{"id":71356,"date":"2023-04-25T09:43:04","date_gmt":"2023-04-25T07:43:04","guid":{"rendered":"https:\/\/www.revista-portalesmedicos.com\/revista-medica\/?p=71356"},"modified":"2024-02-28T10:15:20","modified_gmt":"2024-02-28T09:15:20","slug":"obstruccion-de-la-via-aerea-en-nino-de-10-anos","status":"publish","type":"post","link":"https:\/\/www.revista-portalesmedicos.com\/revista-medica\/obstruccion-de-la-via-aerea-en-nino-de-10-anos\/","title":{"rendered":"Obstrucci\u00f3n de la v\u00eda a\u00e9rea\u00a0 en ni\u00f1o de 10 a\u00f1os"},"content":{"rendered":"

Obstrucci\u00f3n de la v\u00eda a\u00e9rea\u00a0 en ni\u00f1o de 10 a\u00f1os<\/strong><\/p>\n

Autora principal: Alba Mart\u00ednez de la Horra<\/p>\n

Vol. XVIII; n\u00ba 8; 382<\/p>\n

Airway obstruction in a 10-year-old child<\/strong><\/p>\n

Fecha de recepci\u00f3n: 27\/03\/2023<\/p>\n

Fecha de aceptaci\u00f3n: 19\/04\/2023<\/p>\n

Incluido en Revista Electr\u00f3nica de PortalesMedicos.com Volumen XVIII. N\u00famero 8 Segunda quincena de Abril de 2023 \u2013 P\u00e1gina inicial: Vol. XVIII; n\u00ba 8; 382<\/p>\n

Autores<\/strong>:\u00a0 \u00a0 \u00a0Alba Mart\u00ednez de la Horra. Enfermera en 061 Cantabria y servicios de urgencia. Espa\u00f1a.<\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mar\u00eda Casuso Ruiz, enfermera en HUMV unidad de consultas hospitalarias. Espa\u00f1a.<\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Marta Arenal Osorno, enfermer\u00eda 061 Cantabria y servicios de urgencia. Espa\u00f1a.<\/p>\n

RESUMEN<\/strong><\/p>\n

Nos avisa el 061 por ni\u00f1o de 10 a\u00f1os, actualmente sano, que por error se introduce en la boca una canica mientras jugaba con su hermana mayor. A nuestra llegada esta tumbado seminconsciente, con dificultad respiratoria acompa\u00f1ada de estridor, tos inefectiva, cianosis, imposibilidad para hablar. Se procede a iniciar RCP \u00a030:2\u00a0 durante unos 3 minutos hasta que el objeto fue expulsado con \u00e9xito. Se procedi\u00f3 a comprobar pulso, respiraci\u00f3n y capacidad de respuesta del paciente que comenz\u00f3 a respirar con normalidad.<\/p>\n

PALABARAS CLAVE: obstrucci\u00f3n,\u00a0 v\u00eda a\u00e9rea, atragantamiento<\/p>\n

SUMMARY<\/strong><\/p>\n

061 notifies us of a 10-year-old boy, currently healthy, who mistakenly puts a marble in his mouth while playing with his older sister. Upon our arrival, he is lying semiconscious, with respiratory distress accompanied by stridor, ineffective cough, cyanosis, and inability to speak. 30:2 CPR is started for about 3 minutes until the object is successfully expelled. We proceeded to check pulse, respiration and responsiveness of the patient who began to breathe normally.<\/p>\n

KEYWORDS: obstruction, airway, choking<\/p>\n

DISCUSI\u00d3N<\/strong><\/p>\n

Un atragantamiento es la obstrucci\u00f3n de la v\u00eda a\u00e9rea por un cuerpo extra\u00f1o y que si no se resuelve puede provocar asfixia dando lugar a hipoxia grave, inconsciencia e incluso puede derivar a una parada cardiorespiratoria y muerte.<\/p>\n

Hay varios factores de riesgo para que se produzca un atragantamiento: ancianos, ni\u00f1os, personas con discapacidad f\u00edsica o mental, personas con problemas de disfagia, personas bajo los efectos de alcohol o drogas\u2026 Aunque la principal causa de atragantamiento es la comida o en ni\u00f1os m\u00e1s peque\u00f1os la causa suele ser el atragantamiento con objetos\/juguetes peque\u00f1os, como es en este caso.<\/p>\n

En 1970 t\u00e9cnicas como los golpes interescapulares, las compresiones tor\u00e1cicas, fueron recomendadas por la \u201cCruz Roja Americana\u201d y la \u201cAmerican Heart Association\u201d para solventar el problema del atragantado. En 1974 se publica la maniobra de Heimlich, conoci\u00e9ndose en la actualidad como \u201ccompresiones abdominales\u201d.<\/p>\n

Es importante valorar la gravedad de la obstrucci\u00f3n.<\/p>\n

Si el paciente est\u00e1 consciente con una respiraci\u00f3n efectiva, tos y\/o estridor entre accesos de tos, llorando o con respuesta verbal, la obstrucci\u00f3n es parcial y hay que animar al paciente a seguir tosiendo.<\/p>\n

En cambio, si el paciente est\u00e1 consciente o inconsciente con dificultad respiratoria acompa\u00f1ada de estridor o ausencia de respiraci\u00f3n y posible cianosis se debe a que la obstrucci\u00f3n est\u00e1 siendo total. Si est\u00e1 consciente hay que darle 5 golpes interescapulares y en el caso de que no sean eficaces o pierda el conocimiento\u00a0 hay que comenzar con compresiones tor\u00e1cicas hasta que el objeto sea expulsado.\u00a0 Posteriormente hay que comprobar pulso, respiraci\u00f3n y capacidad de respuesta del paciente.<\/p>\n

