CCS Interactive Case 12 Flashcards
7 month-old boy presents to ED w/sudden and dramatic onset of respiratory symptoms. Had peanuts in his vicinity before developing symptoms. RR = 55 (>50 tachypnea in baby), severe cough and stridor. No personal hx of allergies, no family or personal hx of asthma, previously healthy
DDx?
High suspicion for foreign body aspiration and partial airway obstruction; also croup, laryngitis, epiglottitis, retropharyngeal abscess, angioedema, peritonsilar abscess, laryngeal papilloma
Exam?
HEENT/Neck
CV
Lungs
Respiratory distress, cyanosis, nasal flaring, inspiratory stridor, reduced air entry, suprasternal/intercostal retractions
No barking cough (croup), drooling (epiglottitis), facial/tongue swelling
Next step?
Strong suspicion for foreign body aspiration - rigid bronchoscopy
First step when suspecting foreign body aspiration?
Determine complete vs. partial - complete has absence of speech and cough
If complete FBA?
Back blows/chest thrusts in infants, Heimlich in older children
If partial FBA?
Avoid back blows, chest thrusts, and Heimlich (may convert to complete)
Administer O2
Radiography - CXR and neck X-ray (if negative, do not r/o FBA)
Rigid bronchoscopy if suspicion is high (dx and Rx)
IV ABX or IV steroids if infection or airway inflammation
Sequence?
Pulse oximetry, oxygen, IV access
Exam: focused (general, HEENT/Neck, chest/lung, CV)
Order: CXR, Neck-Xray, CBC (all stat)
Clock: advance to obtain results, note the inflated lungs on CXR, neck x-ray is negative
Order: bronchoscopy, stat, pulmonary medicine consult, stat (reason - confirmation and removal of aspirated foreign body)
Clock: advance to get result - foreign body found in airway and removed
Advance to reevaluate
Request interval follow-up and focused exam until symptoms resolve
Order: counsel parents
Location: send home, appointment in 1-2 weeks
Case ends
Final orders - none
Primary diagnosis: foreign body aspiration
