Foreign Body in Airway

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HOLY FAMILY HOSPITALRAWALPINDI

Foreign Bodies in Air Way


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Introduction

Common problem in otolaryngology

It is one of the most common cause of sudden death in

children

Most common foreign bodies are food products(peanuts)


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Introduction

Right main bronchus is most common site of impaction

Rigid bronchoscopy is the best and safe method of foreign

body removal in expert hands


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Classification of Foreign Bodies

Exogenous

Endogenous


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Exogenous foreign bodies

Organic

(vegetable)

Inorganic

(non-vegetable)

Peanuts Whistle

Betel Nut Stone

Popcorn Screws

Seeds Pins


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Organic foreign bodies are dangerous because theseproduce severe chemical bronchitis


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Endogenous Foreign Bodies

Saliva and mucopus inhalations in neuromusculardisorders

During surgery aspiration of blood and debris into

lungs


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Percentage Age Incidence of Foreign Bodies

%Age Age

76% Less than 4 years

18% 4 to 14 years

6% More than 14 years

(HOLINGER AND HOLINGER)


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Clinical Features

Depend on:

Nature

Location of foreign body Degree of bronchial obstruction


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Symptoms

Young child h/o choking with eating or

Slipping of object into the mouth

Severe coughing

Patient may become dyspnoeic or apnoiec

Sharp object may cause pain or haemorrhage


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Signs

Large foreign bodies in trachea: signs are bilateral

Unilateral wheeze is the usual presentation accompanied

with chest crepitations Presentation can be of complete or incomplete bronchial

obstruction


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Two main presentations

Obstructive emphysema

Lung collapse(atelectasis)


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Signs

Incomplete bronchialobstruction:(emphysema)

Wheeze

Hyper resonant chest

Decreased breath sounds

Complete bronchialobstruction(atelectasis)

Dull chest

No breath sounds


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Differential Diagnosis

Pneumoniae

Laryngotracheobronchitis

Atelectasis


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Investigations

X-ray neck lateral view

Chest x-ray on expiration

Fluoroscopy

Ct scan Bronchography

Radio nuclide lung scan

Diagnostic bronchoscopy


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Pre-requisite for Bronchoscopy

Informed written consent from patients attendats Senior available anaesthetist surgical staff should

performAvoidance of sub optimal conditions of night timeWith long history of inhalation it should be done

under antibiotics cover Correct size of bronchoscope should be used


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Bronchoscope Size Used

Age Size of bronchoscope

Infants 3-5 mm

1-3 years 4 mm

3-7 years 5 mm

8-12 years 6 mm

Over 12 years 7 mm


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Indications of Bronchoscopy

Diagnostic

HAEMOPTYSIS OF UNKNOWN CAUSE SUSPECTED BRONCHIAL OBSTRUCTION

OBSECURE CHESTSYMPTOMS


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Indications

Therapeutic

Foreign Bodies Bronchial Toilet

Paliation


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Bronchoscopy

Procedure


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Complications of Anaesthesia

Vocal Cord Damage

Tracheaomucosal Abrasions

Lung Collapse

Respiratory Arrest Cerebral Anoxia


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Complications of Bronchoscopy

Massive bleeding

Laryngospasm

Bronchial rupture

Pneumothorax Cardiac arythmias


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Conclusion

The aspiration of foreign body in tracheobroncheal tree is aserious matter

We must have a high index of suspicion in a child whopresents with sudden respiratory distress or paroxysmal

cough without fever


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Conclusion

Absence of classical history & signs & symptoms does notrule out suspicion of foreign body inhalation

History of repeated chest infections especiallyfailure ofmedical treatment to relieve recurrent pneumonia should

raise the suspicion of f.B. Small objects with danger of inhalation should be kept

away from children


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Case No.1This four year old girlpresented with severestrider. She gave historyof aspirating piece of

beetle nut. On

examination she hadstrider, accessory musclesof respiration were active

with trachial tug..Breathsounds were reduced onright side,Chest X-rayshowed expiratoryemphysema on right side

with mediastinum shiftedto left.Bronchoscopy wasdone under generalanesthesia and foreign

body was retrieved fromright lobe bronchus.


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Case No. 2This little girl wasalone in the room andsuddenly developed achoking spell and thensettled. She was

brought to hospital.On examination shewascomfortable.Auscultation revealed reduced

breath sounds on rightside with ronchi. X-ray chest showed

expiratoryemphysema on rightside. A piece of peanut

was removed onbronchoscopy


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Case 3

This twenty year oldboy was having threeyear history ofcough.Recently he

started withhemoptysis . Chest x-ray revealed metalicforeign body in rightbronchus which wasremoved by rigid

bronchoscopy.Foreign body


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Role of Tracheostomy

To reduce dead space and work of breathing

To prevent postoperative airway obstruction due tosubglottic edema

As an approach


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How To Scope

Check the equipment before starting the anesthesia

Locate the foreign body

Make a plan for removal


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Tips

Scope on suspicion

Scope in case of acute wheeze of unknown cause in infantsand children

Scope in case of chronic wheeze in children which does not

settle with all possible medical treatment

Documents

Foreign Body in Airway