical picture, accompanies chronic bronchitis, bronchitis, asthma.
• Recurrent. Symptoms of impaired bronchial conduction occur and disappear over time without any reason or under the influence of provoking factors.
• Continuously recurrent. It manifests itself as a wave-like character with frequent exacerbations.

When making a diagnosis, it is important to determine the severity of BOS. It depends on the severity of clinical symptoms, the results of the study (blood gas composition, determination of the function of external respiration) and is mild, moderate and severe.

The main mechanisms leading to the occurrence of acute biofeedback are:

• Spasm of smooth muscle cells of the bronchi (with atopic bronchial asthma).
• Edema, swelling of the bronchial mucosa (with infectious and inflammatory processes).
• Blockage of the lumen of the small bronchi with thick mucus, impaired sputum excretion.

All these causes are reversible and disappear as the underlying disease is cured. Unlike acute, the pathogenesis of chronic biofeedback is based on irreversible causes - narrowing and fibrosis of small bronchi.

Clinical manifestations

Broncho-obstructive syndrome is manifested by a number of characteristic signs that can be permanent or temporary:

• Expiratory dyspnea. Difficulty and an increase in the duration of exhalation in relation to inhalation, which is paroxysmal in nature and manifests itself most often in the morning or in the evening.
• Wheezing breath.
• Scattered, auscultated at a distance rales over the lungs.
• Cough, accompanied by the release of a small amount of sputum (viscous mucopurulent, mucous).
• Paleness, cyanosis in the area of ​​the nasolabial triangle.
• Auxiliary muscles are involved in the act of breathing (swelling of the wings of the nose, retraction of the intercostal spaces).
• Forced position during attacks of suffocation (sitting, with emphasis on hands).

On early stages chronic diseases accompanied by bronchial obstruction, the patient's health remains good for a long time.

However, as the pathology progresses, the patient's condition worsens, body weight decreases, shape chest changes to emphysematous, and serious complications arise, which, if not properly treated, lead to death.

Diagnostics

For the first time, the syndrome of impaired bronchial patency, which arose against the background of acute respiratory viral infections and is characterized by a mild course, did not require specialized diagnostics. In most cases, it resolves on its own as the patient recovers.

In case of detecting a protracted or recurrent broncho-obstructive syndrome, it is necessary to undergo a number of additional studies. The complex of methods necessary for diagnostics includes:

Based on the results of the survey, physical examination and additional studies, a differential diagnosis is made between pneumonia, bronchitis, asthma, COPD, tuberculosis and GERD.

Bronchial conduction disorders are treated by a doctor specializing in the treatment of the underlying disease, most often they are general practitioners, pulmonologists, otolaryngologists and allergists.

Treatment

Effective therapy of broncho-obstructive syndrome is impossible without determining its cause. For the best result, it is important to establish the correct diagnosis as soon as possible and start treatment in a timely manner.

To stop the symptoms of impaired bronchial conduction, the following are used:

• Beta2-agonists of short and prolonged action (Salbutamol, Salmeterol, Formoterol).
• M-cholinolytics (Ipratropium bromide).
• Mast cell membrane stabilizers (Ketotifen, cromon derivatives) and antileukotriene agents (Montelukast).
• Methylxanthines (Theophylline).
• Inhaled and systemic glucocorticosteroids (Budesonide, Hydrocortisone, Prednisolone).
• Antibacterial agents.

As additional measures to improve the patient's condition, drugs that stimulate sputum discharge (mucolytics), immunostimulants are used. In the treatment of children under the age of 1 month, artificial ventilation of the lungs is prescribed.

In order to speed up recovery, it is necessary to ensure a protective regime, to avoid contact with possible allergens. A good help in the treatment of BOS will be the use of humidifiers and nebulizers for inhalation medicines holding a chest massage.

Introduction

Respiratory disorders in children

Conclusion

Used Books

Introduction

The importance of breathing for a person cannot be overestimated. We can go without food and sleep for days, stay without water for some time, but a person can stay without air for only a few minutes. We breathe without thinking “how to breathe”. Meanwhile, our breathing depends on many factors: on the state of the environment, any adverse external influences or any damage.

A person begins to breathe immediately after birth, with his first breath and cry he begins life, with the last exhalation he ends. Between the first and last breath, a whole life passes, which consists of countless inhalations and exhalations, which we do not think about, and without which life is impossible.

Breathing is a continuous biological process, as a result of which gas exchange occurs between the body and the external environment. The cells of the body need constant energy, the source of which is the products of oxidation and decay processes. organic compounds. Oxygen is involved in all these processes, and the cells of the body constantly need its supply. From the air around us, oxygen can penetrate the body through the skin, but only in small quantities, completely insufficient to sustain life. Its main entry into the body is provided by the respiratory system. By using respiratory system carbon dioxide, a product of respiration, is also removed. Transport of gases and other necessary for the body substances is carried out using circulatory system. The function of the respiratory system is only to supply the blood with a sufficient amount of oxygen and remove carbon dioxide from it.

In higher animals, the process of respiration is carried out due to a number of successive processes:

1) Exchange of gases between the environment and the lungs? pulmonary ventilation;

2) Exchange of gases between the alveoli of the lungs and the blood? pulmonary respiration

3) Exchange of gases between blood and tissues.

The loss of any of these four processes leads to a violation of breathing and creates a danger to human life. That is why it is necessary to observe the prevention of respiratory organs.

Respiratory arrest is a critical condition. The reasons leading to sleep apnea are diverse: foreign bodies, caught in the respiratory tract; tumor lesions of the larynx, trachea, bronchi; inflammatory diseases tracheobronchial apparatus (respiratory viral diseases, severe pneumonia, bronchial asthma); neuromuscular diseases, overdose sedatives depressing the respiratory center and the activity of the respiratory muscles; thromboembolism in the pulmonary artery.

With apnea, the activity of the respiratory muscles stops, the movement of air through the nose and mouth is not detected. Diffuse cyanosis increases, tachycardia develops, blood pressure drops catastrophically, loss of consciousness occurs. Before loss of consciousness often develops convulsive syndrome. Acute progressive respiratory failure is soon exacerbated by cardiac fibrillation, usually leading to cardiac arrest.

