Airway Obstruction

Inhaled Foreign Body

This describes a foreign object which becomes lodged in the respiratory tract.

– A foreign body can be anything which is easily inhaled, such as toys, buttons, pieces of food

– It can cause an upper airway obstruction by lodging in the trachea/larynx or obstruct deeper in a bronchus

Upper airway obstruction

This is a foreign body which obstructs the larynx or the trachea blocking airflow into the respiratory tract

– This leads to choking and it is a life-threatening emergency

Symptoms:

Signs of choking (coughing, breathlessness, loss of consciousness), cyanosis, stridor

Management:

When managing choking in children, you must discern whether the cough is effective or ineffective:

Effective:

– An effective cough is a loud cough, where child can take a breath before coughing

– The child will be fully responsive and will cry or provide a verbal response to questions

Ineffective:

– An ineffective cough is one that is quiet or silent cough and will be seen in a child who is unable to breath

– The child will be unable to vocalise and will have decreasing levels of consciousness and cyanosis

Guidelines for choking:

i) If infective cough and child is unconscious:

– Open mouth + look for object –> If seen, remove with single finger sweep

– Open the airway and attempt 5 rescue breaths

– If no response, proceed immediately to CPR

ii) If ineffective cough but child is conscious:

11st give 5 back blows –> Put infants <1 year in head-downwards prone position.

– Children >1 year should be in the forward leaning position like adults

2nd give 5 thrusts –> Infants <1 receive chest thrusts with 1 finger above the xiphisternum

– For children (> 1 year), give abdominal thrusts

iii) If effective cough –> Encourage coughing and continue to check for deterioration to ineffective cough

Lower airway obstruction

This describes a foreign body lodged in main or lobar bronchus (usually right main bronchus)

– Partial obstruction –> the foreign body acts as a ball-valve, trapping air distal to the obstruction

– Complete obstruction –> results in atelectasis distal to the foreign body

Symptoms:

This can present acutely but also can go unnoticed for several days

– Abrupt onset cough in a previously well child (if acute)

– May cause signs of respiratory distress (tachypnoea, tachycardia, cyanosis)

– Unilateral expiratory wheeze

– Unilateral decreased breath sounds (complete obstruction) or hyper-resonance (partial obstruction)

Tests:

CXR shows foreign body (if radio-opaque)

Management:

ENT referral for bronchoscopy and removal of foreign body