Updated: 12/25/2021

Foreign Body Aspiration

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  • Snapshot
    • A frantic mother brings her 2-year-old child to the emergency department after he swallowed an earring. Radiographs are shown.foreign body aspiration
  • Introduction
    • Aspirated solid or semi-solid object, usually lodged in the larynx or trachea
      • most often food, but can range from small toys to coins to pens, and so on
    • May be life-threatening is large enough to completely obstruct the airway
    • Can lead to chronic, recurrent infection if retrieval is delayed
  • Epidemiology
    • Usually presents after 6 months of age
    • Risk factors include
      • institutionalization
      • advanced age
      • poor dentition
      • alcohol
      • sedative use
  • Presentation
    • Symptoms
      • severe obstruction may present with
        • respiratory distress
        • aphonia
        • cyanosis
        • loss of consciousness
        • and death in quick succession
      • partial, long-term obstruction may present with
        • less severe respiratory symptoms
        • dysphagia
        • fever
        • hemoptysis
        • dyspnea
        • chest pain
        • symptoms indicative of secondary infection
    • Physical exam
      • unresolved pneumonia
      • decreased breath sounds
      • wheezing
  • IMAGING
    • Foreign body
      • CXR
        • shows hyperinflation of the affected side
    • Acid/alkali ingestion
      • after initial stabilization:
        • chest radiograph
        • gastrografin swallow
        • endoscopy
  • studies
    • ABG
      • necessary for appropriately evaluating ventilation
      • may be useful for following progression of respiratory failure when it is of concern
  • Differential
    • Chronic URI, pneumonia, tonsillitis, pneumonia, pneumothorax, emphysema, respiratory failure
  • Treatment
    • Prevention
      • limit exposure to objects approved for specific age group (i.e. toys, etc)
    • Medical intervention
      • endoscopic (flexible or rigid) retrieval of foreign body
        • flexible broncoscopy is both diagnostic and therapeutic
        • rigid broncoscopy is preferred in children due to wider instrument lumen (as compared to flexible counterpart), which allows for ventilation and easier removal of objects
      • surgical removal
        • indicated when endoscopy is impossible or unsuccessful
    • If the object is thought to be in the esophagus, based on imaging and clinical presentation:
      • Observe for 24 hours with serial radiographs and remove endoscopically if the object does not pass distally within that time frame
      • If object causes symptoms or time-point of ingestion is unknown - attempt immediate endoscopic removal
      • If the ingested item appears relatively benign and has already progressed inferior to the diaphragm on imaging, observe and wait for spontaneous passage
  • Complications
    • May lead to chronic pneumonia
    • Can cause sudden respiratory failure and death
  • Prognosis
    • Very good to excellent if identified and resolved early

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(M3.PD.16.46) A 3-year-old girl with no significant past medical history presents to the clinic with a 4-day history of acute onset cough. Her parents have recently started to introduce several new foods into her diet. Her vital signs are all within normal limits. Physical exam is significant for decreased breath sounds on the right. What is the most appropriate definitive management in this patient?

QID: 103337

Chest x-ray (CXR)

25%

(4/16)

Rigid broncoscopy

62%

(10/16)

Inhaled bronchodilators and oral corticosteroids

0%

(0/16)

Flexible broncoscopy

12%

(2/16)

Empiric antibiotic therapy

0%

(0/16)

M 10 E

Select Answer to see Preferred Response

(M2.PD.15.39) A 4-year-old girl is rushed to the emergency department by her concerned parents after she ingested a US nickel. At the time of her initial ED evaluation, 1 hour had passed since the incident. Initial radiographs suggest that the coin lies in the stomach (Figure A). The patient is currently asymptomatic, denying any abdominal pain, nausea/vomiting, or difficulty breathing. Which of the following is the next best step in the management of this patient?

QID: 104581
FIGURES:

Discharge patient with prescription for laxative and reassurance that the coin will pass in the stool

18%

(7/39)

Observation with serial radiographs until the coin passes

62%

(24/39)

Urgent flexible endoscopy for attempted retrieval of the coin

18%

(7/39)

Attempt bronchoscopy for confirmation of diagnosis and potential removal of coin

0%

(0/39)

Surgical removal of coin

0%

(0/39)

M 7 D

Select Answer to see Preferred Response

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