Foreign Body Aspiration Flashcards
PARTIAL OBSTRUCTION UPPER AIRWAY
Stridor with ability vocalize
Inspiratory stridor = UPPER AIRWAY
Allowing patient to use cough reflex to expel object
If that doesn’t work – BRONCHOSCOPY (NO BLIND SWEEPS)
COMPLETE OBSTRUCTION UPPER AIRWAY
Cyanosis with marked distress, cannot vocalize or cough
1yr or less, awake = 5 rapid blows to back/5 chest thrusts, repeat
>1yr old, awake = Heimlich maneuver
Any age, unconscious = CPR!
LOWER AIRWAY OBSTRUCTION
Wheezing on expiration = LOWER, diminished breath sounds on 1 side
CXR forced expiratory (normal CXR doesn’t exclude FB from diagnosis)
Admit to hospital for treatment
Neb tx with chest PT after removal of object
What age group is HIGHEST risk for extrathoracic FB aspiration?
Answer: 6 mo-3 yr
A mother rushes her 7-month-old daughter to your ED stating that she cannot breathe. Upon exam, you note stridor with the ability to vocalize. What diagnosis is HIGHEST on your differential?
Answer: Partial Foreign Body Obstruction (Aspiration)
In this same patient, what area of the respiratory tract do you suspect is affected – upper or lower airway obstruction?
Answer: Upper airway
Stridor
Low-pitched noisy breathing when the infant/child breathes IN = upper airway obstruction
Wheezing
High-pitched noise when the infant/child breathes OUT = lower airway obstruction
In a patient that presents with FB aspiration, you note cyanosis with marked distress. What are these findings consistent with?
Answer: COMPLETE obstruction
Without prompt treatment of an upper airway obstruction, what complications could occur? SELECT ALL THAT APPLY! A: loss of consciousness B: tachycardia C: diaphragm paralysis D: seizures
A: loss of consciousness
D: seizures
Answer: A, D (THINK IMPENDING RESPIRATORY ARREST! Bodies functions are slowing and shutting down – progressive cyanosis, LOC, seizures, bradycardia, cardiac arrest)
What is considered the GOLD STANDARD for diagnosis of upper airway FB aspiration?
Answer: REFER! Requires rigid bronchoscopy
What is the treatment of a partial airway obstruction of the upper airway?
Answer: allowing choking subject to use his/her own cough reflex to remove object
A 1 yr old child presents to your clinic with cyanosis with marked distress. Patient is awake and alert. What do you suspect and what is your treatment?
Answer: COMPLETE obstruction; place patient face down deliver 5 rapid blows to the back, roll patient over and deliver an additional 5 rapid chest thrusts (repeat until obstruction is relieved)
A 5 yr old child presents to your clinic with cyanosis with marked distress. Patient is awake and alert. What do you suspect and what is your treatment?
Answer: COMPLETE obstruction; perform Heimlich maneuver (abdominal thrusts)
A 10 yr old child is rushed in by his mother who states 30 minutes PTA, they were eating food when he began to choke. This patient is currently unresponsive What do you suspect and what is your treatment?
Answer: COMPLETE obstruction with airway collapse; immediately begin CPR
T or F: Blind finger sweeps in an infant or child is a good alternative if the parents do not know how to perform CPR
Answer: False; this can push FB further into airway (Open airway by jaw thrust – if FB can be visualized – carefully remove with fingers or instrument)
A patient presents to your clinic with sudden onset of wheezing on expiration, diminished breath sounds on the right side, and mild respiratory distress. What diagnosis is HIGHEST on your differential?
Answer: Lower airway FB aspiration
What past medical history should lead the FNP to suspect lower airway FB aspiration?
Answer: chronic cough, persistent wheezing, or recurrent pneumonia
What is an important diagnostic study that can be performed to visualize the affected area / FB in lower airway FB aspiration?
Answer: inspiratory and forced expiratory CXR (+forced expiratory study: unilateral hyperinflation, mediastinal shift AWAY from affected side; complete obstruction: atelectasis and related volume loss)
A patient presents to your clinic with sudden onset of wheezing on expiration, diminished breath sounds on the right side, and mild respiratory distress. You suspect lower airway FB aspiration and order a CXR, which is normal. What is your next intervention?
Answer: Admit to hospital for evaluation and treatment (NORMAL CXR CANNOT RULE OUT FB!)
Following removal of lower airway FB, what is the recommended treatment?
Answer: b-adrenergic neb treatments + Chest PT (helps to clear mucus or treat bronchospasm)
Without prompt treatment of a lower airway obstruction, what complications could occur? SELECT ALL THAT APPLY! A: empyema B: bronchiectasis C: lung abscess D: recurrent pneumonia
B: bronchiectasis
C: lung abscess
D: recurrent pneumonia
Answer: B, C, D (risk justifies an AGGRESSIVE approach to suspected FB in suspicious cases)
VIRAL CROUP
6mo – 5 yr old recent URI Fall or early winter onset Parainfluenza virus Barking seal cough XR: Steeple sign
EPIGLOTTITIS
H. influenzae (unimmunized kids) Non-typeable H.influenzae (immunized kids) 3 D’s: drooling, dysphagia, distress; NO COUGH Sniffing dog position XR: Thumbprint sign
BACTERIAL TRACHEITIS
rhinorrhea, low-grade fever, cough, sore
throat)
Progresses (high fever, COUGH, acutely worsening
STRIDOR)
Prefers to lie flat
UNRESPONSIVE TO STANDARD CROUP THERAPY!
Elevated WBC with left shift [NEW INFECTION – bands]
Lateral Neck XR: Normal epiglottis with severe subglottic and
tracheal narrowing
VIRAL CROUP
Treatment is determined by how stable patient is
Discharge is determined by response to treatment
EPIGLOTTITIS and BACTERIAL TRACHEITIS
REFER for ADMIT to ICU! Intubation
Order blood cultures + initiate IV abx to cover H influenza and S. aureus
ceftriaxone or equiv. cephalosporin
