Symptoms
Observed frequent seizures asphyxia of varying severity, wheezing breathing. Attacks occur more often during feeding, but are sometimes noted when changing position and during rest. The lower jaw is underdeveloped and droops. On examination, the retraction of the root of the tongue is visible.
Urgent measures during an attack of asphyxia. The lower jaw is pulled forward, the tongue is pulled out with a blunt forceps, it is stitched with a silk thread between the tip and the blind hole and fixed in its normal position (temporarily, for 1 month). If this does not help, a tracheotomy is indicated.
Prevention for tongue retraction comes down to feeding with vertical position and fixing the lower jaw with an adhesive plaster or bandage. For this purpose, a bandage is applied around the crown of the head and lower jaw, with a transverse fixation around the forehead.
In addition, there are special wire splints that are placed in the mouth to ensure free entry into the pharynx. Pronounced retrognathia (posterior displacement of the lower jaw due to an anomaly of the masticatory muscles). Elimination of asphyxia is carried out by stretching the lower jaw forward and fixing it.
Surgical treatment.
"Emergency Pediatrics", K.P.Sarylova
epilepsy tongueI took this photo of a tongue bite at the reception, this child had an attack the night before.
Frequently asked questions on the Internet epilepsy tongue . At the appointment of an epileptologist such a question about language during an epileptic seizure asked less frequently.
What happens during an epileptic seizure with the tongue
During grand generalized convulsive seizure Grand mal there is a fall, snoring breathing, salivation, sometimes crying, generalized tonic-clonic convulsions.
Language in such cases of epilepsy can be pulled out tongue prolapse).
During epileptic tongue can be clamped between the teeth and bitten when clenching the jaws during convulsions of the masticatory muscles. There may be bites and the inner wall of the cheek. When biting the tongue during an epileptic seizure, foam from the patient's mouth is stained with blood, has red or pink color. After the attack, traces of the past epileptic seizure remain in the form tongue bite and cheeks. Considering that patients do not remember their seizure, and there may be no witnesses, then tongue bite and the weakness of the whole body may be the only facts confirming.
Is it necessary to pull out the tongue during an epileptic seizure?
No, you do not need to pull out the tongue during an epileptic attack!
It is impossible to swallow the tongue during an attack , it is well attached.
Block the airways with the tongue - this is not so important, since during a large convulsive attack, breathing is disturbed for a short time.
Hold the victim's tongue with your fingers - an ineffective action, and even the threat of biting the fingers of an assistant. Watch out for your fingers, it hurts!
Well, the most common thing is damage to teeth and tongue victim during such "help" during a seizure. If you want to help the patient during an epileptic seizure, they put spoons, sticks, hard objects that have turned up in the mouth in order to unclench your teeth and stick out your tongue . Such actions lead to damage to the teeth and soft tissues of the oral cavity (tongue, lips and cheeks) . Result pulling out the tongue during an epileptic seizure - Broken teeth, tongue bite.
Do not put anything in your mouth or hold your tongue with your fingers during an epileptic attack. .
What to do if the patient swallowed the tongue?
Or rather: what to do if it seems to you that the patient swallowed tongue ?
I looked at what a search on the Internet gives for a request Language epilepsy. Here are common misconceptions in Yandex on the topic epilepsy tongue
1. Epilepsy is a chronic disease … bruises, cuts, missing teeth, cicatricial changes from multiple bites language etc…
But cicatricial changes from multiple tongue bite in patients with different forms Epilepsy at the daily appointment of an epileptologist is not observed. Although each patient at the reception examining the tongue, during a neurological examination and assessment of the function of the cranial nerves. Yes, and broken teeth are rare in patients with epilepsy.
2. The patient may die if he swallows his tongue, he will suffocate. It is necessary, first of all, to plant or lay him down so that he does not fall, take a hard object, preferably a spoon, open his mouth, pressing his tongue with a spoon and keep his mouth open. I explain. These actions will definitely lead to trauma to the teeth and tongue, if you have the strength to do it. Do not open your teeth with hard objects or fingers. Yes, and seating an adult patient during a major convulsive attack is physically difficult and not wise. The patient should be placed on the floor or bed and kept in the lateral position to avoid injury. And the patient will not be able to swallow the tongue, it is physically impossible, it is well attached.
