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
- Usually inhaled from the mouth
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
- Do not do blind finger sweeps. If foreign body visible in the mouth, remove it with a Magill
- 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