Urgent Care. The oral cavity and upper respiratory tract are freed from mucus, foreign bodies, and the retraction of the tongue is eliminated; the lower jaw is pushed forward, artificial ventilation of the lungs is started by the mouth-to-mouth or mouth-to-nose method or with a breathing bag. In the absence of heart contractions, simultaneously carry out indirect massage heart, defibrillation, in the absence of effect, 1 ml of a 0.1% solution of adrenaline is administered intracardiacly. If possible, carry out hardware artificial ventilation of the lungs. 3% solution of sodium bicarbonate is injected intravenously - 100-200 ml, polyglucin - 400 ml; 10% solution intravenously by stream. In case of poisoning with barbiturates - bemegrid at a dose of 10 ml of a 0.5% solution intravenously by bolus, in case of drug overdose - etimizol - 2-5 ml of a 1% solution intravenously by bolus. The fall in blood pressure is corrected by intravenous drip injection of 1 ml of a 0.2% solution of noradrenaline intravenously slowly, 1 ml of a 1% solution of mezaton in 400 ml isotonic solution sodium chloride or 50 mg (10 mg 0.5% solution) of dopamine intravenously in 250 ml of isotonic sodium chloride solution, plasma-substituting solutions are administered.

Noisy breathing (airway obstruction)

Noisy breathing occurs in cases of violation of the rhythm and depth of breathing or in violation of the airway. When the upper respiratory tract (larynx, trachea) is affected, stenotic breathing with difficult inhalation is observed - inspiratory dyspnea. With a sharp degree of narrowing of the lumen of the upper respiratory tract by a tumor formation or an inflammatory reaction, noisy wheezing stridor breathing audible at a distance occurs. Sometimes it can be paroxysmal in nature; so, it appears with a tumor of the trachea, running on a leg. With bronchial asthma, noisy breathing audible at a distance due to bronchial obstruction may also occur. In typical cases, shortness of breath is expiratory, which is characterized by an extended exhalation. With reversible changes in bronchial patency, normal breathing can be restored with the help of therapeutic measures (hot drink, mustard plasters, if there are no signs of bleeding; bronchodilators, mucolytics, anti-inflammatory drugs). With persistent violations of the patency of the airways (tumor and cicatricial processes in the respiratory tract and adjacent tissues, foreign bodies), it is required surgical intervention to prevent threatening asphyxia. Pathological processes accompanied by impaired airway patency may be complicated by the development of atelectasis followed by pneumonia.

Influenza bronchopneumonia. Severe course flu can be complicated by bronchopneumonia. The most common causative agent of bronchopneumonia in influenza is staphylococcus aureus. The clinical picture is dominated by general intoxication symptoms, fever, general weakness. Dry cough resulting from tracheo-oronchitis, with the addition of pneumonia, changes its character. Prognostically unfavorable is hemoptysis. Hemorrhagic pneumonia is a serious complication of influenza.

Bronchial asthma. Respiratory disorders in bronchial asthma occur due to impaired bronchial patency.

Tumors of the trachea and bronchi. With tumors of the trachea or main bronchi that close the lumen of the airways, stridor breathing develops. With a significant closure of the lumen of the trachea by a tumor, bubbling breathing can be observed; wet gurgling rales are heard at the patient's mouth. An agonizing cough worries, sputum leaves in a meager amount. With complete closure of the lumen, asphyxia occurs. A tumor of a large bronchus prevents the discharge of secretions, therefore, in the corresponding area of ​​\u200b\u200bthe lung, a large number of coarse bubbling wet rales. With complete obstruction of the lumen of the bronchus by the tumor, atelectasis of the lobe or the entire lung develops, depending on the level of the lesion. Sometimes the tumor grows on a stalk; when the patient changes position, the patient notes difficulty in breathing. In some cases, patients take a characteristic position (knee-elbow or, on the contrary, avoid tilting the body), in which they note free breathing. Bronchodilatory therapy is not successful. With the development of asphyxia, a tracheostomy and artificial lung ventilation may be required.

Foreign bodies of the trachea and bronchi. When foreign bodies enter the trachea or bronchi, respiratory failure develops suddenly. Stridor breathing appears, with a large size of a foreign body, asphyxia develops. Aspiration of foreign bodies occurs with vomiting, especially when intoxicated; aspiration of blood may occur with bleeding from the upper respiratory tract, nosebleeds, bleeding from the esophagus and stomach. Foreign bodies (buttons, thimbles, coins, etc.) are more often aspirated by children. Complete blockage of the bronchus causes atelectasis of the segment, lobe, of the entire lung (depending on the size of the bronchus). Accession of infection often leads to the development of perifocal pneumonia. With atelectasis, the lobes disappear breath sounds during ascultation, there is a dullness of percussion sound, lagging of the corresponding half of the chest during breathing. To clarify the diagnosis, chest x-ray is necessary.

mediastinal syndrome. Develops with compression of the walls of the trachea or main bronchi tumor process, enlarged lymph nodes or as a result of mediastinal displacement. Compression and deformation of the trachea and bronchi lead to a narrowing of the airway lumen, causing increasing shortness of breath, which sometimes takes on an asthmatic character, accompanied by a suffocating cough and cyanosis. With a pronounced degree of compression of the bronchi, increasing dyspnea and cyanosis are combined with a lag in the respiratory movements of the corresponding half of the chest and the subsequent development of lung atelectasis. In the later stages of the mediastinal syndrome, symptoms of compression of the blood vessels of the mediastinum (syndrome of the superior vena cava), symptoms of compression of the recurrent nerve (voice change up to aphonia), and compression of the esophagus appear.

