Inhaled Foreign Body
Inhaled Foreign Body
Epidemiology
Pathophysiology
Hx
Sudden onset:
Choking (difficulty breathing)
Cough
Haemoptysis
Dyspnoea
Chronic cough
Recurrent pneumonia
Ex
WOB
Cynosis, hypoxia
Reduced GCS
Tachypnoea
Fever
Stridor
Hoarseness
Wheeze (often focal and monophonic)
Reduced AE
Ix
PA/Lateral airway film
CXR (Insp/exp, Lateral decubitus symptomatic side down) (evidence is may not add much to normal film)
Bronchoscopy
Moderate / High risk
Rx
NO blind sweep as may convert partial to complete obstruction
Encourage to cough
Back blows
Chest thrusts
CPR
?Not relief of obstruction in 1 minute
Laryngoscope and Magills forceps
?FB removed
Above cords > cricothyroidotomy (needle <12y, surgical >12y)
Below cords > Intubate right main bronchus to push down right withdraw to normal position and ventilate left side up
OT for rigid bronchoscopy (ENT) +/- flexible (resp)
Thoracotomy if visualised but cannot be removed
All moderate to high risk get bronchoscopy (CXR normal in 30% FBA)
Prevention
Epidemiology
- Most common cause of accidental death in <1
- Monitor from 6mo (from birth if with older sibling), Peak 1-3yo
- Right (60%) Left (23%) Trach (13%) Larynx (2%) Bilateral (2%)
Pathophysiology
- Small parts = spherical <4.44cm, linear <7.62cm
- Outcome: expectorate +/-swallow, retain, asphyxiate
Hx
Sudden onset:
Choking (difficulty breathing)
Cough
Haemoptysis
Dyspnoea
Chronic cough
Recurrent pneumonia
Ex
WOB
Cynosis, hypoxia
Reduced GCS
Tachypnoea
Fever
Stridor
Hoarseness
Wheeze (often focal and monophonic)
Reduced AE
Ix
PA/Lateral airway film
CXR (Insp/exp, Lateral decubitus symptomatic side down) (evidence is may not add much to normal film)
- Radioopaque (10% of inhaled FB)
- Partial obstruction: hyperinflated, lucent lung distal to obstruction, +/- mediastinal shift
- total obstruction: atelectasis
- Late presentation: signs of pneumonia, abscess, bronchiectasis
Bronchoscopy
Moderate / High risk
- witnessed foreign body aspiration
- Episode of choking with any subsequent symptoms / signs / X-ray findings
- No episode fo coughing but no other explanation for: cyanotic spell, dyspnea, stridor, sudden onset of cough or wheezing, unilaterally diminished breath sounds
- no signs / symptoms, normal CXR
Rx
NO blind sweep as may convert partial to complete obstruction
Encourage to cough
Back blows
Chest thrusts
CPR
?Not relief of obstruction in 1 minute
Laryngoscope and Magills forceps
?FB removed
Above cords > cricothyroidotomy (needle <12y, surgical >12y)
Below cords > Intubate right main bronchus to push down right withdraw to normal position and ventilate left side up
OT for rigid bronchoscopy (ENT) +/- flexible (resp)
Thoracotomy if visualised but cannot be removed
All moderate to high risk get bronchoscopy (CXR normal in 30% FBA)
- 95% success rate for removal
- 1% compilation rate (piece into other bronchus > respiratory arrest, PTX, haemorrhage)
- Followed by flexible Bronch to screen for fragments/other FB as see to subsegmental bronch)
- If delayed presentation and infection/inflamation and can't remove
- Antibiobics and prednisolone
- Repeat bronch
Prevention
- Monitor from 6mo
- No hard/round foods, no small part toys (Choke check), until 4yo