Clinical Practice Guidelines

Foreign bodies inhaled

  • The signs and symptoms of a foreign body in the upper airway or bronchial tree will vary depending upon the site of impaction.

    See also:  Upper Airway Obstruction

    Impaction in the larynx or main bronchus

    History

    • Sudden and catastrophic event.
    • Coughing, choking and possibly vomiting.
    • If obstruction is total - rapidly progresses to unconsciousness and cardiorespiratory arrest.
    • May be present in a child in cardiorespiratory arrest and who it is impossible to ventilate.

    If obstruction is total:

    • Open the airway and under direct vision (preferably using a laryngoscope) check in the mouth for a foreign body - if present remove it with magills forceps.
    • Place child prone with the head down.
    • Apply 5 blows with the open hand to the interscapular area.
    • Turn child face up.
    • Apply 5 chest thrusts using the same technique as for chest compression during CPR.
    • Check in the mouth to see if foreign body has appeared, and remove if possible.
    • If the obstruction is not relieved, continue with alternating back blows and chest thrusts.
    • Positive pressure "ventilation" can be tried in an attempt to force the foreign body into the left or right main bronchus.
    • A surgical airway may be tried if the obstruction is in or above the larynx and it is impossible to remove it through the mouth.

    If obstruction is partial:

    • DO NOT perform the above manoeuvres.
    • Place child upright in the position they feel most comfortable.
    • Arrange for urgent removal of foreign body in the operating theatre.

    Goto Top

    Impaction lower than the main bronchus:

    History

    • Children between the ages of 6 months and 4 years are at greatest risk.
    • There may have been an episode of choking, coughing or wheezing while eating or playing but many episodes are unwitnessed.
    • Symptoms may include persistent wheeze, cough, fever or dyspnoea not otherwise explained. Recurrent or persistent pneumonia may be the presenting feature.
    • The child may be asymptomatic after the initial event.

    Examination

    • Asymmetrical chest movement
    • Tracheal deviation
    • Chest signs such as wheeze or decreased breath sounds.
    • The respiratory examination may be completely normal.

    Radiology

    Request inspiratory and expiratory chest films.

    Look for:

    • an opaque foreign body
    • segmental or lobar collapse
    • localised emphysema in expiration (ball valve obstruction)

    The CXR may be normal.

    Goto Top

    Management

    • DO NOT perform the above manoeuvres.
    • Place child upright in the position they feel most comfortable.
    • Arrange for urgent removal of foreign body in the operating theatre.

    Prevention

    • No child less than 15 months old should be offered foods such as popcorn, hard lollies, raw carrot or apples. Children under the age of 4 years should not be offered peanuts.
    • Encourage the child to sit quietly while eating and offer food one piece at a time.
    • Avoid toys with small parts for children under the age of 3 years.