Everything you need to know about false routes: hydration and dysphagia in adults
"Wrong roads": The causes and symptoms of wrong roads and how to react in case of wrong roads?
False airways are obstructions of the airways by a foreign body. It is an accident of everyday life responsible for approximately 4,000 deaths per year and it is for this reason that it is necessary to know the gestures of first aid to deal with it.
It can affect anyone, but there are also populations particularly at risk, such as the elderly who are particularly sensitive to this problem due to certain physiological changes and regulations.
What are the causes of misdirection?
To understand the occurrence of false routes, it is first necessary to take an interest in the anatomy of the aero-digestive tract.
The Pharynx (or aero-digestive crossroads) is at the crossroads of two routes: the one taken by the air we breathe and the one taken by the substances we swallow.
· Inhaled air passes through the trachea, located in the front part of the body, to the lungs.
· Food, drink and secretions pass through the esophagus which is a tube behind the trachea, leading directly to the stomach.
When chewing and swallowing, the tongue brings the chewed food to the pharynx, the arrival of food at the back of the throat causes the swallowing reflex : it consists of bringing the food bolus into the throat. esophagus while closing the airways to protect them.
False route is the obstruction of the airways by a foreign body when the swallowing mechanism is poorly executed.
At any age, eating, drinking, or speaking can go wrong when, by accident, a small volume of food, water, or saliva passes through the trachea.
When this happens, the body's first reflex is to cough in order to expel the swallowed substances back into the pharynx. Then a new swallowing brings them back in the right way: that of the esophagus, the lungs are thus protected.
In the elderly, false passages can result from various factors such as swallowing disorders called "dysphagia" in medical jargon. These are physiological problems that appear over time.
What are the symptoms and risks of a false route?
False routes can have two consequences :
First, a partial obstruction of the airways: this is the situation in which the subject can still speak, breathe and cough. No outside help is needed to solve it, coughing is enough.
Then, we have the most serious case which is total obstruction : in this case the subject can neither speak nor breathe. Intervention is urgently needed because asphyxia can occur quickly.
To tell the difference between a partial or total misdirection, you have to see if the person speaks or not, if they don't speak, you have to act quickly. In general, in the case of total obstruction, people have the reflex to show their throat to signify that something is obstructing it. We then understand that they are choking.
False routes have 3 main consequences :
Choking, asphyxia : which can lead to cardio-respiratory arrest.
· Lung infections : if a foreign body reaches the bronchi, it is possible that bacteria or microorganisms, carried by the foreign body, settle and infect the lung tissue.
· Undernutrition : in the elderly, this fear of false routes can lead to a reduction or even a cessation of food, of which undernutrition is one of the main consequences.
How to react in case of misdirection?
In the event of partial obstruction : the person must be asked to cough as hard as possible with their mouth open and to breathe well through their nose so that they clear the airways themselves.
· Do not slap the back, as the vibrations produced could make the ingested thing move in the wrong direction and cause a total obstruction.
· Do not calm the cough by giving a liquid which could aggravate the false route.
In case of total obstruction , the first aid actions are:
Kick on the back :
· Stand next to the person, tilt the thorax forward to mobilize the foreign body.
· With the flat of the hand we tap vigorously between the two shoulder blades: we can repeat this up to 5 times.
· If at the end of the 5th time the foreign body has not come out, we move on to the Heimlich manoeuvre.
Abdominal compression method: Heimlich maneuver :
· We stand behind the person and place our hands at the level of the xiphoid (at the place indicated in the image on the right).
· We clench our fist and we put the 2nd hand on top.
· The movement to be performed is an inward and upward movement in order to put pressure on the diaphragm and evacuate the foreign body.
· This movement is to be performed up to 5 times maximum. It allows the evacuation of the foreign body in 80% of cases.
If that didn't work, we alternate the 2 methods of slapping on the back and abdominal compression in series of 5 until the evacuation of the foreign body.
If this happens to a child, there are techniques adapted to the size of the child.
If the person is unconscious and not breathing, check the pulse and call the emergency services directly, it is possible to do the Heimlich maneuver on the ground or if the person is seated, then go to the cardiac massage while waiting for help to arrive.
What monitoring and what treatment after a false route?
In the case of a total obstruction , it is advisable to call the SAMU (number 15) when it is observed and even if the foreign body is cleared when the emergency services arrive, an examination is recommended, especially for the most vulnerable subjects. fragile (children, elderly).
In the case of partial airway obstruction :
In most cases in young subjects, no special monitoring is necessary.
In the elderly, we look at the frequency of occurrence of false routes to adapt the care and reduce their occurrence. Often the doctor recommends changing the texture of the diet. You have the choice between 4 textures: whole, chopped, ground, mixed. We can end up with syringe feeding or even parenteral feeding on subjects who can no longer eat normally orally.
Why can carbonated water help avoid false routes?
In EHPADs, we see that many elderly people only drink sparkling water to avoid going the wrong way. Gelled water can also be used for more severe swallowing disorders.
Indeed, using carbonated or gelled drinks stimulates the epiglottis . The latter participates in the swallowing reflex, its stimulation therefore makes it possible to avoid false routes. For greater safety, these drinks are sometimes even combined with the use of straws, allowing coordination of movements which reduces the risk of going the wrong way.
Points to remember
The wrong road is a frequent accident of everyday life, but its complications can quickly become serious
· It is essential to know how to differentiate partial obstruction from total obstruction because the management is not the same depending on the type of obstruction. The first aid gestures and the reflexes to have must also be well mastered.
· Pay attention to populations at risk (children and the elderly) for whom appropriate monitoring is necessary.
· In case of false routes too frequent in the elderly, an adaptation of food and drink can be considered.