En el caso de los ni\u00f1os cuando la\u00a0obstrucci\u00f3n\u00a0<\/strong>de la v\u00eda a\u00e9rea es\u00a0completa\u00a0<\/strong>lo primero que hay que hacer es pedir ayuda si estamos solos. Intercalaremos\u00a05 golpes interescapulares y 5 compresiones abdominales\u00a0hasta la resoluci\u00f3n de la obstrucci\u00f3n (cuando el ni\u00f1o est\u00e9 consciente).<\/p>\n

Si el ni\u00f1o es menor de 1 a\u00f1o las compresiones se realizar\u00e1n tor\u00e1cicas. Esta maniobra se llama\u00a0Heimlich modificado\u00a0y se realiza siempre en mujeres embarazadas (para no da\u00f1ar al feto), obesos y ni\u00f1os menores de 1 a\u00f1o (por riesgo de rotura de v\u00edsceras).<\/p>\n

Si fuese lactante pediremos ayuda y posteriormente lo colocaremos en\u00a0dec\u00fabito prono\u00a0con la cabeza m\u00e1s baja que el t\u00f3rax y daremos\u00a05 golpes interescapulares\u00a0<\/strong>seguidos de\u00a05 compresiones tor\u00e1cicas, que se realizan con el beb\u00e9\u00a0en dec\u00fabito supino.<\/p>\n

DISCUSSION <\/strong><\/p>\n

A choking is the obstruction of the airway by a foreign body and if not resolved it can cause asphyxia leading to severe hypoxia, unconsciousness and can even lead to cardiorespiratory arrest and death. There are several risk factors for choking to occur: the elderly, children, people with physical or mental disabilities, people with dysphagia problems, people under the influence of alcohol or drugs… Although the main cause of choking is food or in children smaller, the cause is usually choking on small objects\/toys, as in this case.<\/p>\n

It is important to assess the severity of the obstruction. If the patient is conscious, breathing effectively, coughing and\/or stridor between coughing fits, crying or with a verbal response, the obstruction is partial and the patient should be encouraged to continue coughing On the other hand, if the patient is conscious or unconscious with respiratory distress accompanied by stridor or no breathing and possible cyanosis, it is because the obstruction is being total. If he is conscious, he must be given 5 interscapular blows and in the event that they are not effective or he loses consciousness, chest compressions must be started until the object is expelled. Subsequently, the pulse, breathing and responsiveness of the patient must be checked.<\/p>\n

In 1970 techniques such as interscapular blows, chest compressions, were recommended by the \u00abAmerican Red Cross\u00bb and the \u00abAmerican Heart Association\u00bb to solve the problem of choking. In 1974 the Heimlich maneuver was published, currently known as \u00ababdominal thrusts\u00bb.<\/p>\n

In the case of children when the airway obstruction is complete, the first thing to do is ask for help if we are alone. We will alternate 5 interscapular blows and 5 abdominal compressions until the obstruction is resolved (when the child is conscious). If the child is under 1 year old, chest compressions will be performed. This maneuver is called modified Heimlich and is always performed on pregnant women (so as not to harm the fetus), obese women, and children under 1 year of age (due to the risk of ruptured viscera).<\/p>\n

If it is an infant, we will ask for help and later we will place it in the prone position with the head lower than the thorax and we will give 5 interscapular blows followed by 5 chest compressions, which are performed with the baby in the supine position.<\/p>\n

BIBLIOGRAFIA<\/strong><\/p>\n

1- Tshiassny K. Ludwig\u2019s angina: an anatomic study of the lower molar teeth in its pathogenesis. Arch Otolaryngol Head Neck Surg 1943; 38:485-496.<\/p>\n

2- Saifeldeen K, Evans R. Ludwig\u2019s angina. Emerg Med J 2004; 21:242-243.<\/p>\n

3- Boscolo-Rizzo P, Da Mosto MC. Submandibular space infection: a potentially lethal infection. Int J Infect Dis 2009; 13:327.<\/p>\n

4- Larawin V, Naipao J, Dubey SP. Head and neck space Infections. Otolaryngol Head Neck Surg 2006; 135(6):889\u2013893.<\/p>\n

5- Brook I. Microbiology and principles of antimicrobial therapy for head and neck infections. Infect Dis Clin North Am 2007; 21:355.<\/p>\n

6- Lemonick DM. Ludwig\u2019s Angina: Diagnosis and Treatment. Hospital Physician 2002; 31-37.<\/p>\n

7- Hurley MC, Heran MK. Imaging studies for head and neck infections. Infect Dis Clin North Am 2007; 21:305.<\/p>\n

8- Ovassapian A, Tuncbilek M, Weitzel EK, Joshi CW. Airway management in adult patients with deep neck infections: a case series and review of the literature. Anesth Analg 2005; 100:585.<\/p>\n

9- Viera F, Allen SM, Stocks RM, Thompson J. Deep<\/p>\n

neck infections. Otolaryngol Clin North Am 2008; 41(3):459\u2013483<\/p>\n

10- Greenberg SL, Huang J, Chang RS, Ananda SN. Surgical management of Ludwig\u2019s angina. ANZ Journal of Surgery 2007; 77(7):540\u2013543.<\/p>\n","protected":false},"excerpt":{"rendered":"

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