EMmedonline

Airway Foreign Body

• Aspiration of the foreign body to the airway can be life threatening, that requires immediate intervention.

• Airway foreign body aspiration mainly occurs in children's between 1 - 3 years old as a result of increasing mobility and oral exploration.

• A foreign body aspiration is suspected when there is history of sudden coughing and chocking in the child. This is most predictive of all signs and symptoms in foreign body aspiration.

• Foreign body aspiration should be considered in all young child presenting with breathlessness, regardless of duration, because many children's may present >24hrs after foreign body aspiration.

Clinical Feature

• The classic dogma is laryngotracheal foreign bodies cause stridor and hoarseness whereas bronchial foreign body cause unilateral wheezing and decreased breath sounds.

• 80% - 90% of foreign bodies are present in the bronchi.

Diagnosis

• X-ray:

• They help to diagnose but doesn't exclude the diagnosis.

• AP and lateral views are taken.

• Chest X-ray is normal in >50% of tracheal foreign bodies and ¼^th of bronchial foreign bodies.

• Indirect radiologic signs of a radiolucent airway foreign body include unilateral obstructive emphysema, atelectasis and consolidation.

• Unilteral emphysema is observed when a foreign body obstructs air flow, mainly on expiration. This generates a check- valve obstruction that results in hyperinflation of the affected side and mediastinal shift to the opposite side.

Chest X-ray of a 5 year old child, presented to ED after5 days with recurrent cough, mother gaves history of playing with  hairpin five days back, which she noticed that child had spitted it out, but she had swallowed one pin apparently which she didn't notice&  was detected later.

Treatment

• If unstable start BLS immediate;y.

• If foreign body is visible try to remove with magill's forceps.

• When foreign body is not visible or able to be removed, orotracheal intubation with dislodgement of the foreign body more distally can relieve the complete obstruction and may be life saving.

• Monitor the child's vitals, if stable.

• Bronchoscopic removal of foreign body under general anesthesia should be done.

Updated on 29/1/2015

Reference

• Tintinalli