Foreign body in the respiratory air-way (choking)

Notes

## Basic introductiona,b

  • Choking is a key cause of respiratory emergencies in infants and children
  • It occurs when foreign bodies (FBs) are inhaled and partially or completely block the airway
  • Children and infants are at increased risk of choking and FB airway obstruction due to:

_Immature airway

_Distractions during feeding

_Playing around with objects that usually end up in the mouth

  • In most cases of accidental choking in adults, FBs are expelled actively by coughing
  • Most of the FBs that are involved in choking are small, round or cylindrical in shape, conforming to the contours of the airwayb

## Some common causes of chokingb:

  • Food such as hot dog, whole grains, peanuts and hard candy
  • Buttons
  • Coins
  • Toy parts
  • Chewing gum
  • Latex balloon

## Pathophysiology

  • Complete obstruction of the larynx or trachea may cause immediate asphyxia and death
  • Incomplete obstruction can cause local:

_Inflammation

_Edema

_Cellular infiltration

_Ulceration

_Granulation

_Emphysema

_Bronchiectasis

_Pneumonia (necrotizing, post-obstructive or suppurative)

_Hypoxic vasoconstriction

_Abscess

## Statisticsa,b,c

  • Choking is the 4th leading cause of accidental death in the U.S, accounting for about 5,000 cases/yeara
  • The mortality rate of chocking is above 3% (of all cases)
  • 80% of cases are below the age of 3 (peak frequency in the 1-2yrs)
  • Boys are 50% more likely to be affected by choking than girls
  • Distribution of locations of impacted FBs in choking: larynx (1-5%), trachea (5-15%), light main bronchus (30-35%), left main bronchus (30-40%), light lobar bronchus (5-15%) and left lobar bronchus (5-15%).
Symptoms
  • Grasping of the throat
  • Anxious and distressed
  • Difficulty in breathing
  • Aphonia (loss of voice)
  • Persistent Cough
  • Cyanosis
  • Unconsciousness or diminishing conscious level
  • Dyspnea
  • Asthmatoid wheezing
  • Hoarse voice
  • Hemoptysis
  • Blood-streaked sputum
  • Metallic taste
Diagnosis
  • Clinical review
  • X-ray (lateral and anteroposterior of the neck, chest x-ray)
  • Laryngoscopy (can confirm diagnosis)
  • Bronchoscopy
  • Arterial blood gas
  • Monitoring oxygen saturation with pulse oximeter
Differential
  • Syncope
  • Anaphylaxis
  • Seizure
  • Myocardial infarct
Prevention
  • Surveillance
  • Legislation and standards
  • Product design
  • Education
Reference

a. National Safety Council, 2015. http://www.nsc.org/learn/safety-knowledge/Pages/safety-at-home-choking.aspx

b. Cyr, C., & Injury Prevention Committee. (2012). Preventing choking and suffocation in children. Paediatrics & child health, 17(2), 91.

c. Soroudi, A., Shipp, H. E., Stepanski, B. M., Ray, L. U., Murrin, P. A., Chan, T. C., ... & Vilke, G. M. (2007). Adult foreign body airway obstruction in the prehospital setting. Prehospital emergency care, 11(1), 25-29.

d. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

Management

## Heimlich maneuver

  • For adults,

_Stand behind the victim

_Place a fist above the victim’s navel

_The thumb should be placed again the abdomen

_Cover the fist with the other hand

_Thrust UP and IN

_The force of thrust should be adequate to lift the victim off the ground

  • For a child,

_ Stand behind the child

_Place a fist above the child’s navel

_The thumb should be placed again the abdomen

_Cover the fist with the other hand

_Thrust UP and IN

_the force of thrust should NOT be adequate to lift the child off the ground

  • For an infant,

_The infant is placed across the forearm of the dominant hand while facing down

_The infant is given 5 thumps on the back with the heel of the other hand

Otherwise,

_The infant is placed across the forearm of the dominant hand while facing up

_With the other hand, place two fingers in the middle of the infant’s breastbone

_Then give 5 quick downward thrust

  • When a person is alone,

_ Lean over a chair or countertop

_Place a fist above the navel

_The thumb should be placed again the abdomen

_Cover the fist with the other hand

_Thrust UP and IN

## Back blows

  • This is performed when FB is not dislodged with the Heimlich maneuver
  • Deliver 5 blows to the person's back with the heel of the hand aim for the area between the shoulder blades

## Other types of management

  • Extract FB bronchoscopically
  • Bronchotomy in case of failure of bronchoscopic FB extraction
  • Tracheotomy
  • Antibiotics to treat secondary infections
  • Administer steroid for inflammation
  • Segmental or lobar resection (in case of chronic obstruction with bronchiectasis and destruction of lung parenchyma)
Drug Index 2.0 is here
Our new update features a more powerful search feature and easier login. Having any issues? Contact us today. Contact Us