Inhaled foreign body

Question 1

Impaction in larynx or main bronchus history

Answer 1

Sudden/catastrphic
Coughing, choking, vomiting
If total->CR arrest/unconsciousness

Question 2

Impaction in larynx or main bronchus management if total

Answer 2

If Obstruction Is Total:

Open the airway and under direct vision (preferably using a laryngoscope) check in the mouth for a foreign body - if present remove it with magills forceps.

Place child prone with the head down.
Apply 5 blows with the open hand to the interscapular area.
Turn child face up.
Apply 5 chest thrusts using the same technique as for chest compression during CPR.
Check in the mouth to see if foreign body has appeared.
Apply 5 lateral chest thrusts.
If unsuccessful repeat interscapular blows, central chest compressions and lateral chest thrusts.

Positive pressure “ventilation” can be tried in an attempt to force the foreign body into the left or right main bronchus.

A surgical airway may be tried if the obstruction is in or above the larynx and it is impossible to remove it through the mouth.

Question 3

Impaction in larynx or main bronchus management if partial

Answer 3

DO not perform any manoeuvres
Sit child in position they are most comfortable
Immediate arrangement for removal in OT

Question 4

Impaction lower than bronchus history

Answer 4

6 mo- 4 years +risk
Choking, coughing, wheezing while eating/playing
Many episodes unwitnessed
Persistent wheeze, cough, fever, dyspnea not otherwise explained
Recurrent pneumonia may be presenting feature

Question 5

Impaction lower than bronchus examination

Answer 5

Assymetrical chest wall movement
Tracheal deviation
Wheeze, -ve breath sounds
May be completely normal

Question 6

Impaction lower than bronchus radiology

Answer 6

Look for opaque foreign body, segmental/lobar collapse, emphysema in expiration (ball valve obstruction)
May be normal

Question 7

Impaction lower than bronchus management

Answer 7

DO not perform any manoeuvres
Sit child in position they are most comfortable
Immediate arrangement for removal in OT

Question 8

How to prevent inhalation of foreign bodies (4)

Answer 8

No child less than 15 months old should be offered foods such as popcorn, hard lollies, raw carrot or apples.

Children under the age of 4 years should not be offered peanuts.

Encourage the child to sit quietly while eating and offer food one piece at a time.

Avoid toys with small parts for children under the age of 3 years.