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Full text of "Diseases Of The Nose Throat And Ear"

INHALED AND SWALLOWED FOREIGN BODIES         219

TREATMENT. This is the removal of the object at bronchoscopy, and a
history suggestive of the inhalation of a foreign body is sufficient justification
for a diagnostic bronchoscopy even in the absence of positive clinical or
radiological signs. Bronchoscopy is performed under general anaesthesia
administered by a skilled anaesthetist, whose duty it is to maintain a constant
watch on the pulse, slowing of which is the earliest sign of hypoxia, which
may rapidly lead to cardiac failure. The younger the child, the greater is the
danger and the more difficult is the successful removal. Each bronchoscopist
has his own method but it is found that satisfactory results are obtained by a
two-stage procedure. The first bronchoscopy is used to aspirate secretions and
to locate the foreign body and note its position. The child is immediately

Fig. 110. Tack in right main bronchus.

deepened aaaesthetkally, the bronchoscope re-inserted and the object grasped
and removed. Inorganic foreign bodies of average size are usually easily
removed. A small object, such as a pin, may have moved peripherally so that
it cannot be seen through the bronchoscope, and if it cannot be extracted by a
magnetized probe, its removal may have to be undertaken by the thoracic
surgeons at a thoracotomy. An organic foreign body of recent inhalation
presents fewer problems than one which has been allowed to remain in the lung
for some time. In the latter instance there is local oedema and even granulation
tissue around the object which itself may have become soft and friable. In such
a case it is important that after removing the main part of the object a further
examination is made immediately to ensure a complete extraction. A foreign
body of plastic material produces no local reaction and is thus reasonably easy
to remove.

PROGNOSIS. A successful removal of a foreign body will result in the recovery
of the lung. If an organic object has lain for some weeks in the bronchus
before removal the expansion of the collapsed lobe will be slow in virtue of the
local infection present, and antibiotic therapy will be necessary. An incomplete
removal of such an organic object, or the lack of diagnosis of an organic
foreign body, will lead to a lung abscess, which may require thoracic surgery,