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Analysis Of Foreign Bodys Biology Essay

In generally foreign body can be describing as the component or thing which is not belonging to the human body and it is stranger to the human body. Foreign body can get into the human body by two ways, which is through the aspiration mean inhale the foreign body to human body or by ingestion either ingest with the food during eating or without food. Foreign body aspiration means the inhale the foreign body through the trachea into the respiratory tract like lungs and bronchus. Foreign body ingestion means ingest the Foreign body through the oesophagus into the digestive tract like stomach. Foreign body will affect more to the children less than 4 year old than the adult people. Because adult people can differentiate between the thing can eat, thing can’t eat and have general knowledge. But for the children, they may don’t know to differentiate between food and foreign body due to the process of the development, mouth to explore to the environment because of the age and they are lack of the posterior dentition to properly chew food. But ingest or inhale foreign body still will occur to adult for whom more than 65 years old due the mental disorder or some disease. When the young children inhale or ingest the foreign body into the body, this condition can lead to the morbidity and mortality. The immediately treatment is needed to removal the Foreign body from child. When some is ingest or inhale the foreign body, they will shoe some sign and symptom, with this sign and symptom we can guess they may ingest or inhale the foreign body. So, we can take them to hospital for further evaluation about the body condition and may for the treatment.

Type of the foreign body

Commonly foreign body can divided in two main groups, which are radiopaque foreign body and radiolucent foreign body. Radiolucent foreign body mean the foreign body can’t been see on the general radiograph because it will not absorbed the x ray and will allow the x ray pass through typically is due to low atomic number. Radiopaque foreign body typically has high atomic number and can absorbed the X ray. The image can be seen on the general radiograph. Plastic object normally is the type of the radiolucent foreign body and metallic object is the radiopaque foreign body.

Radiolucent Foreign Body or Plastic Object

Hot dog

Mild food

Plastic material

Meat

Vegetable matter like peanut

Nail pieces

Plastic toys

Latex balloon

Marble ball

Radoopaque Foreign body or Metallic Object

Coin

fish bone

Chicken bone

Metal pin

Metallic material like small nut.

Small battery

Needles

Nut

Common Location of the Foreign Body

Common location of the foreign body mean the place in human normally will affect or located by the foreign body. The location wills not specific collect in one place because of the time passing, the foreign body will pass from one part to another part due to the physiological of human body like swallowing and breathing. Foreign body either ingestion or aspiration always will affect or will located in few part of the human body. The part will be affected or located is due to the physical condition and physiological functional of human body. The common location can divided into two types which is internal location and external location. Internal location mean the foreign body located at inside own body like digestive tract and respiratory tract. External mean foreign body located outside human body like surface of skin and surface of eye.

Internal Location of Foreign Body

tonsils

vallecula epiglottica

trachea ( laryngeal)

oesophagus

main bronchus

lungs

gastroesophageal junction

stomach

External Location of Foreign Body

skin

eye

Sign and Symptom

The sign and symptom will be shown when someone is accidently ingest or inhale foreign body either for children or adult people. This sign and symptom help us or help parent to evaluate the children and adult health condition. When they suspect them have ingest or inhale foreign body, so parent or guardian can take them to hospital for confirmation and further treatment for removal foreign body. The common sign and symptom for children and adult and for both foreign body ingestion and aspiration have listed down following:

choking

wheezing

coughing

dysphagia

odynophagia

gagging

dysphonia

Some radiologic examination should be carry to see the location of foreign body. The X ray projection will do in radiology department is AP or PA chest examination, AP abdomen examination and AP neck cervical examination. The examination is depend on the time interval between the patient ingest or inhale foreign body and the time going to do x ray. Patient may ingest the coin at half an hour before the examination, so the PA or PA chest radiograph will take if more than 45 minutes AP abdomen radiograph will take. At the same radiograph have reduced the total dose to the patient especially for children.

PA Projection of Chest Procedure

Size cassette

35 cm x 43 cm

Patient position

place the patient in upright position against the erect Bucky in PA position

Position of Part

center the MidSagittal plane (MSP) of patient to the midline of vertical grid devices

ask patient hanging the arm at the side

adjust the image receptor 2 inches about the patient’s shoulder

ask patient stand straight, with the weight of the body equally distributed on the feet

ask patient extend the chin enough to prevent superimposition of mandible with the area of interest

make sure the MSP of patient is perpendicular to the midline of grid

flex he patient arm and rest the hand on the low hip

depress the shoulder to lie on the same transverse plane

Central Ray

central ray perpendicular to the T7 or lower tips of scapula

Structure shown

thoracic viscera shown the air filled trachea

lung diaphragmatic dome

heart shadow

aortic knob

AP Projection of Abdomen Procedure

Size cassette

35 cm x 43 cm

Patient Position

Position the patient in supine position in the table

Position of the Part

Center the MSP of the patient to the midline of the table

Ensure that patient arm is lie on the area of interest, place the arm near the head

Canter the IR at the level of iliac crest

Ensure the pubis symphysis is included in the radiograph

Central Ray

Perpendicular to the center of IR at the level of iliac crest

Evaluation Criteria

Area from the pubic symphysis to the upper abdomen

Proper alignment can determine by the cantered vertebral column

No rotation of the patient can determine by the Spinous process in the center of the lumbar vertebrae.

