Ending with the presence of itching painful swelling
3. Laryngoscopy (direct and indirect);
7. Endoscopy (bronchoscopy, tracheobronchoscopy);
8. Stroboscopy (gives an idea of the movement of the vocal folds).
Laryngeal edema is a symptom of a certaindiseases of the throat, larynx, acute and chronic infectious diseases (measles, scarlet fever, flu, tuberculosis, syphilis), neck injuries, thermal and chemical burns of the larynx) and non-inflammatory (heart failure, liver and kidney disease, allergic reaction ).
Clinic depends on the degree of narrowing of the larynx lumen and the speed of spread of edema.
1. pain when swallowing;
2. Sensation of a foreign body;
5. a picture of suffocation (a feeling of lack of air, cyanosis, anxiety, participation in the respiration of the auxiliary musculature).
2. medicines, reducing tissue edema - diuretics (lasix),
3. drugs that reduce the permeability of the vascular wall (10% solution of calcium chloride, 20% glucose solution with insulin, 5% solution of ascorbic acid),
4. desensitizing, hormonal drugs;
5. with the development of asphyxia - immediate intubation (conicotomy, cryotomy, tracheotomy, etc.).
burns of pharynx and larynx;
Clinical picture</ i> stenosis of the larynx:
1st stage - compensation:
2. difficulty breathing appears with physical exertion, crying;
3. Noisy breathing, inspiratory dyspnea.
2 nd stage - subcompensation:
2. noisy breathing at rest - a long breath, a sharp exhalation;
3. participation in respiration of the auxiliary musculature;
4. tachycardia, increased blood pressure;
5. forced position of the patient - sitting with his head thrown back;
3rd stage - decompensation:
1. severe anxiety, fear;
2. Breathing shallow, rapid, noisy, audible at a distance;
3. tachycardia and increased blood pressure are more pronounced;
4. The skin of the face is crimson-cyanotic, covered with cold, sticky sweat;
5. cyanosis of the lips and nails;
6. The voice and cough become mute.
4th stage, asphyxia:
1. obscuration or loss of consciousness;
2. Cheyne-Stokes breathing;
3. pupils are sharply dilated;
4. pronounced pallor of the skin;
5. blood pressure is sharply reduced, there is no pulse;
6. death occurs.
Urgent care with acute stenosis of the larynx:
3. mustard foot baths;
4. provision of fresh cool air in the room;
In the hospital with stenoses of 1-2 degree conservative treatment is carried out:
6. Oxygen therapy (humidified oxygen, oxygen tent);
7. drugs that reduce tissue edema - diuretics (lasix), reducing the permeability of the vascular wall (10% calcium chloride solution, 20% glucose solution with insulin, 5% solution of ascorbic acid), desensitizing, hormonal drugs;
8. antibacterial drugs according to indications.
With stenoses 3-4 stage urgent surgical care is used: conicotomy, tracheotomy.
Conicotomy - dissection of the conical bundle - is made in an extreme situation. It is necessary to take the following measures to save the patient's life:
1. prepare a cutting tool, a hollow tube with unbreakable edges;
2. To implement, as far as possible, aseptic rules;
3. Sit the patient with his head thrown back and fix it;
4. palpation of the location of the conical ligament (a depression between the lower edge of the thyroid cartilage and the arch of the cricoid cartilage);
5. make a horizontal cut of the skin and conical ligament to a depth of no more than 0.5-1 cm in the adult patient to avoid injury to the posterior wall of the larynx;
6. insert into the resulting incision a hollow tube and fix it with adhesive plaster or other improvised material;
7. to urgently transport the patient to a hospital for tracheotomy.
Tracheotomy is an operation of dissection of the trachea with the introduction of a respiratory tube.
Fig. Variants of surgical interventions on the larynx and trachea:
5. Average tracheotomy (Ovchinnikov Yu.M. 1988)
Indication for tracheotomy is a violationrespiration with the phenomena of stenosis of the 3-4th degree, caused by the disease of the larynx of various etiologies. For the timely provision of emergency care in ENT departments, surgical rooms and infectious departments, it is necessary to have a sterile set of instruments and anesthetics for tracheotomy. Tracheotomy tubes are manufactured in various sizes from metal, plastic and biological materials.
position of the patient: lying on his back with an unbent neck and a roller, laid under his back;
anesthesia: in the provision of emergency care - local, during a routine operation - intubation anesthesia;
location of the incision: in relation to the isthmus of the thyroid gland, the tracheotomy is distinguished by the upper, middle and lower tracheotomy;
execution of a skin incision: strictly along the middle line from the thyroid cartilage to the jugular recess;
displacement of the thyroid isthmus: up or down depending on the mode of operation;
dissection of tracheal rings: a linear incision through 2 and 3 tracheal rings and the introduction of a tracheotomy tube;
fixing the tube, suturing the wound, applying an aseptic dressing.
If it is necessary to wear the tube for a long time, a tracheostomy is made - the formation of a round hole on the front surface of the trachea - the stoma.