I also took this photo in my office, when the parents said that the other day, during an attack, they “saved the life of their daughter so that she would not swallow her tongue. And they broke their teeth with a spoon, so it’s not scary, we’ll insert new ones. ” It's scary to break your teeth and it's a shame. Learn from the mistakes of others, every tooth is precious.
3. I know that the main thing is not to let the person swallow the tongue. To do this, the jaw is fixed with a stick.
I explain. It is generally difficult to imagine how exactly to fix the jaw with a stick? In addition to injury, nothing can be achieved by such fixation of the jaw with a stick. These actions are dangerous.
Internet search results:
What offers in Yandex search on request epilepsy tongue It's not funny, it's sad, it's wrong. Myths are common, these actions are not rational and dangerous.
So we have established that with epilepsy, the tongue should not stick out during an attack. During an attack epilepsy, it is not necessary to open the jaw with hard objects so as not to break your teeth. The tongue in epileptic seizures is rarely bitten off, often the tongue is bitten. But damage to the tongue after a bite during an epileptic attack heals quickly, and there is no scarring. And swallowing the tongue during an epileptic attack is physically impossible.
It is very important to address the underlying causes as soon as possible and ensure adequate ventilation of the lungs. Therapy in each case should be carried out taking into account the main pathogenetic factors of ARF. To maintain adequate ventilation of the lungs, it is first of all necessary to restore the patency of the airways, reduce the elastic resistance of the lungs and chest, normalize contractile function respiratory muscles and central regulation of respiration. However, all these measures require a considerable amount of time, so they can be carried out with preserved spontaneous breathing without threatening asphyxia, and with a sharp violation of breathing or its complete cessation, it is necessary to establish artificial ventilation of the lungs.
With no consciousness to recover patency airways, it is necessary first of all to throw back the patient's head and push his lower jaw forward. If the patient is lethargic and unable to actively cough, the accumulated sputum should be aspirated with a catheter inserted through the nose blindly or under the control of a laryngoscope. To stimulate cough in some cases, percutaneous catheterization of the trachea (microtracheostomy) is appropriate. AT individual cases to remove sputum, it is necessary to perform therapeutic bronchoscopy under conditions of surface anesthesia or local anesthesia. Stimulation of active expectoration, chest muscle massage, inhalation therapy using fragrant herbs, phytoncides, bronchodilators, antispasmodics, mucolytic agents contribute to sputum discharge and restore airway patency.
The fall of the tongue is one from common causes airway obstruction in poisoned patients who are in coma. Air ducts are used to prevent retraction of the tongue; for the same purpose, tracheal intubation is also used, especially in cases where breathing is sharply weakened and at any moment it may be necessary to carry out artificial ventilation of the lungs. Intubation also creates Better conditions for suction of a secret from a tracheobronchial tree.
In case of FOS poisoning, the priority the use of antidotes (anticholinergics and cholinesterase reactivators) should be considered. If, after antidote therapy, acute respiratory failure persists or continues to increase, it is urgent to switch to artificial lung ventilation with the use of muscle relaxants.
laryngospasm may occur reflexively when exposed to irritating poisons or mechanical stimuli (foreign bodies, vomit, etc.) on the respiratory organs, when irritating other organs and as a result of the influence of the central nervous system(pharmacodynamic laryngospasm and from hypoxia).