Urgent Care. If foreign bodies enter the respiratory tract, urgent hospitalization is necessary to remove them. When blood, vomit, etc. enter the respiratory tract, and the development of asphyxia, intubation is performed, followed by suction of these liquid masses. If necessary, the patient is transferred to artificial ventilation of the lungs through an endotracheal tube or tracheostomy according to indications (see Asphyxia). With broncho-obstructive syndrome, the introduction of bronchodilators is indicated - 10-15 ml of a 2.4% solution of eufillin intravenously with 10 ml of isotonic sodium chloride solution or drip in 200 ml of the same solution. In the presence of infection, antibiotic therapy is indicated, taking into account the type of sown microflora. In the absence of data on the pathogen, treatment begins with benzylpenicillin (30,000-500,000 units 6 times a day) or semi-synthetic penicillins (ampicillin 0.5 g every 6 hours, oxacillin 0.5 g every 6 hours, ampiox 0.5 g every 6 hours) or tseporin 0.5 g every 6 and or gentamicin at the rate of 2.4-3.2 mg / (kg / day) for 2-3 injections. With influenza bronchopneumonia, oxygen therapy is needed. To increase activity immune system prescribe anti-influenza or anti-staphylococcal immunoglobulin. With complications of influenza pneumonia (pulmonary edema, drop in blood pressure), corticosteroids are indicated (prednisolone 90-120 mg intravenously, dexamethasone 8-12 mg, hydrocortisone 100-150 mg). With tumors in the trachea and bronchi, cicatricial narrowing of the airways, mediastinal syndrome, respiratory disorders develop gradually and require planned surgical treatment.

Hospitalization. If foreign bodies enter the respiratory tract, urgent hospitalization. Patients with an intractable attack of bronchial asthma are subject to hospitalization. Patients with acute tracheobronchitis with signs of respiratory failure and severe broncho-obstructive syndrome, as well as patients with influenza bronchopneumonia, also need hospitalization.

Violations of the rhythm and depth of respiratory movements

These disorders are characterized by the appearance of pauses in breathing, a change in the depth of respiratory movements. The reasons may be:

1) immoral effects on the respiratory center associated with the accumulation of incompletely oxidized metabolic products in the blood, the phenomena of hypoxia and hypercapnia due to acute disorders of the systemic circulation and ventilation function of the lungs, endogenous and exogenous intoxications (severe liver diseases, diabetes mellitus, poisoning);

2) reactive-inflammatory edema of cells reticular formation(traumatic brain injury, compression of the brain stem);

3) primary lesion respiratory center viral infection (encephalomyelitis of stem localization);

4) circulatory disorders in the brain stem (spasm of cerebral vessels, thromboembolism, hemorrhage).

Biot's breathing is a form of periodic breathing, characterized by alternating uniform rhythmic respiratory movements and long (up to half a minute or more) pauses. Observed at organic lesions brain, circulatory disorders, intoxication, shock. It can also develop with a primary lesion of the respiratory center with a viral infection (encephalomyelitis of stem localization). Often, Biot's breath is noted in tuberculous meningitis.

Cheyne-Stokes breathing. With this type of respiratory disorder, the amplitude and frequency of respiratory movements increase and decrease in waves. There are pauses in the respiratory movements. After a pause lasting several seconds, rare respiratory movements follow, first superficial, then deepening and becoming more frequent; having reached maximum strength, the respiratory movements become less deep and slow down, and after a pause they become more frequent again. Cheyne-Stokes respiration is usually noted with reduced excitability of the respiratory center due to damage to the central nervous system, circulatory disorders in the brain stem, endogenous and exogenous intoxications, poisonings; with uremic or diabetic coma, with poisoning with opiates, ethyl alcohol, acetone, barbiturates and other substances. Cheyne-Stokes respiration can occur with a sharp increase in intracranial pressure (brain injury, compression of the brain by a tumor), with asthmatic status, when a hypoxic-hypercapnic coma develops as a result of a violation of pulmonary ventilation.

Kussmaul breathing is characterized by rhythmic rare respiratory cycles, deep noisy inhalation and increased exhalation. observed at extremely serious condition(hepatic, uremic, diabetic coma), with methyl alcohol poisoning (see Poisoning) or with other diseases leading to acidosis. As a rule, patients with Kussmaul's breath are in a coma. In diabetic coma, Kussmaul's breath appears against the background of exsicosis, the skin of these patients is dry; gathered in a fold, it is difficult to straighten. There may be trophic changes on the legs, scratching, hypotension of the eyeballs, and the smell of acetone from the mouth. The temperature is subnormal, blood pressure is lowered, consciousness is absent. Often, others indicate that the patient was treated for diabetes. In uremic coma, Kussmaul respiration is less common, Cheyne-Stokes respiration is more common. Uremic coma develops slowly. The anamnesis contains indications of renal pathology. With uremic coma, consciousness is absent, the skin is dry, pale, with scratching and whitish coating, the exhaled air has the smell of ammonia (the smell of urine). Blood pressure is increased, the pulse is tense, muscle tone and tendon reflexes are increased, fibrillar muscle twitches are often noted.

Tachypnea - frequent shallow breathing, leading to hypoventilation and functional insufficiency of external respiration. Tachypnea develops as a result of a violation of gas exchange with the accumulation of carbon dioxide in the blood and a decrease in the oxygen content in it. The amplitude of respiratory movements decreases, and the developing compensatory increase in breathing cannot eliminate the resulting respiratory failure. Tachypnea is caused by:

1) extensive lesions of the respiratory organs of inflammatory and non-inflammatory origin (acute pneumonia, exudative pleurisy, spontaneous pneumothorax, diffuse pneumosclerosis, etc.), which lead to the exclusion of a significant part of the lung from the respiratory function;

2) pulmonary embolism;

3) diseases accompanied by circulatory failure;

4) severe anemia;

5) high fever;

6) torpid phase of shock;

7) neurological diseases leading to increased intracranial pressure;

8) hysteria, accompanied by frequent shallow breathing;

9) botulism.

Bradypnea - decrease in respiratory movements up to 10-12 in 1 min. It is caused by inhibition of the respiratory center or a decrease in its excitability when:

1) serious illnesses the brain and its membranes (impaired cerebral circulation, cerebral edema, increased intracranial pressure due to the presence of a tumor, brain abscess, brain injury, primary lesion of the respiratory center with a specific infection - stem localization encephalomyelitis);

2) intoxication (uremia, hepatic coma, infectious diseases, poisoning with baroiturates, morphine, alcohol);

3) difficulties for air to enter the respiratory tract (obstruction in the airways or their narrowing).

Emergency care includes a complex of therapeutic measures. aimed at eliminating the underlying disease.

