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FOREIGN BODY ASPIRATION IN
CHILDREN
Dr Yusuf Imran
Resident Department of Pediatrics
J.N Medical College
AMU-India
INTRODUCTION
• Foreign body (FB) aspiration into the airway is one of the
dramatic pediatric emergencies.
• Incoordination...
PATHOGENESIS
• Certain anatomical and cognitive constraint predispose the
child for aspiration:
(a) Oral phase, i.e., tend...
• Loss of co-ordination during swallowing results in aspiration
of foreign bodies into the airway.
• In 90% of such occasi...
Natural History
• Three phases have been recognized in the natural history of FB
aspiration:
• Phase I: "Choking" - immedi...
• Phase III is the stage of complications in the form of
secondary effects of airway obstruction and/or secondary
infectio...
Clinical Features
• Clinical features depend on site, size, nature and duration since
aspiration of foreign body.
1. In 10...
2. Commonly the FB may lodge in the bronchial tree (80-90%).
• In children right and left side are involved equally.
• The...
• The common modes of presentation of bronchial FB are:
(a) Acute respiratory distress;
(b) Recurrent respiratory symptoms...
• What are the usual foreign bodies ?
• Food items are the commonest (65- 85%) FB encountered.
• In India, peanuts are the...
Investigations
(a) Plain Chest X-ray(CXR): 80% of laryngotracheal FB and
15-28% of bronchial FB can have normal CXR.
• Non...
(b) Fluoroscopy: Fluoroscopy being a dynamic method of
evaluation is more sensitive than plain X-ray.
• It is most useful ...
• In suspected chronic FB aspiration, investigations like CT
scan, and contrast study may be required.
• Ventilation perfu...
Diagnosis
• In a patient with a history of choking with or without clinico-
radiologic signs, the diagnosis of FB aspirati...
Algorithm for diagnosis of FB
Management
• Signs of upper airway obstruction including aphonia or apnea
need to be urgently managed.
(a) Infants : 4 bac...
(b) Children above 1 year (Heimlich maneuver): 6-10 abdominal
thrusts, visualize pharynx, if FB is seen, extract.
If faile...
If above measures fail:
• urgent cricothyrotomy
• tracheostomy.
• Endotracheal intubation with smaller size tube.
Intubation should not be tried in cases of:
• Large FB,
• Subglottic FB
• Certain seeds such as tamarind seeds, as they ca...
Bronchoscopy
• Once stabilized the child is kept nil orally.
• Oxygen should be administered in cases with respiratory
dis...
Chronic bronchial FB may require:
• thoracotomy or lobectomy.
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Foreign body aspiration dr yusuf imran

Forengn body aspiration/inhalation in children. Symptoms,presentation,diagnosis and management.

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Foreign body aspiration dr yusuf imran

