3. Foreign Body Aspiration

Question 1

DDx of FBA in 2yo (5)

Answer 1

1. Foreign Body aspiration
2. Croup
3. Epiglottitis
4. Whooping cough/diphtheria
5. Asthma
6. URTI
7. Bronchilitis

Question 2

Invx / expect on CXR

Answer 2

Minimal to avoid upset

CXR -
1. may be normal

2. May see foreign body if radio opaque
3. Lobar collapse / mediastinal shift
4. End expiratory film / fluoroscopy -
   Hyperinflation during expiration if co operative
   unilateral emphysema

Question 3

How would you anaesthetise patient

Before bits

Answer 3

1. Pre asses
   standard / hx / exam / consent
   -> no Resp Distress - ?wait till starved
   -> Avoid distressing - may exacerbate
2. Experienced anaesthetists - Paeds experience for 1
3. Experienced assistance / emergency equipment & drugs / Anaesthetic machine check

Question 4

How would anaesthetise

induction

Answer 4

1. Recommended inhalation induction
   O2 & Sevo
   try Maintain spont venting
2. Depth is adequate
   IV access
   consider anti sialagogue (atropine 20mcg/kg)
   - min secretions
   - Lidocaine spray (max 4mg/kg) to VCord & larynx prevent coughing prior to airway instrumentation w/ bronch
3. Position = Supine with neck extension using interscapular support

Question 5

Intraop

Answer 5

1. Storz bronchoscope w/ side arm ayre tpiece for o2 anaesthesia + ventilation
2. Technique gentle IPPV as SV may be hard to maintain
   coughing / breath holding
3. ?bg propofol infusion if SV for depth of GA

Question 6

Post op

Answer 6

1. IV dexa 0.25mg/kg - min airway tisisue swelling + oedema
2. If significant swelling / oedema / trauma / resp distress
   intubate + Ventilate and picu
3. Humidified O2 / Physio / regular dex
4. Consider Abx