Treatment consists in eliminating the causes of laryngospasm, blockade of reflexogenic zones (aerosol inhalation of 1-2% novocaine solution), administration of atropine sulfate (0.5-1 ml of 0.1% solution), diphenhydramine (1-2 ml of 2% solution) intramuscularly or intravenously. With complete and persistent laryngospasm, muscle relaxants, tracheal intubation and the transition to artificial respiration. In some cases, a tracheostomy is performed. With bronchospasm and bronchiolitis, spasmolytic substances (eufillin, ephedrine hydrochloride, mezaton, atropine sulfate, etc.) are used parenterally or inhaled in the form of aerosols; . may be useful and application antihistamines(diphenhydramine, diprazine), as well as prednisolone (60-90 mg intravenously).
Respiratory failure can occur different reasons, but the most dangerous - violation of the patency of the upper respiratory tract(asphyxia). The development of asphyxia (suffocation) can lead various reasons. They can be grouped according to the principle of blocking the airways - from the inside or outside. Among the factors that can mechanically block the flow of air from the inside, there are: sunken tongue, vomit, blood, water (drowning), food, dentures and other foreign bodies, as well as spasm (closing) of the glottis. Overlapping of the airways from the outside can occur when the neck is squeezed with a noose, hands, compression of the chest with wide flat objects with a significant mass, for example, fragments of reinforced concrete structures during the destruction of buildings.
Rendering first medical care each of these situations has its own characteristics.
The decline of the language. Retraction of the tongue is one of the most common causes of airway obstruction in unconscious victims. In this condition, the inhaled air does not enter the respiratory tract, and the exhaled air does not go out.
Manifestations of asphyxia (suffocation) when the tongue is retracted: severe cyanosis of the face and upper half of the chest, swelling of the neck veins, severe sweating, unsuccessful attempts to inhale against the background of the victim's choking movements, hoarse arrhythmic breathing, pronounced, intense participation in the act of breathing of the auxiliary muscles (intercostal muscles, diaphragm, superficial muscles of the neck).
If the retraction of the tongue is the only cause of respiratory failure, then usually after tilting the head back, the respiratory movements become effective. With a short, stiff neck, tilting the head may not be enough, so the lower jaw is additionally brought forward and down. Make fixation of the victim in this position or on the side. If breathing remains difficult after the mandible has been removed, especially during inhalation, the presence of a foreign body in the airway should be suspected.
Foreign bodies in the upper respiratory tract. Foreign bodies that enter the trachea and bronchi are of the most diverse type: sunflower, watermelon, pumpkin seeds, husks from them, grains of cereals, beans, peas, vomit, dentures, fish bones, pins, nails, coins, rings, small toys, etc. Under normal conditions, if it enters the larynx foreign bodies coughing and spasm of the glottis occur reflexively, and when it gets into the nose, sneezing. If a foreign body overcomes the resistance caused by natural reflexes, then it enters the trachea and then into the bronchi, more often the right one (it is larger in diameter and its position is more vertical). The size, shape and properties of a foreign body have big influence its localization in the lower respiratory tract. In victims with loss of consciousness, protective reflexes are either absent or reduced, and foreign bodies can freely enter the larynx, trachea, and bronchi. So, for example, leakage of gastric contents into the airways can occur.
An important sign of the presence of a foreign body in the trachea and bronchi is a paroxysmal cough, accompanied by cyanosis and vomiting. At the same time, movements of a foreign body in the trachea and bronchi can be heard even at a distance, in the form of peculiar pops. The victim complains of chest pain, often in a specific area. After some time, the mucous membrane of the trachea and bronchi, due to the depletion of the cough reflex, ceases to respond to the presence of a foreign body, which makes coughing less frequent. Further manifestations depend on the nature of the foreign body, its size, shape and ability to swell.
For example, beans, beans, peas, increasing in size, can lead to suffocation.
First aid for asphyxia caused by the presence of a foreign body (vomit, dentures, earth, sand, etc.) in the upper respiratory tract, first of all, begins with cleansing the mouth, nose and throat. To remove a solid foreign body from the mouth and pharynx of the victim, you need to turn on your side and hit hard with your palm several times on the back (between the shoulder blades), and then remove the foreign body with your index finger. The liquid is removed with a finger wrapped in gauze or a handkerchief.