Care after a tracheotomy.
In the postoperative period the patient needsindividual care and monitoring of the general condition, body temperature, skin conditions in the area of the operating wound. In addition, the nurse according to the prescription of the doctor must perform the following types of care:
1. monitor the air humidity in the room;
2. to carry out a regular change of gauze napkin under the tube shield to prevent skin irritation;
3. Perform skin treatment in the area of the operating wound when maceration occurs with drying agents (Lassar paste) or ointments with antibiotics or corticosteroids (flucinar, lorindene);
4. to carry out a toilet and a shift, an internal tracheotomy tube (the entire cannula is replaced by a doctor);
5. insert into the tube an alkaline-oil solution of 2-3 drops in 2-3 hours for liquefaction of sputum, solutions of chymotrypsin, antibiotics;
6. Remove phlegm from the tube by an electro-pump with a flexible tip;
7. Follow the correct position of the patient (on the side) and change the position every 2 hours;
8. to conduct therapeutic and respiratory exercises, chest massage.
Acute inflammatory diseases of the larynx.
Acute laryngitis - inflammation of the mucosalarynx, often spreading from the nose and pharynx in the process of respiratory viral infection, measles, whooping cough and other diseases. The cause of the inflammatory process can be irritation of the mucous membrane by harmful factors of an industrial nature.
1. Percolation in the larynx, dry, painful cough;
2. hoarseness of the voice, which can be replaced by a silent voice (aphonia);
3. painful pressure or sadness behind the sternum (when spreading the process into the trachea area);
4. difficulty breathing, which occurs with the accumulation of mucopurulent sputum; intoxication moderately pronounced, subfebrile temperature.
hyperemia and swelling of the mucous membrane of the vestibule of the larynx and podvigosal space;
hyperemia of the vocal folds, which look like thick rollers;
a viscous muco-purulent secret located on the vocal folds and between them in the form of strands.
Treatment acute laryngitis is performed in outpatient settings:
1. voice rest, exclusion of irritating factors;
2. Sparing diet, warm alkaline drink;
3. distractions: mustard baths and mustard plasters for calf muscles, dry heat to the neck area;
4. Local effects on the mucosa:
a) warm alkaline-oil inhalations,
b) physiotherapy (electrophoresis with calcium chloride, diadynamic currents-DDT, UHF);
c) infusion of the drug into the larynx (hydrocortisone emulsion, dioxidine, sunflower oil);
5. General treatment -
b) removing the cough reflex at the beginning of the disease, expectorant drugs,
at) antibacterial and desensitizing agents;
d) at a temperature, anti-inflammatory agents.
Chronic laryngitis occurs frequently in people of certain professions.
The most characteristic sign of these diseasesis a periodic violation of voice - dysphonia. If this symptom does not appear, do not self-medicate, and it is recommended to seek advice from the ENT doctor, or phoniatrist, for the examination.
Distinguish catarrhal, hyperplastic and atrophic form of chronic laryngitis.
frequently recurring acute inflammation of the larynx;
long inflammatory processes in the upper organs (rhinitis, sinuitis, tonsillitis, pharyngitis) or inferior (bronchitis, tracheitis);
exposure to harmful factors (smoking, gas contamination, dustiness of industrial premises);
overstrain of the voice apparatus in persons of speech professions.
1. hoarseness of the voice, periodically amplified; fatigue of the voice apparatus, hoarseness of voice by the end of the working day;
2. Persecution, scratching in the larynx;
congestive hyperemia of the laryngeal mucosa more pronounced in the area of vocal folds;
moderate amount of mucous secretion.
Treatment chronic catarrhal laryngitis:
2. elimination of irritant factors;
3. restoration of nasal breathing;
4. inhalation of physiological solution with antibacterial drugs;
5. infusion into the larynx of solutions of antibiotics, suspension of hydrocortisone;
more common in men due toThe inability to eliminate professional irritants or bad habits. The disease is divided into a limited and diffuse form and is considered as a precancerous condition.
Clinical manifestations similar to the catarrhal form, but more pronounced hoarseness of the voice, periodically changing into aphonia.
marked hyperemia and infiltration of the mucosa;
uneven thickening, tuberosity of vocal folds;
the formation of small edematous thickenings on both vocal folds that prevent the closure (nodules of singers).
To clarify the diagnosis, histological and cytological studies are performed.
Treatment chronic hyperplastic laryngitis provides:
1. elimination of all harmful factors;
2. strict voice mode;
3. infusion of solutions of antibiotics, corticosteroids, antihistamines;
Patients with chronic hyperplastic laryngitis should be on dispensary records.
is associated with an atrophic process of the nasal and pharyngeal mucosa.
suffered acute infectious diseases (scarlet fever, diphtheria).
2. dry, painful cough;
3. The sensation of a foreign body in the larynx.
brightly hyperemic glossy mucous membrane in the initial stages of the disease and dry yellowish hue in the following;
viscid mucus, crusts of dark green color.