Hospitalization. If there are violations of the rhythm of breathing and the depth of respiratory movements, the issue of hospitalization is decided taking into account the underlying disease and general condition sick.

Respiratory disorders in children

CRUP. Acute inflammation larynx and trachea various etiologies, complicated by difficulty breathing, is referred to as croup. There are true, diphtheria, and false, caused by another infection, croup (measles, influenza, parainfluenza, scarlet fever). Due to mass immunization against diphtheria, true croup is rare, while false croup is relatively common. In the development of stenotic breathing, edema of the mucous membrane of the larynx (from the vocal cords to the trachea) and reflex muscle spasm are important. The accumulation of inflammatory exudate in the glottis, fibrin deposits, crusts, mucus reduce the airway lumen up to obstruction. The most severe with rapid progression of stenosis, the disease occurs in children 1-3 years of age.

Depending on the severity of the narrowing of the lumen of the larynx, stenosis (croup) I, II and III degree. Stenosis of the 1st degree (compensated): hoarse voice, even breathing at rest, unsharply pronounced when an attack of stenosis is initiated (slight retraction of the jugular fossa and supple places of the chest), acid-base state and P02 of the blood are within normal limits. Stenosis II degree (subcompensated): children are excited, stenosis is significant, breathing is noisy, all auxiliary muscles are involved in the act of breathing, retraction of pliable places of the chest is expressed, fluttering of the wings of the nose; the skin is bright red, then a slight cyanosis appears, the pulse is frequent, tense; indicators of the acid-base state are within the normal range, sometimes there is a subcompensated metabolic or mixed acidosis. Stenosis III degree (decompensated): children are excited or inhibited, pronounced stenosis with noisy, audible breathing at a distance, cyanosis of the nasolabial triangle, sticky cold sweat, tachycardia, expansion of the boundaries of the heart, signs of congestion in the pulmonary circulation, pupils dilated, on the face fear, cough, barking, rough, worse and more frequent with anxiety; develops mixed respiratory and metabolic acidosis, hypoxemia, which becomes more pronounced in cases of descending purulent laryngotracheobronchitis or due to associated pneumonia. With the progression of the process, asphyxia occurs, which is sometimes distinguished as IV degree of stenosis. In young children, croup of I degree can very quickly turn into croup of II-III degree.

differential diagnosis. Diagnosis of croup in typical cases does not cause difficulties. However, in children, especially at an early age, it should be differentiated from pharyngeal abscess and nasopharyngitis, in which, although breathing is difficult, the voice remains sonorous and there is no barking cough. Breathing is not stenotic, but snoring. In addition, with a retropharyngeal abscess, the patient's head is thrown back due to pain, swallowing is difficult. The diagnosis of a pharyngeal abscess is confirmed by the detection of a protrusion on the back of the pharynx. Sometimes an asthmatic condition is misunderstood as croup. However, a careful examination reveals the main differential diagnostic criterion for these conditions: stenotic breathing with croup (difficulty inhaling) and expiratory dyspnea (difficulty exhaling) with bronchial asthma.

Foreign bodies in the larynx, trachea and bronchi can cause the development of stenosis, simulating croup. Croup stenosis develops, as a rule, at night, it is preceded by a respiratory infection, fever, and relapses are not uncommon. With foreign bodies in the respiratory tract, the cough is paroxysmal, and in between stenosis is not clinically manifested. In the presence of a balloting foreign body in the trachea, attacks of severe coughing periodically occur with suffocation, redness or cyanosis of the face, sputum may have an admixture of blood. When a foreign body enters the bronchi, the right bronchus is more often obstructed.

It is necessary to exclude papillomatosis of the larynx, which can lead to stenosis. The disease develops slowly, hoarseness increases gradually (sometimes years).

Emergency care and treatment of croup is always complex and is primarily aimed at restoring airway patency and eliminating hypoxia. It is necessary to organize the proper care and regime of the child. You should try to remove or reduce the effects of stenosis with the help of reflex distracting procedures. good action have a general hot tub lasting up to 5-7 minutes (water temperature is usually up to 38-39? C) or foot baths with mustard. After the bath, the child must be wrapped up to keep warm and expand. skin vessels. At a high body temperature (above 37.5? C), a bath is not done. Sometimes the effect is achieved by mustard plasters, they can be placed up to 3-4 times a day. warm recommended alkaline drink(milk combined with sodium bicarbonate or Borjomi-type mineral water). Shown are alkaline (2 teaspoons of sodium bicarbonate per 1 liter of water) and steam inhalation, which are repeated every 3 hours. The appearance of a milder cough indicates the effectiveness of the procedure. Pipolfen (diprazine) 0.008-0.01 g is prescribed for children under 6 years old and 0.012-0.015 g for children over 6 years old 2-4 times a day or intramuscularly 0.5-1 ml of a 2.5% solution. You can administer intramuscularly 1% diphenhydramine solution in doses for children up to 6 months - 0.002 g (0.2 ml), 712 months - 0.005 g (0.5 ml), 1-2 years - 0.007 g (0.7 ml ), 3-9 years - 0.01 g (1 ml), 10-14 years - 0.02 g (2 ml) up to 3 times a day or 2% suprastin solution: children under 1 year - 0.005 g. (0.25 ml), 1-2 years - 0.006 g (0.3 ml), 3-4 years - 0.008 g (0.4 ml), 5-6 years 0.01 g (0.5 ml) , 7-9 years old - 0.015 g (0.75 ml), 10-14 years old - 0.02 g (1 ml). These activities are usually sufficient to provide emergency care with stenosis of the larynx 1 degree.

With stenosis of the larynx of the II degree, the distracting procedures listed above are also used. In addition, dehydration therapy is carried out (intravenous administration of 20% glucose solution, 10% calcium gluconate solution from 1 to 5 ml and 2.4% solution of aminophylline intravenously: children under 1 year old - 0.3-0.4 ml, 1-2 years - 0.5 ml, 3-4 years - 1 ml, 5-6 years - 2 ml, 7-9 years - 3 ml, 10-14 years - 5 ml 2-3 times a day), combined with a warm drink and inhalations. Antihistamines are administered parenterally according to indications. Prednisolone is prescribed orally (1-2 mg / kg per day).

