Inhaled Foreign Body – Choking

Last Updated on 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

 

Ineffective coughing  An effective cough 
  • Unable to vocalize
  • A quiet or a silent cough
  • Unable to breathe
  • Cyanosis
  • Decreasing level of consciousness
  • Crying or verbal response to questions
  • A loud cough
  • Able to take a breath before coughing
  • Fully responsive

 

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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