FOREIGN BODY IN THE AIRWAY

Mostly occurs in children <5 years

Types of FBs include seeds (groundnuts, beans, maize) plastics, rubber, metal wires, ball bearings
- Usually inhaled from the mouth
  - Child is chewing, laughing, or crying or there is a sudden disturbance, which opens the vocal cords so the object is inhaled

Sudden onset of choking followed by stridor (noisy breathing) or
Cough, difficulty in breathing, wheezing
Hoarseness of voice if FB stuck at the vocal cords
Symptoms start suddenly, some symptoms may be transient (may disappear after a short period), but
complications may present few days later (sudden death, intractable pneumonia)
Upper airway obstruction as shown by: flaring of the nostrils, recession of the chest inlet and/or below the ribs,
rapid chest movements and reduced air entry (usually on the right side)

Once the history and examination are suggestive, investigations can be omitted to save time
Chest x-ray may show lung collapse, hyperinflation, mediastinal shift, shift of heart shadow

Child

If chocking, attempt to dislodge it by 3 cycles of 5 back slaps/5 chest compressions (for infants)
or Heimlich manoeuvre (for children)
- Do not do blind finger sweeps. If foreign body visible in the mouth, remove it with a Magill
  forceps
If severe respiratory distress, refer to higher level for airway visualization. Give oxygen if necessary

Adult

Dislodge large FB, e.g. chunk of meat, from the pharynx by cycles of 5 back slaps and Heimlich
manoeuvre (standing behind the patient with both arms around the upper abdomen and giving
5 thrusts)
- If patient pregnant or very obese: Perform 6-10 chest thrusts with patient lying on the back
If still suspect of FB, refer for airway visualization

Do not give groundnuts or other small hard food items to children <2 years
If a child is found with objects in the mouth, leave the child alone to chew and swallow or gently persuade the child to spit out the object
- Do not struggle with/force the child