With croup II-III degree, long-term repeated steam inhalations are carried out. Baths are contraindicated. Parenteral administration of prednisolone at a dose of 1-5 mg / kg per day or hydrocortisone - 35 mg / kg is necessary, depending on the severity of the condition. Antibiotics shown a wide range action, sedative therapy is one of the essential measures: seduxen (intramuscularly and intravenously 0.3-0.5 mg / kg, not more than 10 mg per injection up to 3 times a day), sodium hydroxybutyrate ( single dose at the age of 1-6 months. - 0.05-0.1 ml, 1-3 years - 0.1-0.2 ml, 4-7 years - 0.20.3 ml, over 7 years - 0.3-0.4 ml, enter 3-4 times a day) or corglicon - 0.06% solution (single dose at the age of 1-6 months - 0.1 ml, 1-3 years - 0.1-0.3 ml, 4-7 years - 0.3-0.4 ml, older than 7 years - 0.5-0.8 ml, administered no more than 2 times a day). Direct laryngoscopy is performed with diagnostic purpose, and for suction of mucus, if necessary, repeat the procedure. Nasotracheal intubation and tracheostomy are performed according to vital indications.

Children with III-IV degree croup are transferred to the intensive care unit for direct laryngoscopy with a full sanitation of the larynx and trachea (removal of mucus clots, crusts, etc.). In the absence of the effect of this procedure, as well as with an increase in signs of circulatory failure, the imposition of a tracheostomy or nasotracheal intubation with plastic tubes is indicated. Tracheostomy is performed under mask halothane anesthesia.

With diphtheria croup, along with the above measures, as well as the fight against toxicosis, it is necessary to introduce antidiphtheria serum according to the method of A.M. Bezredki. At the I degree, 15000-20000 AU are administered, at the II degree - 20000-30000 AE, at the III degree - 30000-4000 AU. A day later, the indicated dose is administered again. In the future, a half dose is administered for several days.

Conclusion

In conclusion, it should be noted that the person himself is the "blacksmith" of his health.

In the 20th century, man actively invaded natural processes all layers of the earth. The main source of air pollution that we breathe is industrial enterprises, which annually emit huge amounts of harmful waste into the atmosphere. First of all increased content Airborne chemicals cause respiratory diseases, especially among children. In 2007 specific gravity respiratory diseases in the structure of the total primary morbidity in children was 64.3%, and in adolescents - 55.5%. The values ​​of respiratory diseases in children are 4.8 times higher than in adults, and 1.5 times higher than in adolescents. Considerable attention should be paid to this problem, treatment facilities should be built, cities should be greened, and environmentally friendly technologies should be used.

important social problem leading to respiratory diseases is smoking. Among young people it is necessary to actively promote a healthy lifestyle. Medical personnel should conduct conversations in schools and other educational institutions about the success of a person in all areas of activity if he gives up bad habits.

More attention should be paid to preventive measures. “The disease is easier to prevent than to defeat!” Since prevention is not given attention in our country, this slogan should be heard more often at various public events and actively introduced into society. Establishments should conduct annual medical examinations and conduct competent diagnostics to detect diseases at an early stage.

As far as possible, it is necessary to heal your body by undergoing spa treatment.

Be attentive to your health!

Used Books

apnea breathing emergency violation

"Urgent health care", ed. J.E. Tintinalli, Rl. Crouma, E. Ruiz, Translated from English by V.I. Candrora, M.V. Neverova, Moscow "Medicine" 2001

Eliseev O.M. Handbook for the provision of emergency and emergency care, "Leila", St. Petersburg, 1996

Kiselenko T.E., Nazina Yu.V., Mogileva I.A. Respiratory diseases. - Rostov-on-Don: Phoenix, 2005. 288 p.

Ruina O.V. Medical encyclopedia for the whole family: Everything you need to know about diseases. - M.: Tsentrpoligraf, 2009. 399 p.

Practical latest medical encyclopedia: All the best means and methods of academic, traditional and traditional medicine/ Per. from English. Yu.V. Bezkanova. - M.: AST Astrel, 2010. 606 p.

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Treatment of respiratory failure should be differentiated, i.e. carried out taking into account in each case the features of its pathogenesis. But in the content of therapy for all forms of respiratory failure, along with specific ones, there are many non-specific components. These include ensuring the patency of the respiratory tract, enriching the inhaled air with oxygen, improving blood circulation in the lungs, artificial ventilation, and some others.

Almost all patients and victims with symptoms of respiratory failure require special measures aimed at maintaining airway patency. They are dictated by excessive formation of bronchial secretions under conditions of hypoxia, its increased viscosity, insufficient function of the ciliated epithelium, often suppression of the cough reflex and insufficient cough efficiency.

The goal is achieved by influencing the sputum, the peripheral sections of the tracheobronchial tree and the alveoli. The most accessible are the warming and humidification of the inhaled air with the help of inhalers, as well as aerosol therapy using pharmacological agents of three groups that affect sputum and its formation, the mucous membrane and bronchial tone, and the alveoli. The first group includes moisturizers (warm sterile water and sodium bicarbonate solution), mucolytics (acetylcysteine), stimulants ciliated epithelium(β-agonists, xanthines), cough stimulants (5-10% solution of propylene glycol and glycerin). The second group includes decongestants and anti-inflammatory drugs (propylene glycol, glucocorticoids, antibiotics), bronchodilators (β-agonists, M-anticholinergics, xanthines, glucocorticoids). The third group consists of surfactants, defoamers, antibacterial drugs.

Mobilization of sputum from deep departments tracheobronchial tree helps the following set of measures: postural drainage, therapeutic percussion of the lungs, vibration massage, oscillatory ventilation of the lungs, cough stimulation by pressing on the cricoid cartilage and by deep breath and subsequent maximum exhalation with simultaneous compression of the lower chest.

