Editing Tracheal foreign body


== Epidemiology ==

* Much more common in children (80% below 15 years old)

== Risk factors ==

* Age >75
* Neurologic disorders
* Loss of consciousness
* Alcohol or sedative use

== Presentation ==

* Acute asphyxiation can occur due to large obstructing foreign bodies in the airway, but is uncommon
* More commonly subtle/silent - due to distal wedging in lower lobe bronchi
* Cough and other secondary signs such as pneumonia may be seen

== Initial management of life-threatening asphyxiation ==

* In community:
** Five blows to upper back
** Hug patient from behind, forming a fist with one hand at solar plexus, and reinforcing with the other hand. Simultaneously thrust from behind and push inwards and upwards. Can also be done supine.
* Resuscitate with 100% oxygen
*# Bag-valve mask ventilation
*# ETT
*# Cricothyroidotomy or tracheotomy
*#* If no time due to arrest, can trial the 'down then up' manoeuvre by pushing the uninflated ETT down to attempt to displace the FB beyond the carina, thus subsequently allowing single-lung ventilation
* Laryngoscopic evaluation of oropharyn to retrieve large supraglottic foreign bodies - use Magill forceps to retrieve if seen
* Then rigid bronchoscopy to evaluate trachea and major bronchi

== Removal of foreign bodies ==

* Above vocal cords - laryngoscopy
* Below vocal cords - bronchoscopy
** Flexible bronchoscope is better for subacute presentations and small objects
** Rigid bronchoscope will be needed for large items in central airway

[[Category:ENT]]