Treatment chronic atrophic laryngitis includes:
1. Exclusion of irritant factors;
3. alkaline-oil inhalations for three to five days are prescribed in the presence of crusts in the larynx;
4. inhalation of physiological solution with iodine preparations, 1-2% menthol solution in oil;
5. electrophoresis on the larynx of novocaine, potassium iodide;
Lining laryngitis (false croup)
occurs in children from two to five years due to the presence in this age in the podvigosovom space a significant amount of loose fiber, which reacts to irritation with edema.
violation of metabolic processes (exudative diathesis, rickets, etc.);
allergic diseases (bronchial asthma, vasomotor rhinitis);
infectious diseases (ARVI, measles, scarlet fever).
The attack begins suddenly, the voice becomessighing, coughing barking, inspiratory shortness of breath arises, breathing noisy. In severe stenosis, auxiliary muscles, supra- and subclavian space participate in the act of breathing.
Objectively: cyanosis of the nasolabial triangle, fingernails and toenails.
An attack can pass without a trace, only a hoarse voice remains.
In typical cases, the duration of the attack is from a few minutes to half an hour. Then there is a marked sweating, breathing becomes free, the child falls asleep.
However, recently due to the growth ofthe number of allergic diseases attacks podgolosovogo laryngitis occur much heavier and are accompanied by the development of severe degrees of stenosis of the larynx. Against the backdrop of gradually increasing dyspnea, a sudden stop of breathing, associated with laryngospasm, may develop.
Due to the fact that the disease develops suddenly, in the middle of the night, the child needs urgent help:
1. to give the patient an elevated position, to unbutton the restraining clothes;
2. Ensure that the room is wet, cool fresh air or carry oxygen therapy;
3. hot foot baths;
4. cause a vomitive reflex by pressing on the root of the tongue in the event of a sudden stop of breathing to relieve the reflex spasm of the vocal folds;
5. water the child with warm milk, alkaline solutions (1 teaspoon of soda in 1 liter of boiled water);
6. When improving the condition, I recommend that you consult a doctor the next day;
7. in the absence of the effect of the assistance provided, to provide urgent hospitalization.
AT hospital the child will receive the following assistance:
1. direct laryngoscopy and in the presence of indications - intubation;
2. parenteral administration of antihistamine, hormonal drugs;
4. the appointment of diuretics, sedatives, expectorants, antibacterial drugs.
Dysphagia of the larynx (true croup)
- acute infectious disease, more common in children two to four years, sometimes in adults. Usually the process spreads from the mucous membrane of the nose or pharynx.
1. gradual increase in temperature to febrile figures, lethargy, decreased appetite;
2. a wet cough at the beginning of the disease, gradually turning into a coarse, barking, and then into a silent one;
3. hoarseness of the voice, appearing in the first day, then develops aphonia;
4. Breath noisy, difficult on inspiration;
5. increasing respiratory insufficiency, pallor of the skin, cyanosis of the nasolabial triangle;
6. severe anxiety, cold sweat, cyanosis of the lips, an aponic voice, indicating a severe course of the disease, development of the third stage of stenosis of the larynx;
7. loss of consciousness, severe pallor of the skin precede the lethal outcome.
hyperemia and edema of the laryngeal mucosa;
dense dirty-gray fibrinous films covering the laryngeal mucosa, vocal folds and narrowing the vocal cavity.
When suspected of diphtheria the following activities are carried out:
ü bacteriological examination for the presence of Leffler's bacilli to clarify the diagnosis;
ü emergency notification to SES;
ü hospitalization of the patient in the infectious disease department;
ü monitoring of contact, their bacteriological examination.
Treatment Diphtheria of the larynx is carried out only in a hospital and includes:
1. strict bed rest;
2. carrying out anti-epidemic measures;
3. Introduction of antidiphtheria serum according to the method. It is not rare in doses corresponding to the form of the disease;
5. alkaline-oil inhalations to accelerate the separation of films;
6. infusion into the larynx of chymotrypsin on isotonic solution;
8. Intubation or tracheotomy in cases of stenosis of the 3rd-4th degree.
Foreign bodies of larynx, trachea and bronchi
more common in children, however, are noted in adults and arise for the following reasons:
1. in the absence of supervision of young children by adults;
2. when talking, laughing while eating;
3. in connection with the professional habit of keeping small things in your mouth (nails, needles, staples);
4. in the presence of dentures or tooth defects;
5. when vomiting in a state of intoxication or anesthesia.
Penetration of the foreign body in the respiratory tractat any level poses a threat to the health and life of the patient. The deeper the penetration, the worse the forecast. A frequent place of localization of the foreign body of the lower respiratory tract is the right bronchus due to the peculiarities of the structure. Removal of the foreign body with the help of a cough is impeded by the mechanism of constriction of the bronchi during exhalation and the closing of the vocal folds when stimulated by a foreign body. Very dangerous foreign bodies of plant origin, which, swelling, increase in size and can cause choking.