In cases where the methods considered do not give the desired effect, and the sputum accumulated in the trachea and bronchi significantly complicates breathing, it is necessary to suction the secret with a catheter inserted through the nasal passage after anesthetizing its mucous membrane. In case of viscous, difficult-to-separate sputum, the tracheobronchial tree should be washed through this catheter (and if the patient is intubated or a tracheostomy is applied, respectively, through a tube or cannula), followed by suction of the contents. The elimination of dehydration and hyperosmolarity of the extracellular fluid also contributes to a decrease in the viscosity of bronchial secretions.

In addition to maintaining airway patency in order to optimize gas exchange in the lungs, the correct choice of ventilation mode is important in both spontaneous breathing and mechanical ventilation. With obstructive processes in the lungs, as well as in cases of their combination with restrictive ones, an improvement in alveolar ventilation against the background of spontaneous breathing can be achieved with a regimen that provides positive intrapulmonary pressure at the end of exhalation (PEEP). To do this, use an adjustable water lock, a spring or magnetic valve, as well as oscillatory modulations that create expiratory resistance in the range of 0.6-0.8 kPa (6-8 cm of water column).

In cases where changes of an obstructive and restrictive nature are pronounced, which usually happens with respiratory distress syndrome and total pneumonia, it is advisable to use the continuous positive pressure (CPP) mode. It is achieved by additional active blowing of gas into the lungs under increased pressure. However, it must be borne in mind that this regimen affects hemodynamics by increasing the resistance to blood flow in the lungs more than the PEEP regimen.

To overcome respiratory disorders, one should strive, when possible, to mobilize the efforts of the patient himself. In particular, with obstructive forms, patients should be oriented towards deepening and slowing down of the phases of the respiratory cycle, and with restrictive forms, vice versa.

Improving the composition of the inhaled gas mixture is important in the treatment of respiratory failure. The most accessible is its enrichment with oxygen. Indications for O2 inhalation can usually be determined based on the clinical manifestations of respiratory failure. But if possible, it is better to be guided by the tension of O2 and CO2 in the blood. The method under consideration must be used in all cases where the partial pressure (of arterial blood) of oxygen (PaO2) is below 8.7 kPa (65 mmHg) and (or) the partial pressure of (venous blood) of oxygen (PaO2) is below 4.7 kPa (35 mmHg). If, along with hypoxemia, there is hypercapnia, i.e., the partial pressure (of arterial blood) of carbon dioxide (PaCO2) is more than 6.0 kPa (45 mm Hg), then the concentration of O2 in the inhaled air during spontaneous breathing should not exceed 40% . At higher concentrations of O2, hypercapnia may increase due to a decrease in lung ventilation. If it is impossible to eliminate hypercapnia in such conditions, it is necessary to switch to mechanical ventilation.

by the most accessible way enrichment of the inhaled air with O2 during spontaneous breathing is to supply it to the patient through nasal catheters. With an oxygen flow through them of 4-5 l / min, its content in the inhaled gas mixture reaches 30-40%. Approximately the same efficiency is provided when the catheter is inserted into the endotracheal tube or into the tracheostomy cannula. In this case, the diameter of the catheter should not exceed 1/3 of the inner lumen of the tube.

If O2 inhalation is indicated in more than high concentrations or in pure form, you have to apply it through a device consisting of a breathing bag, a non-reversible valve and a mask that is fixed to the patient's face. It should be borne in mind that prolonged breathing of pure O2 inevitably leads to its side effects on the body, manifested by the formation of small atelectasis, the occurrence of the so-called hyperoxic blood shunting, a decrease in the amount of reduced hemoglobin, a violation of the normal chain of biological oxidation, and a deterioration in the function of the ciliated epithelium of the respiratory tract mucosa. Therefore, breathing with 100% oxygen should be practiced only when absolutely necessary, trying to ensure satisfactory gas exchange in the lungs at an oxygen concentration in the inhaled air not exceeding 50%. PaO2 can serve as a reference point at various concentrations of O2 in the inhaled air in healthy people.

The change in PaO2 depending on the content of O2 in the inhaled air with healthy lungs (Zilberu A.P., 1986) is shown in Table. 1.

Table 1

Other types of oxygen therapy include hyperbaric oxygen therapy (HBO) and enteral O2. The last method, which consists in the introduction of O2 into the stomach and small intestine, is used in severe liver pathology. It is one of the very rarely used.

HBO in patients with respiratory failure has relatively broad indications. The method finds application in all forms of hypoxia, namely, circulatory, hemic, caused by methemoglobin formation, organophosphorus insecticides, etc. It is less effective in arterial hypoxia associated with primary lung damage, since in such cases HBOT leads to respiratory depression and the exacerbates respiratory acidosis. It should also be borne in mind that HBO can activate peroxide and free radical oxidation, the products of which tend to damage biological membranes, which leads to disruption of cell activity.

The considered methods of correction of respiratory insufficiency are quite effective. This usually happens with moderate respiratory disorders. Concerning sharply pronounced violations gas exchange function of the lungs, then they often have to resort to artificial respiration support.

Artificial lung ventilation (ALV) and assisted lung ventilation (ALV) are relatively complex IT methods. In military hospitals, mechanical ventilation is used in 7% of patients receiving IT. Experience shows that in relation to this method, errors are still allowed, which are expressed in a delay with the start of mechanical ventilation, insufficient control over its adequacy, in deviation from correct technique transition to spontaneous breathing. It is very important not to be late with the transfer of patients to mechanical ventilation. V. L Kassil (1981) showed that in the group of very seriously ill patients with respiratory failure, early transfer to mechanical ventilation allowed him to reduce mortality from 80 to 24% and at the same time reduce the duration of mechanical ventilation by 3.6 times.

Each of the considered methods has its indications. VVL, which until recently found relatively limited use in our country, can be used much more widely with the advent of more advanced domestic devices. In particular, it is indicated for patients who are conscious, in whom, with good airway patency and the absence of a pronounced increase in breathing, for one reason or another, ventilation rates are reduced. In such cases, IVL can be carried out through a breathing mask tightly fixed on the face. In addition, the IVL method makes it possible to ensure the safe transfer of patients with mechanical ventilation to spontaneous breathing after a long period of it, as well as in the immediate period after operations performed under general anesthesia with tracheal intubation. The devices mentioned above allow IVL to be carried out in trigger and minute forced breathing modes.

