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Key Features

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  • Sudden onset of coughing or respiratory distress

  • Difficulty vocalizing

  • Children 6 months to 4 years are at the highest risk

  • Without treatment, progressive cyanosis, loss of consciousness, seizures, bradycardia, and cardiopulmonary arrest can follow

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Clinical Findings

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  • Coughing, choking, or wheezing

  • Onset is generally abrupt

  • Complete obstruction indicated by acute onset of choking along with inability to vocalize or cough and cyanosis with marked distress

  • Partial obstruction indicated by drooling, stridor, and ability to vocalize

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Diagnosis

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  • Chest radiography and other imaging studies have been used to evaluate for foreign body ingestion

  • However, rigid bronchoscopy is diagnostic gold standard

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Treatment

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  • If complete obstruction is present, immediate intervention is necessary

  • If partial obstruction is present, then the choking patient should be allowed to use his or her own cough reflex to remove the foreign body

  • If child is awake and younger than 1 year with a complete obstruction,

    • Place the child face down over the rescuer's arm

    • Deliver five measured back blows rapidly followed by rolling the infant over and delivering 5 rapid chest thrusts

    • Sequence is repeated until the obstruction is relieved

  • In a choking child older than 1 year, abdominal thrusts (Heimlich maneuver) should be performed

  • If the child of any age becomes unresponsive, cardiopulmonary resuscitation is recommended; chest compressions may help dislodge the foreign body

  • Blind finger sweeps should not be performed in infants or children because the finger may push the foreign body further into the airway

  • The airway may be opened by jaw thrust, and if the foreign body can be directly visualized, careful removal with the fingers or instruments should be attempted

  • Patients with persistent apnea and inability to achieve adequate ventilation may require emergency intubation, tracheotomy, or needle cricothyrotomy

  • Foreign body removal is most successfully performed using rigid bronchoscope under general anaesthesia

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