FOREIGN BODY IN THE AIRWAY

Mostly occurs in children <5 years

Cause

  • 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

Clinical features

  • 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)

Investigations

  • 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

MANAGEMENT

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

Prevention

  • 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