Foreign Body Aspiration Flashcards
Why are children at higher risk of foreign body aspiration
Children are at high risk for foreign body aspiration because of poor chewing ability, their tendency to put objects in their mouths, the lack of posterior dentition, and uninhibited inspirations when laughing or crying
When are children most at risk from foreign body aspiration
Significant morbidity and mortality are seen in younger children (2 months to 4 years old) because of their narrow airways and immature airway protective mechanisms. More commonly seen in boys
Presentation of foreign body aspiration
- Should be suspected if a previously well child presents with an abrupt onset cough followed by wheeze.
- May also present with gagging or stridor, dyspnoea and fever
- Unilateral wheezing (an decreased breath sounds) suggests partial obstruction of the main or distal bronchi
- Eventually airway swelling can lead to obstruction and lobar collapse
Investigations for foreign body inspiration
- CXR performed during expiration will show persistent hyperinflation of the lungs distal to the obstruction.
- Flexible bronchoscopy confirms suspected cases of foreign body aspiration and can be used to attempt removal of the foreign body
Management of foreign body aspiration if concious
Should encourage coughing and perform external manoeuvres (5x back blows and 5x abdominal thrusts)
* Abdominal thrusts should not be performed on infants and very young children- should instead perform chest thrusts
Removal of foreign body:
* 1st line- Flexible bronchoscopy or rigid bronchoscopy
* Rigid bronchoscopy is preferred in cases of stridor, asphyxia, radio-opaque object seen on CXR, localised wheeze, obstructive hyper-inflation, or atelectasis
* In other cases, flexible bronchoscopy should be performed to confirm the diagnosis
* Both procedures are done with conscious sedation or general anaesthesia
* 2nd line- surgery, thoracotomy
Management of foreign body aspiration if unconscious
- Need to secure the airway immediately via endotracheal intubation, unless the foreign body can be seen and removed from the upper airway
- May need to perform a cricothyroidotomy
- Foreign body should then be removed in the same manner