A 63-year-old man required emergency endotracheal intubation and mechanical ventilation for complications of acute myocardial infarction. After the patient was extubated, a tooth, which had apparently been dislodged during intubation and had remained in the posterior pharynx, was aspirated into the right lower-lobe bronchus. Vigorous chest percussion and postural drainage administered every 2 hours enabled the patient to cough up the tooth 17 hours after its discovery. He subsequently recovered uneventfully from both the myocardial infarction and the foreign-body aspiration. Although bronchoscopy, with either a rigid or a flexible instrument, is currently the treatment of choice for an adult patient with a foreign object in the lower airway, chest physiotherapy could represent a less invasive, less expensive initial therapy for patients who can cough and who can be moved into the appropriate drainage position. (Respir Care 1986;31:1099-1101.)
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References
1.
SpearmanCB, SheldonRL, EganDF. Egan's fundamentals of respiratory therapy. 4th edition. St Louis: CV Mosby, 1982.
2.
KacmarekRM, MackCW, DimasS.The essentials of respiratory therapy. Chicago: Year Book Medical Publishers, 1985.
3.
ShapiroBA, HarrisonRA, KacmarekRM, CaneRD. Clinical application of respiratory care. 3rd edition. Chicago: Year Book Medical Publishers, 1985.
4.
Conference on the scientific basis of in-hospital respiratory therapy. Am Rev Respir Dis1980;122(5, part 2):1–161.
5.
KiginCM. Advances in chest physical therapy. In: O'DonohueWJJr, editor. Current advances in respiratory care. Park Ridge IL: American College of Chest Physicians, 1984:37–71.
6.
GaskellDV, WebberBA. The Brompton Hospital guide to chest physiotherapy. Oxford: Blackwell, 1973.
7.
FrownfelterDL, editor. Chest physical therapy and pulmonary rehabilitation. Chicago: Year Book Medical Publishers, 1978.
8.
MackenzieCF, CieslaN, ImlePC, KlemicN.Chest physiotherapy in the intensive care unit. Baltimore: Williams & Wilkins, 1981.
9.
EubanksDH, BoneRC. Comprehensive respiratory care. St Louis: CV Mosby, 1985:459.
10.
BorrieJ.Management of thoracic emergencies. 3rd edition. New York: Appleton-Century-Crofts, 1980:275.
11.
GlinzW.Chest trauma: Diagnosis and management. New York: Springer-Verlag, 1981:39.
12.
FieselmanJF, ZavalaDC, KeimLW. Removal of foreign bodies (two teeth) by fiberoptic bronchoscopy. Chest1977;72:241–243.
13.
ZavalaDC, RhodesML. Experimental removal of foreign bodies by flexible bronchoscopy. Am Rev Respir Dis1974;110:357–360.
14.
ZavalaDC. Flexible fiberoptic bronchoscopy: A training handbook. Cedar Rapids IA: University of Iowa, 1978:118–119.
15.
EllisJHJr. Foreign body aspiration and atelectasis. In: CherniackRM, editor. Current therapy of respiratory diseases 1984-1985. Philadelphia: BC Decker, 1984:143–145.
16.
BurringtonJ, CottonEK. Removal of foreign bodies from the tracheobronchial tree. J Pediatr Surg1972;7:119–122.
17.
CottonEK, AbramsG, Van HoutteJ, BurringtonJ.Removal of aspirated foreign bodies by percussion and postural drainage. Clin Pediatr1973;12:270–276.
18.
LawD, KosloskeAM. Management of tracheobronchial foreign bodies in children: A reevaluation of postural drainage and bronchoscopy. Pediatrics1976;58:362–367.
19.
FletcherMA. Intensive care of asthma, cystic fibrosis, and other pediatric respiratory diseases. In: BurtonGG, HodgkinJE, editors. Respiratory care. 2nd edition. Philadelphia: JB Lippincott, 1984:781.
