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Aspirated Foreign Bodies

Foreign body (FB) aspiration is the most common cause of inhome accidental death in children under 6 years old. FBs of both the upper esophagus and tracheobronchial tree can present with airway symptoms, with FBs of the latter accounting for 10% to 15% of all cases. However, symptoms may subside or be absent with passage of an FB into the airways. Delayed wheezing or stridor may be seen with FBs of the mainstem bronchus. A coin is the most common esophageal FB, whereas peanuts and sunflower seeds are the most commonly aspirated FBs of the respiratory tree. Rubber balloons are common causes of asphyxiation.

Causes

Among adults, the following conditions facilitate foreign body aspiration:

  • Dental, pharyngeal
  • Altered sensorium
  • Maxillofacial trauma
  • Impaired cough reflex
  • Mental retardation
  • Alcohol or sedative use

Symptoms

  • Choking ++++
  • Coughing ++++
  • Gagging

Signs

  • Auscultation (abnormal) ++++
  • Inspiratory stridor implies FB location at or above the larynx.
  • Inspiratory and expiratory stridor suggests obstruction in the trachea. Expiratory stridor implies obstruction below the carina.
  • Inability to vocalize

Treatment

Check mouth: remove any retrievable object but beware converting partial into complete obstruction. Child: turn upside down and give several hard smacks on the back. Heimlich manoeuvre:

  • clasp hands and press into epigastrium
  • give sharp squeeze to elevate diaphragm Emergency laryngotomy
  • stand behind patient
  • preferable to tracheotomy in non-specialist hands as the cricothyroid membrane is more superficial than the trachaea Scalding:
  • there may be a delayed airway obstruction after ingestion
  • for cases where foreign body is impacted in larynx
  • admit any young child with such a history for observation eg drinking tea from teapot spout ref: H/B of Emergencies in Gen Pract 2e, N Lawrence et al
   
   

 
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