Indications for mechanical ventilation during IT are:

1) cessation of spontaneous breathing;

2) sharp violation breathing rhythm;

3) excessive work of the respiratory muscles, which is manifested by the participation of auxiliary muscles in breathing;

4) progressive symptoms of hypoventilation and hypoxia with widespread atelectasis of the lungs, closed injury chest with multiple fractures of the ribs, severe traumatic brain injury, asthmatic status with increasing hypercapnia.

Mechanical ventilation is also indicated for a more or less significant period (about 4 hours on average) in some very seriously ill patients admitted to the intensive care unit immediately after operations performed under general anesthesia with tracheal intubation. This applies, in particular, to patients with peritonitis, in a state of shock, with eclampsia, as well as to those patients who had serious complications during anesthesia and surgery that caused deep hypoxia.

The basis for the transition to mechanical ventilation is the clinical manifestations of respiratory failure, which, if possible, should be supported by laboratory data. These include cyanosis, earthy skin color, sweating, increased breathing (more than 35 per minute) or significant difficulty in it, anxiety or agitation with a feeling of lack of air, impaired cardiac activity.

Functional laboratory data dictating the need for mechanical ventilation are: vital capacity lungs less than 15 ml/kg, PaO2 less than 9.3 kPa (70 mmHg) when breathing pure O2, PaCO2 more than 7.3 kPa (55 mmHg), alveolar-arterial difference in O2 tension during breathing pure O2 for 10 minutes - more than 60 kPa (450 mm Hg).

When switching to mechanical ventilation and during its implementation, the following requirements must be taken into account:

a) choose the method and mode of mechanical ventilation, taking into account the nature and degree of violation of gas exchange and hemodynamics, as well as the specific conditions for its implementation;

b) reliably maintain airway patency and airiness of the lungs;

c) synchronize the appeared spontaneous breathing with the ventilator;

d) carefully monitor the parameters and adequacy of mechanical ventilation;

e) prevent complications and adverse side effects of mechanical ventilation on the human body.

Currently, several ventilation modes are used, namely: with passive exhalation; with active exhalation; with positive pressure. Each of these modes has its own indications.

IVL with active exhalation is indicated for patients with severe hypovolemia, right ventricular failure, and pulmonary compression. However, it should be borne in mind that this mode creates the prerequisites for the formation of atelectasis in the lungs, so it should be used only until severe gas exchange disorders are eliminated.

Positive expiratory pressure ventilation is preferred for pulmonary edema, the so-called adult respiratory distress syndrome. However, when high pressure on exhalation (more than 6 cm of water column), hemodynamics may worsen, which requires monitoring of it even in case of a decrease in stroke volume (SV), cardiac index(SI), blood pressure, you need to reduce the expiratory pressure or switch to a mode with periodic automatic expansion of the lung, or with an inverted (increased) inhalation / exhalation time ratio - from 1:1 to 4:1.

High-frequency lung ventilation (HFV) is carried out using special devices ("Spiron-605", "Phase-5"). This method is indicated in cases where it is impossible to ensure the tightness of the lungs during mechanical ventilation, with the so-called "hard" lungs (respiratory distress syndrome, "shock" lung, etc.), as well as with some endobronchial interventions. VChV can also be used as an assisted ventilation of the lungs.

The advantages of VCV over traditional mechanical ventilation are: providing a higher PaO2, facilitating the adaptation of patients to the ventilator, the possibility of ventilation with a leaky “device-patient” system without tracheal intubation and tracheostomy, safety in relation to aspiration, the possibility of toileting the tracheobronchial tree without interrupting ventilation.

The disadvantages of the method with its long-term use are the need for systematic monitoring of CO2 tension in arterial blood, high oxygen consumption, drying of the mucous membranes of the respiratory tract and hypothermia of patients when using devices that do not provide proper humidification and warming of the supplied gas mixture.

When resorting to mechanical ventilation in one form or another, it should be borne in mind that this very important method of IT, with the wrong choice of breathing mode or the composition of the respiratory mixture, insufficient control of the effectiveness of mechanical ventilation, and non-compliance with other requirements for it, can lead to serious complications.

Significant attention should be paid to the transfer of patients with mechanical ventilation to spontaneous breathing, especially after a long period of it. Experience shows that often, even with a well-founded decision to stop mechanical ventilation, a certain period is needed to restore full spontaneous breathing. In order to exclude the possibility of respiratory failure at this time, it is advisable to transfer patients to assisted lung ventilation using the Phase-5 apparatus and others.

Transfer to spontaneous breathing is possible with the restoration of good muscle tone, stable hemodynamics without the use of cardiovascular agents, the absence of hyper- and hypothermia, the presence of consciousness (except for patients with cerebral coma) and laboratory indicators, allowing to stop mechanical ventilation, in particular, PaO2 n PaCO2 within normal values ​​at an oxygen content (FiO2) of 25-30%. If, when observing the patient for 15-60 minutes (depending on the duration of mechanical ventilation) after turning off the ventilator against the background of inhalation of O2 through a catheter inserted into the endotracheal tube, the respiratory volume and respiratory rate do not go beyond the normal range, there are no clinical signs of hypoxemia and hypercapnia, the patient can be extubated and transferred completely to his own breathing. In this case, it is necessary every 5 minutes in the map intensive care register indicators characterizing the patient's condition.

When transferring patients to spontaneous breathing, it is advisable to use a special Marganroth scale (1984) to predict the success of the transition to spontaneous ventilation (see Zilber A.P. Respiratory therapy in everyday practice. 1986, p. 225).

If gas exchange is disturbed due to insufficient transport of gases by the blood or inadequate tissue respiration, it is necessary to eliminate disorders of the cardiovascular system, improve the respiratory function of the blood and gas exchange at the level of mitochondria (increase in hemoglobin concentration up to 100 g / l and above, correction of shifts (COS), introduction ascorbic acid, antihypoxants, etc.).

Nechaev E.A.

Manual for Intensive Care in Military Medical Institutions of the SA and Navy

Ensuring the patency of the upper respiratory tract is the most important component of emergency care, as well as the first stage of cardiopulmonary resuscitation. Conduction requires quick and thoughtful actions, as well as knowledge of anatomical landmarks. There are several methods of airway management in both emergency and controlled situations. These include intubation, conicotomy, and tracheotomy.