  1. 1. FOREIGN BODY ASPIRATION IN CHILDREN Dr Yusuf Imran Resident Department of Pediatrics J.N Medical College AMU-India
  2. 2. INTRODUCTION • Foreign body (FB) aspiration into the airway is one of the dramatic pediatric emergencies. • Incoordination of swallowing leads to aspiration. • Depending on size, shape and nature, the aspirated FB lodges in the larynx, trachea or bronchial system. • It is a completely treatable and to much extent preventable situation. • Delay in recognition and removal leads to chronic complications.
  3. 3. PATHOGENESIS • Certain anatomical and cognitive constraint predispose the child for aspiration: (a) Oral phase, i.e., tendency to take everything into mouth; (b) Poor mastication; (c) Inadequate control of deglutition; (d) Crying /laughing while eating; (e) Certain parental behavior patterns like thumping or spanking while feeding, feeding a crying child, etc.
  4. 4. • Loss of co-ordination during swallowing results in aspiration of foreign bodies into the airway. • In 90% of such occasions FB are coughed out by strong cough reflex, in only 10% it gets lodged in the airway.
  5. 5. Natural History • Three phases have been recognized in the natural history of FB aspiration: • Phase I: "Choking" - immediately after aspiration, the child develops violent cough, stridor, respiratory distress and/ or wheezing. Later the receptors get adapted and child passes on to • Phase II; i.e., the asymptomatic phase: It's during this phase that FB aspiration is either forgotten or neglected. This stage may last from hours to weeks.
  6. 6. • Phase III is the stage of complications in the form of secondary effects of airway obstruction and/or secondary infection. • Only 25% of patients present within 24 hours of aspiration. • They are most likely to have foreign body in upper airway, trachea or one of the main bronchi.
  7. 7. Clinical Features • Clinical features depend on site, size, nature and duration since aspiration of foreign body. 1. In 10-20% cases, the FB can lodge in the larynx or trachea. These patients usually present with acute life threatening upper airway obstruction characterized by stridor and suprasternal retractions.
  8. 8. 2. Commonly the FB may lodge in the bronchial tree (80-90%). • In children right and left side are involved equally. • The clinical presentation of bronchial foreign bodies depends on the severity of obstruction and mechanism involved.
  9. 9. • The common modes of presentation of bronchial FB are: (a) Acute respiratory distress; (b) Recurrent respiratory symptoms; (c) Chronic respiratory illness. Usually the child recovers from acute phase and presents later in one of the following ways- a. The clinical and radiologic features include obstructive emphysema. b. Recuuent Pneumonia, non-resolving pneumonia. c. Recurrent wheeze, recurrent hemo-ptysis, lung abscess, or bronchiectasis.
  10. 10. • What are the usual foreign bodies ? • Food items are the commonest (65- 85%) FB encountered. • In India, peanuts are the most common. • Generally organic FB produce intense inflammation and hence worsen the obstruction. • Certain edible objects like toffee, chocolate and lozenges draw water from mucosa, swell and produce progressive obstruction.
  11. 11. Investigations (a) Plain Chest X-ray(CXR): 80% of laryngotracheal FB and 15-28% of bronchial FB can have normal CXR. • Nonetheless, plain X-rays in inspiration and expiration are useful. • Obstructive emphysema, segmental or lobar collapse and pneumonia are useful diagnostic findings. • A radiopaque FB is seen in only 6- 17% patients.
  12. 12. (b) Fluoroscopy: Fluoroscopy being a dynamic method of evaluation is more sensitive than plain X-ray. • It is most useful when radiolucent FB is suspected and plain X-ray is inconclusive. • In the above situations, fluoroscopy would show phasic mediastinal shift. • Mediastinal shift during inspiration indicates the side of FB.
  13. 13. • In suspected chronic FB aspiration, investigations like CT scan, and contrast study may be required. • Ventilation perfusion scans have also been used
  14. 14. Diagnosis • In a patient with a history of choking with or without clinico- radiologic signs, the diagnosis of FB aspiration must be considered. • However, inspite of this history, the diagnosis may be delayed beyond 24 hours because of ignorance by parents or lack of a high index of suspicion by the primary physician. • The presence of underlying bronchial asthma or pulmonary tuberculosis may also cause confusion in diagnosis of FB aspiration.
  15. 15. Algorithm for diagnosis of FB
  16. 16. Management • Signs of upper airway obstruction including aphonia or apnea need to be urgently managed. (a) Infants : 4 back blows with head held low followed by 4 chest compressions. Visualize the pharynx with jaw lift, if FB is seen, extract (avoid blind finger sweeps). If above measures fail, give rescue breathing, then repeat the above procedure.
  17. 17. (b) Children above 1 year (Heimlich maneuver): 6-10 abdominal thrusts, visualize pharynx, if FB is seen, extract. If failed, give rescue breathing, then repeat the above procedure. • However, these measures should not be instituted in a child who is able to speak or cry or is breathing.
  18. 18. If above measures fail: • urgent cricothyrotomy • tracheostomy. • Endotracheal intubation with smaller size tube.
  19. 19. Intubation should not be tried in cases of: • Large FB, • Subglottic FB • Certain seeds such as tamarind seeds, as they can slip down and straddle across the carina, • Worsening the condition. Similarly postural drainage should not be attempted.
  20. 20. Bronchoscopy • Once stabilized the child is kept nil orally. • Oxygen should be administered in cases with respiratory distress. • Dehydration, dyselectrolytemia and acid-base disturbances should be corrected before bronchoscopy. • Rigid bronchoscopes are the best. • Flexible bronchoscopes are generally not preferred.
  21. 21. Chronic bronchial FB may require: • thoracotomy or lobectomy.

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