There is no reason to count on spontaneous discharge of a foreign body from the trachea and bronchi. Foreign bodies from the upper respiratory tract of a victim with an intact chest can be removed by sequentially performing two cough-simulating techniques.
The first technique is as follows: apply 3-4 jerky blows with the palm of the hand on the spine of the victim at the level of the upper edge of the shoulder blades (Fig. 3.56, a). If the patient is unconscious, lying on his back, he should be turned on his side facing the person who is providing assistance, and the described technique should be carried out (Fig. 3.56, b).
If this does not work, you can apply the second method. The victim is placed on his back. The assisting person places the palm of one hand on the upper abdomen of the victim between the xiphoid process and the navel, and the palm of the other hand on back surface first. Then 3-4 jerky pushes are made in the direction from front to back and a few - from the bottom up (Fig. 3.57). As a result of the techniques performed, the foreign body can move from the upper respiratory tract to the oral cavity, from where it is removed. 
It is especially dangerous when gastric contents enter the respiratory tract. The ingress of acidic contents into the respiratory tract causes reflex cardiac and respiratory arrest (Mendelssohn's syndrome). To prevent this, the victim is placed in a position in which the gastric contents do not enter the respiratory tract (Fig. 3.58).
Despite the satisfactory condition, after the removal of the foreign body from the upper respiratory tract, the victim must be urgently sent to the ENT hospital or other medical facility. You can not allow him to make sudden movements, walk independently and eat food. When transporting to a hospital, it must be accompanied. 
Strangulation asphyxia (hanging). It occurs mainly as a result of a suicide attempt, more often by persons in a state of alcohol or drug intoxication.
A characteristic feature is the strangulation furrow (trace from the rope) on the neck. Marked cyanosis (cyanosis of the face, body), puffiness of the face, eyeballs bulging, small punctate hemorrhages on the conjunctiva, pupils are wide with a weak reaction to light or its absence. Severe respiratory distress. It becomes arrhythmic or completely absent. The pulse is frequent, arrhythmic. There may be convulsions, loss of consciousness, involuntary urination.
First aid. First of all, you need to cut the loop above the knot. It is necessary to support the body, as its fall will aggravate the likelihood of a fracture of the cervical spine. Then, in order to ensure the patency of the upper respiratory tract, the oral cavity should be cleared of mucus, foamy secretions, the tongue should be pulled out, and the victim should be laid on his side. In the absence of spontaneous breathing, artificial ventilation of the lungs is started using the “mouth-to-mouth”, “mouth-to-nose” method, and in case of cardiac arrest, external massage.
When removing from the loop and turning the head of the victim, care should be taken, since when hanging, there may be dislocations and fractures in the cervical spine.
Required urgent hospitalization lying on a stretcher with limited movement in the neck (you can limit movement with rollers, pillows).
Airway obstruction by a foreign body
New Description
Airway obstruction by a foreign body causes asphyxia and is a life-threatening condition, occurs very quickly, the patient very often cannot explain what happened to him. If the obstruction is severe, it can lead to rapid loss of consciousness and death if the victim is not treated quickly and successfully. Immediate recognition of airway obstruction by a foreign body and treatment are of paramount importance.
Because recognition plays a key role in successful care, it is important to ask the victim, "Are you choking?" This gives him the opportunity to answer at least with a nod if he cannot speak.
Choking should be suspected, especially if:
- the episode occurred while eating, and its onset is very unexpected;
- an adult victim may grab his neck, point to his throat.4
- in children, the clue to recognition may be, for example, eating or playing with small objects before the onset of symptoms.
Severity score
Not severe choking:
- the victim can breathe and speak, his cough is effective;
- the child is conscious, cries or verbally answers questions, coughs loudly, can take a breath before coughing.
Severe suffocation:
- the victim cannot speak or make sounds;
- wheezing;
- silent or silent cough;
- cyanosis and gradual deterioration of consciousness (especially in children) to its complete loss.
Urgent care
In adults:
For mild obstruction, encourage the victim to continue coughing. There is no need to take any action other than monitoring the patient's condition.
