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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
Ineffective coughing | An effective cough |
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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
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