AP Projection of the Cervical Procedure

Size cassette

8 inch x 10 inch

Patient position

Place the patient in the upright position

Position of the part

Center MSP of the patient to the midline of the grid

Extend the patient’s chin enough to prevent superimposition of the mandible to the midcervical vertebrae

Center the IR at the level of C4

Adjust the patient’s head so that the MSP is straight to the midline of IR

Central Ray

Central ray through the C4 at the angle 15° to the 20° cephalad

Structure shown

Lower 5 cervical

Upper 2 or 3 thoracic

Above is the common projection will be done to see the location of the foreign body. If the projection is not enough to evaluate the exact location of foreign body, radiologist may will order extra projection like lateral projection of chest and AP projection of pelvis for ensure doctor know the exact location. This is very important especially for the surgical removal of foreign body.

Patient care

Patient care divides into 3 parts which is before, during, and after. Patient care is very important in hospital. We have to take care the patient very well because this is response to patient right and also responsibility of medical officer.

Before:

Ensure patient understand the procedure including the risk and complication.

Help patient in bowel preparation

Ensure female patient is not pregnant

During:

Help patient whenever they need

Observe the patient condition and any small reaction from patient

After:

Help patient to change the dress

Help them go to ward

Notice the abnormal reaction of patient

Assist them whenever they need.

Complication After Ingest and Inhale Foreign Body

Complication means unwanted or unfavourable evolution due to the disease. The complication of ingest and inhale of the foreign body is depend on the type of foreign body. Normally metallic object will cause severe complication than the plastic object because metallic object is physically harder than the plastic object. In addition, in aspect of sharpness, metallic object will be sharper then plastic object and can cause severe perforation in oesophagus and in stomach. Metallic object tend to rusting when it experience air and water together from the aspect chemically and will further damage the human body either in respiratory tract or in digestive tract . example of the metallic object is battery. The common complication for both ingestion and aspiration foreign body have list down following:

Cough

Emphysema ( is the lung disease that will cause breathing problem like shortness)

Haemoptysis ( is a coughing out of the blood or blood sputum)

Pneumonia

Lung abscess ( is a necrosis of pulmonary tissue)

Fever

Perforation of oesophagus

Perforation of stomach

Mediasstinal abscess

Break of aorta

Esophageal fistula

Asphysia (either cause by fully obstruction of airway or partial airway obstruction)

Airway edema

Dyspnea

Stenosis of digestive and respiratory tract

Injury to the vocal cord

Possible get cardiac arrest

Perforation of pleural and pnemothorax due to the inhale thin and sharp objet

Equipment and Method to Removal foreign Body

Management of the foreign body in depend on the type and location of the foreign body. Different type and different location required different methods use to manage the foreign body. Removal of the foreign body is depending on the how the foreign body is get inside the body. Normally aspiration foreign body required surgical intervention procedure. For ingestion foreign body normally can be remove the foreign body through the endoscopy procedure.

The equipment and the methods for removal foreign body foe both in respiratory tract and digestive have list down following:

Laryngoscope

Bronchoscope

Retrograde dilation

Surgical remove

Aspiration catheter ( important for removal of secretion yielding better visualization of the foreign body)

Fogarty catheter ( is the balloon tips catheter)

Telescope guided ( use for assess the airway, for excellent visualization, for continuous administer of oxygen and anesthetic agent)

Graspher

Spontaneous passage

Selection of the suitable equipment of removal the foreign body is depends on the each patient’s characteristics and also the anatomical location of foreign body. Especially in selection of the scope size in depends on the age of children. Doctor should choose appropriate size of the scope to catch the object and reduce the interaction of scope and the tract ( esophagus and trachea) for maximize the therapeutic purpose and minimize the injury to the patient.

Bronchoscopy is the type of technique to see the inside of the airway. Brochoscopy technique has 2 main purposes which are for therapeutic and diagnostic. Bronchoscope is flexible tube will inserted to the respiratory tract either through the mouth or nose to examine the patient respiratory tract especial for the foreign body

Direct laryngoscope technique can be use to remove the foreign body. The scope will inserted to the level of the object and will be catch by the forceps under fluoroscopy unit.

For both brochoscopy and laryngoscopy technique in done with the fluoroscopy unit because this unit can terminate continuous exposure so doctor can see the direction of the scope and the location of object.

Radiation protection

Radiation protection must apply to reduce total dose received by patient and also technologist either in general x ray room or in fluoroscopy room.

Give the shield gonads to patient to protect the sensitive part from radiation.

Try to minimize total time as less as possible on the examination while produce good image. It also can reduce the radiation to patient.

Always collimate x ray beam to minimize size to area been exam. It can reduce total scatter radiation produce due to small area and improve image quality.

Provide lead grown to all staff that involve in this procedure.

Install modern image intensifies with photocathodes and digital image processing.

Use video recorder instead of cine camera whenever possible

Caustic ingestion

Is an injury to the digestive tract due to the foreign body. The common side is pharyngeal, laryngeal and esophageal. The ingestion object will because injury is material have acid and alkaline properties like battery, soap and bleach. This kind of ingestion normally will happen to the paediatric population. The cause for the paediatric population may is the family streets or environmental condition. If happen to adult mean the reason mainly is attempt to suicide. The symptom may be varying due to the chemical properties. The treatment including esophagoscopy, drinking water or milk to neutralise the chemical properties, giving antibiotic and retrograde dilation.

What to Think About Foreign Body

Foreign body ingestion and aspiration is a very dangerous thing because it will cause the mortality if the object fully obstructed the airway. The reason why the right main bronchus will affect more than left is due to the size of the right bronchus is wider than the left. In addition, the carina position is slightly to the left side and right main bronchus has more direct extension of the trachea than the left. Other condition including age of patient physical position at the of aspiration. So as parent or family member has take care the children very careful and always observe they condition.

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