[95] Foreign Body Aspiration Flashcards
What is foreign body aspiration?
The inhalation of a foreign body into the larynx and respiratory tract
When do most causes of foreign body aspiration in children occur?
In children aged 6 months - 3 years
Why do most cases of foreign body aspiration occur in children aged 6 months - 3 years?
- Due to the tendency of small children to place objects in their mouth and nose
- Most children of this age lack molars, and cannot grind up food into small pieces for proper swallowing
What are the risk factors for foreign body aspiration?
- Age <4 years
- Decreased consciousness
- Bulbar dysfunction
What are the clinical features of foreign body aspiration?
Sudden onset of respiratory distress, associated with;
- Gagging
- Coughing
- Stridor
What does unilateral wheezing suggest in foreign body aspiration?
Partial obstruction of main or distal bronchi
What is the initial imaging of choice in suspected foreign body aspiration?
CXR
Why is CXR the initial imaging of choice in suspected foreign body aspiration?
As radio-opaque foreign bodies can be visualised
What is the sensitivity of CXR for foreign body aspiration?
Around 20%
What other imaging modality can confirm foreign body aspiration?
Flexible bronchoscopy
Other than confirming the diagnosis, what else can flexible bronchoscopy be used for in foreign body aspiration?
Confirming the diagnosis
What can be performed if flexible bronchoscopy fails?
Rigid bronchoscopy
What are the differential diagnoses of foreign body aspiration?
- Asthma exacerbation
- Cystic fibrosis with exacerbation
- Croup
- Epiglottitis
- Pneumonia
What is the treatment of foreign body aspiration determined by?
The severity of the obstruction of the airway involved
How can foreign body aspiration often be managed in partial obstruction?
The patient can usually be cleared by coughing
What is required in complete obstruction in foreign body aspiration?
Acute intervention
What is the first line intervention in complete obstruction by foreign body?
Heimleich manoeuvre and back slaps
What can be done if the Heimlich manoeuvre and back slaps do not clear the obstruction in foreign body aspiration?
Laryngoscopy with removal of the foreign body with forceps if it can be visualised
What should be done if the foreign body cannot be visualised on laryngoscopy in foreign body aspiration?
Intubation, tracheotomy, or needle cricothyrotomy
What is the initial imaging of choice in suspected foreign body aspiration?
CXR
Why is CXR the initial imaging of choice in suspected foreign body aspiration?
As radio-opaque foreign bodies can be visualised
What is the sensitivity of CXR for foreign body aspiration?
Around 20%
What other imaging modality can confirm foreign body aspiration?
Flexible bronchoscopy
Other than confirming the diagnosis, what else can flexible bronchoscopy be used for in foreign body aspiration?
Confirming the diagnosis
What can be performed if flexible bronchoscopy fails?
Rigid bronchoscopy
What are the differential diagnoses of foreign body aspiration?
- Asthma exacerbation
- Cystic fibrosis with exacerbation
- Croup
- Epiglottitis
- Pneumonia
What is the treatment of foreign body aspiration determined by?
The severity of the obstruction of the airway involved
How can foreign body aspiration often be managed in partial obstruction?
The patient can usually be cleared by coughing
What is required in complete obstruction in foreign body aspiration?
Acute intervention
What is the first line intervention in complete obstruction by foreign body?
Heimleich manoeuvre and back slaps
What can be done if the Heimlich manoeuvre and back slaps do not clear the obstruction in foreign body aspiration?
Laryngoscopy with removal of the foreign body with forceps if it can be visualised
What should be done if the foreign body cannot be visualised on laryngoscopy in foreign body aspiration?
Intubation, tracheotomy, or needle cricothyrotomy
