Tracheal foreign body
Epidemiology
[edit | edit source]- Much more common in children (80% below 15 years old)
Risk factors
[edit | edit source]- Age >75
- Neurologic disorders
- Loss of consciousness
- Alcohol or sedative use
Presentation
[edit | edit source]- 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
[edit | edit source]- 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
[edit | edit source]- 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