Inhaled Foreign Body

Question 1

What can be used to prevent inhalation of foreign body?

Answer 1

Rubber dam
Mouth sponges
Instrument chains

Question 2

If someone inhales a foreign body, they will usually show signs of choking. What are the general signs of choking?

Answer 2

Attack occurs while eating/misplaced dental instrument/restoration
Victim may clutch his/her neck

Question 3

Signs of mild airway obstruction

Answer 3

Can speak
Can cough
Can breathe

Question 4

If patient has mild airway obstruction (can speak, cough effectively and breathe), what should we do?

Answer 4

Encourage coughing the foreign body out
Continue to check for deterioration to ineffective cough or relief of obstruction

Question 5

What are the signs of severe airway obstruction?

Answer 5

• Cannot speak
• Unable to breathe
• Breathing sounds wheezy
• Attempts at coughing are silent
• Victim may be unconscious

Question 6

If patient is conscious with severe airway obstruction (ineffective cough), what can we do?

Answer 6

5 back blows
5 abdominal thrusts

Question 7

If patient is unconscious with severe airway obstruction, what should be done?

Answer 7

CPR

Question 8

For infants less than 1 y/o with inhaled foreign body, what should NOT be done and why?

Answer 8

Finger sweep should not be performed due to the risk of pushing the foreign body further back (only perform in adult if foreign body can be seen)

Question 9

Why is the end point of an inhaled foreign body most likely the right lung?

Answer 9

Right main bronchus opens up slightly higher and more vertical than the left main bronchus

Question 10

What happens when a foreign body has been inhaled and we cannot locate it visibly?

Answer 10

Repeat of history
Patient examination (including auscultation of chest)
Chest radiographs (in 2 planes at 90 degrees)

Question 11

After examination and radiographs, if the inhaled body is in the lungs or any part of the airways, what should be carried out to remove it?

Answer 11

Bronchoscopy
Fine instruments with small forceps to retrieve the object
Rarely, open surgery may be required

Question 12

In a dental situation, what can we do if no ventilation is possible in acute choking situation?

Answer 12

Continue ‘compression only’ CPR
Consider needle cricothyroidotomy if appropriately trained

Question 13

Needle cricothyroidotomy:
1. Patient supine with neck extended
2. Large _____ needle needed
3. Neck swabbed
4. Palpate cricothyroid membrane anteriorly between _______ cartilage and _________ cartilage
5. Stabilise trachea with thumb and forefinger of one hand
6. Puncture skin in midline directly over the cricothyroid membrane (a small __________ helps)
7. Direct needle at ___ degree angle caudally (aimed towards the feet), applying negative pressure to the syringe (drawing air out)
8. Insert needle, aspirate as needle advances
9. Aspiration of air signifies entry into ________
10. Remove syringe, withdraw stylet and advance catheter (beware of puncturing posterior wall of trachea)
11. High flow oxygen is attached

Answer 13

Bore, cricoid, thyroid, incision, 45, trachea

Question 14

Problems related to cricothyroidotomy:
* Inadequate ventilation leading to hypoxia and death - in best scenario, only good for ___ to ____ minutes
* Aspiration (blood)
* Oesophageal laceration
* Haematoma
* Posterior tracheal wall perforation
* Subcutaneous and/or mediastinal perforation
* Thyroid perforation

Answer 14

30 to 45

Question 15

What is an elective/semi-elective procedure which should be carried out in the operating theatre?

Answer 15

Tracheostomy