Foreign Body Aspiration in the Extrathoracic Airway

Key Features

• 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

Clinical Findings

• 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

Diagnosis

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

• However, rigid bronchoscopy is diagnostic gold standard

Treatment

• 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