Last Updated on February 4, 2019 by FRCEM Intermediate

Inhaled Foreign Body

Overview

• passage of a foreign body into the respiratory tract
• potentially life-threatening

History

• 1-3 year old
• coughing with food
• stridor
• respiratory distress
• wheeze
• cyanosis
• collapse
• infection symptoms (pneumonia)

Examination

• stridor
• decreased SpO2
• increased RR and WOB
• decreased AE on the affected side
• rhonchi and wheeze on the affected side

Investigations

CXR findings

• Hyperinflation of one lung or lobe may occur (obstructive emphysema)
• increased lucency
• Lobar or segmental atelectasis
• Mediastinal shift
• Pneumomediastinum
• an opaque foreign body

Confirmatory imaging studies:

• If the patient is clinically able, an expiratory chest radiograph may demonstrate air-trapping on the affected side by lack of collapse of the lung and shift of the mediastinum away from the side with the foreign body
• If the patient is a child or otherwise not able to cooperate for an expiratory study, a decubitus view of the chest, with the suspected side down, may show a lack of collapse of the air-trapped lung
• CT may demonstrate the foreign body or better show the narrowing of the bronchus

A normal chest radiograph does not exclude an aspirated foreign body

Treatment

• Bronchoscopic removal

Complications

• Mediastinitis or tracheoesophageal fistulas
• Bronchiectasis
• Air trapping leading
  • Obstructive emphysema
  • Atelectasis
  • Post-obstructive pneumonia
  • Abscess

Choking

An effective cough (recognized by the victim’s ability to speak, cry or take a breath between coughs)

• Encourage coughing (a spontaneous cough is more effective at relieving an obstruction than any externally imposed maneuver)
• Support and continuously assess

A conscious but an ineffective cough (recognized by a cough that is quieter or silent, or the victim’s inability to cry, speak or take a breath, or if the victim becomes cyanosed)

• Five back blows (back blows with the heel of one hand in the middle of the back between the shoulder blades) followed by
• Five chest thrusts (in infants < 1 year)( lower sternum approximately a finger’s breadth above the xiphisternum ) or five abdominal thrusts (in children and adults.
• Repeat assessment
• If the obstruction is not relieved, continue alternative five back blows with five chests/abdominal thrusts. Do not use abdominal thrusts (Heimlich maneuver) for infants

Unconscious

• Call for help
• Place child supine on a flat surface
• Open mouth and attempt to remove any visible object
• Airway opening techniques (head-tilt/chin lift, jaw thrust)
• Five rescue breaths
• Start CPR 15:2 (even if rescue breaths were ineffectual)
• Assess for foreign body each time breaths are attempted