A) Epidemiology. The need to control the patency of the upper respiratory tract may arise in various pathological processes. The most common reason for performing a tracheotomy is mechanical ventilation for more than 1-2 weeks.

b) Terminology. The term airway usually refers to the path that airflow takes from the upper respiratory tract to the tracheobronchial tree. Patency failure can occur at any of these levels. Accurate knowledge of anatomy allows the doctor to build a clear plan of action and manipulation necessary to restore respiratory function.

A tracheotomy is the surgical opening of the trachea under the cricoid cartilage. A conicotomy is a dissection of the cricothyroid (conical) ligament, located between the thyroid and cricoid cartilages.

V) Anatomy. The inhaled air passes through the nasal cavity, where it is warmed and humidified. It then passes through the nasopharynx, oropharynx, and lower larynx, passing into the trachea through the subglottic space under the true vocal cords.

On anterior surface of the neck there are several anatomical landmarks that aid in surgical airway management. The notch of the sternum and the cricoid cartilage are an excellent guide to the midline of the neck, along which the trachea runs. One of the most notable landmarks is thyroid cartilage(Adam's apple), which protects the internal structures of the larynx.

most important landmark for tracheotomy is the cricoid cartilage, because it is located directly above the tracheal rings.

IN emergency When ideal access is not possible, anterior neck landmarks are especially valuable to the surgeon. On palpation of the neck, the first solid mass above the jugular notch is usually the cricoid cartilage. Next comes the larger thyroid cartilage. A small depression or hollow between them is the cricothyroid (conical) ligament, the site of the conicotomy.

G) Causes of airway obstruction. Respiratory tract complications can arise from many different causes, including trauma, anaphylactic reactions, cardiopulmonary shock, infections, exposure to toxins, congenital factors, neurological disorders, hypoventilation, and many others.

Natural course and development of the disease. A patient with hemodynamic disturbances and airway obstruction should be treated immediately, because. lack of oxygen in the blood leads to death within 4-5 minutes. In the case of stable hemodynamics or with restored patency, it is possible to perform additional methods examinations. In patients undergoing endotracheal intubation, the risk of developing complications, including stenosis of the larynx and trachea, increases. With an increase in the duration of intubation, the risk of complications also increases.

Possible Complications. Airway damage leads to dysphonia, stridor, inability to breathe adequately, and possibly death.

Disease assessment. Airway assessment systems are generally not suitable for surgically repaired patients.

Most successful operation performed with a lean physique, a well-extensible neck and palpable thyroid and cricoid cartilages.

Most a simple method for assessing complexity intubation is a classification by Mallampati, which is based on the degree of visualization of the oropharynx when the mouth is fully opened. Patients are divided into four classes. Class I - full view of the palatine arches, pharynx, uvula, soft palate; the risk of complications during intubation is low. At the other end of the classification is class IV when large tongue closes the view of the oropharynx, and only the hard palate can be visualized; in these patients, intubation will be more difficult.

e) Diagnosis of airway obstruction:

Complaints. The picture in respiratory failure can vary greatly from complaints of "throat discomfort" to an unconscious patient who cannot be ventilated. Signs of existing or impending airway obstruction may include stridor, increased salivation, frequent and shallow breathing, decreased oxygen saturation, tachycardia, swelling of the tongue, dysphonia, sensation of a lump in the throat, fractures of the facial skeleton; all these symptoms and complaints require immediate action.

Examination of an unconscious patient. When examining an unconscious patient, first of all it is necessary to push the lower jaw and assess the presence of breathing. Care must be taken not to damage the cervical spine. After establishing the fact of airway obstruction, it is necessary to clarify the mechanism of damage, localization, hemodynamic stability and the possibility of urgent action. Immediately after the patient entered medical institution, it is necessary to install a heart monitor with a pulse oximeter and provide access to a vein.

Examination of a patient in. The fact that the patient is conscious does not negate the urgency of assessing the airway, as many factors can quickly lead to deterioration. After the initial examination and history taking, it is necessary to clarify the facts about the effects of allergens, taking medicines, time of onset, mechanism of injury, associated symptoms, drug use, and life and medical history.

An extremely important symptom is the presence of stridor, which must be paid attention to during the history taking and examination. The characterization of the stridor helps the clinician in estimating the level of obstruction. Inspiratory stridor indicates obstruction at the level of the larynx, while expiratory stridor indicates damage to the underlying parts of the tracheobronchial tree. The cause of mixed stridor is a lesion at the level of the fold or subglottis of the larynx.

Inspection. A complete examination is an indispensable tool in clinical decision making. Neurological status is assessed using the Glasgow Coma Scale (GCS). A complete examination of the head and neck is necessary, including examination of the eyes, ears, nose, throat, and face, especially in patients with traumatic injuries. Be sure to carefully palpate the neck in order to identify neoplasms that can cause airway compression.

Then, a study of the respiratory and cardiovascular systems is carried out, paying attention to the level of respiratory load and the participation of additional muscles in breathing. If the patient's condition is stable, fibroscopy imaging of the larynx and underlying parts of the respiratory tract is indispensable.

Laboratory Research and Imaging. When the state is sufficiently stable, it is useful to carry out computed tomography, which allows you to determine the degree of damage to the internal structures of the upper respiratory tract. With the development of respiratory failure, the determination of the gas composition of the blood helps to diagnose its cause.

Differential Diagnosis. Several pathological conditions can mimic acute respiratory failure. Anxiety disorder can manifest as panic attacks, one of the symptoms of which may be respiratory failure. Hyperventilation further exacerbates the suffocation and terror felt by the patient.

Acute respiratory failure can have many causes, it can lead to any violation of the anatomical integrity or narrowing of the lumen. Tumors, formations, injuries and foreign bodies of the pharynx, larynx or trachea can lead to the development of severe respiratory failure. Direct compression of the airways by tumors near the trachea (anaplastic carcinoma) thyroid gland, pronounced goiter), can lead to severe complications. The immobility of the true vocal folds, especially bilateral, can lead to almost complete airway obstruction.