For severe airway obstruction in a conscious victim:
- stand to the side of and slightly behind the patient, support the chest with one hand and tilt it forward (so that the foreign body enters the mouth, and does not fall down the airways);
- make 5 sharp blows to the back between the shoulder blades with the other hand (check after each blow if the obstruction has been released);
- if unsuccessful, perform 5 abdominal thrusts (Heimlich maneuver). Stand behind the victim, lean forward, place both hands clasped together around the upper abdomen and pull sharply inward and upward;
- continue alternating between 5 blows to the back and 5 abdominal thrusts until they succeed or until the victim loses consciousness.
If the victim is unconscious:
- put it on the floor, on your back;
- call an ambulance immediately;
- initiate CPR (even if a pulse is present in a choking patient who is unconscious).
Algorithm for emergency care for obstruction by a foreign body in adults
In children:
- If the obstruction is not severe, encourage the child to cough and watch him
- In an conscious child with severe airway obstruction by a foreign body:
- Give 5 hits to the child's back
- If back blows do not clear the airway, give 5 chest thrusts for children under 1 year of age or 5 abdominal thrusts for children over 1 year of age. This technique creates an artificial cough, which increases the pressure in chest cavity and may dislodge the foreign body.
- position the child lying, face down, on your lap;
- support the baby's head by placing thumb hands on the corner of the lower jaw, and one or two other fingers of the same hand on its opposite side;
- do not compress soft tissues under the child's mandible, as this can increase airway obstruction;
- make 5 sharp blows on the back of the child between the shoulder blades;
- the goal is to clear the airway with any of these punches, not to do all 5.
Back blows in children older than 1 year:
- are more effective if the child is positioned head down;
- a small child can be positioned on the rescuer's lap, like an infant;
- if this is not possible, lean the child forward while supporting him and hit the back between the shoulder blades from behind.
If blows to the back have not dislodged the foreign body and the child is still conscious, use chest thrusts in infants or abdominal thrusts in children over 1 year of age. Do not use abdominal thrusts on infants.
- turn the child into a supine position, head down. This is safely achieved by placing the free hand along the back of the baby and clasping the back of his head with a brush;
- support the baby with the hand that is placed on your hip;
- determine the location of chest compressions (in the lower half of the sternum, about one finger width above the xiphoid process);
- perform 5 chest thrusts; they are similar to chest compressions, but sharper and less frequent.
Abdominal tremors in children older than 1 year:
- place yourself behind the child, place your hands around his body, connect them together on the stomach between the navel and the xiphoid process;
- sharply pull your hands in and up;
- repeat up to 5 times;
- make sure you don't push xiphoid process or ribs - this can cause injury to the abdominal organs.
After chest thrusts or the Heimlich maneuver, the child should be reassessed. If the foreign body has not been removed and the child is still conscious, alternate back blows and chest thrusts or Heimlich maneuvers.
- An unconscious child with severe airway obstruction by a foreign body:
- Airway patency. Open the child's mouth and look for a visible foreign body. If found - try to remove it with one finger. Do not blindly try and try again - this can push the foreign body deeper.
- Artificial breaths. Open the airway with head extension and mandibular thrust, then deliver 5 rescue breaths. Monitor the effectiveness of each breath in lifting the chest.
- Chest compressions and CPR:
- after 5 artificial breaths (if there is no reaction - movements, coughing, spontaneous breathing), proceed to chest compressions without assessing signs of circulation;
- if you are alone, perform CPR as recommended on children for 1 minute, and then call an ambulance (unless someone else has done this);
- when the airways are open for artificial respiration - check the oral cavity for the presence of a foreign body;
- if it is visualized, try to remove it with one finger;
- if the foreign body is removed, open and check the airway; administer artificial respiration if the child is not breathing;
- if the child regains consciousness and begins to spontaneously breathe effectively, place him in a stable position on his side and control his breathing and level of consciousness until the ambulance arrives.
old description
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