Podcast #146: Tracheal Foreign Bodies

65e2e5c6-4107-44ea-89c5-08a58ae3dc72Run Time: 7 minutes

Author: Aaron Lessen M.D.

Educational Pearls:

  • It is important to differentiate between an airway foreign body, which presents as more respiratory choking and difficulty breathing VS esophageal foreign body, patients often complain “I can’t swallow” or spit up what they try to drink /swallow.
  • 1-2 year old children are the most common patient to get airway foreign body, and the most common foreign bodies are food – grapes or hot dogs, round and smooth objects like balloons, and small toys.
  • Patients present with a history of choking, stridor, respiratory distress, wheezing, retractions, and increased work of breathing.
  • It is important to differentiate between a complete obstruction versus an incomplete obstruction.
  • Incomplete obstruction patients will be more awake, but in distress – the patient could decompensate and turn to a complete obstruction if there is too much intervention. Patients should be observed in the ER and move to the OR as soon as possible where peds ENT can perform a controlled removal of the foreign body.
  • With complete obstruction patients BLS measures are the first intervention techniques that should be taken – for a patient <1yo: 5 back blows followed by chest compressions, and for a patient >1yo the heimlich maneuver is recommended.
  • Laryngoscopic removal with magill forceps is the next intervention.
  • In more severe and rare cases where the foreign body is lodged at the trachea or below the vocal cords there are a few techniques that can be used: Needle transtracheal ventilation (you cannot cric a child under 8yo because they do not have a cricothyroid membrane), or possible endotracheal tube and try to advance the foreign body into the right mainstem bronchus so you can oxygenate the left lung until you can get the patient to the OR.

Link to Podcast: http://medicalminute.madewithopinion.com/tracheal-foreign-bodies/

References: http://journal.publications.chestnet.org/article.aspx?articleid=1080585

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881610/

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