Foreign Body in Throat Dr. Vishal Sharma. Aspirated (Airway) Foreign Body

Foreign Body in Throat

Dr. Vishal Sharma

Aspirated (Airway) Foreign Body

Clinical Staging

1. Initial phase: choking, coughing, wheezing,

gagging

2. Asymptomatic phase: due to mucosal adaptation

3. Late phase: Laryngeal / Tracheal / Bronchial

4. Complication phase: pneumonia, emphysema,

lung abscess, atelectasis

Late Clinical Featuresa. Laryngeal: partial or total airway obstruction,

hoarseness, aphonia, hemoptysis

b. Tracheal: airway obstruction, hemoptysis,

wheezing, palpatory thud, auscultatory slap

c. Bronchial: cough, ipsilateral wheezing,

ipsilateral decreased breath sounds

Bypass valve & Stop valve effectPartial Obstruction Total Obstruction

Wheezing Late Atelectasis

Check valve effectNo Expiration No Inspiration

Emphysema Early Atelectasis

Clinical Diagnosis

Conscious pt:

1. Hoarseness / aphonia

2. Respiratory distress

Unconscious pt:

1. No chest movement

2. No air exchange at nose /

mouth. 3. Cyanosis.

Radio-opaque F.B. larynx

Radio-opaque F.B. Bronchus

Radio-lucent F.B.

Right Lung collapse & Left emphysema

Management of choking in an unconscious patient

1. Patient placed in supine position

2. Open airway + mouth to mouth ventilation

3. Correct airway obstruction

Opening the airway

1. Head-tilt:

Extension of

neck by backward

pressure on

forehead

Opening the airway

2. Head-tilt, chin-lift:

Extension of neck

by backward

pressure on

forehead + lift pt’s

chin keeping mouth

open.

Opening the airway

3. Head-tilt, neck-lift:

Lift pt’s neck

while pushing

down on forehead.

Prevents falling

back of tongue.

Opening the airway

4. Modified jaw-thrust:

For pt with neck /

spinal injuries. Push

patient’s jaw forward

by applying pressure

at angle of mandible.

Avoid head tilt.

Correcting airway obstruction Back blows

Abdominal thrusts

Chest thrusts (for pregnancy, age < 8 yrs)

All 3 raise subglottic pressure, to dislodge out FB

Open pt’s mouth

Blind finger sweeps in mouth

Back blowsPlace pt in lateral

position, supporting pt’s

chest against your knees.

Use free hand to deliver

five rapid blows to spinal

Area b/w scapulae, to

dislodge F.B.

Abdominal thrusts

Straddle supine pt at his hip.

Place your hand heel b/w pt’s

umbilicus & ribcage, in midline.

Hold that hand with your other

hand & apply 5 rapid, inward +

upward thrusts, to dislodge FB.

Chest thrustsKneel beside supine pt at

chest level. Place hand

heel on centre of pt’s

sternum.

Lock hands. Apply 5 rapid

downward thrusts.

Only 2 fingers used for a

small child.

Opening patient’s mouth

Tongue-jaw lift technique:

Hold pt’s tongue + lower jaw b/w your thumb & fingers.

Lift pt’s tongue to move it

away from pharyngeal wall.

Opening patient’s mouth

Crossed-finger technique:

Cross your thumb under

your index finger.

Place your thumb against

pt’s lower lip & index

finger

against his

upper teeth.

Uncross your fingers to

open pt’s

mouth.

Blind finger sweeps

Open pt’s mouth. Insert index

finger of free hand into

pt’s mouth,

along pt’s cheek, till

tongue base.

Use it as a hook to

roll out FB.

Avoid pushing FB further back.

Avoid blind sweeps in a child.

Attempt to remove visible FB only.

Correcting airway obstruction in an unconscious pt

5 Back blows

failure

5 Abdominal thrusts Or 5 Chest thrusts

failure

Open pt’s mouth + blind finger sweeps.

Continue this sequence till FB is removed or pt is ready to be shifted to operation theatre.

Management of choking in a conscious pt

If patient can speak, cough, or breathe:

Do not interfere. Patient to be examined by an

ENT specialist as soon as possible.

If the patient cannot speak, cough, or breathe:

Begin treatment for obstructed airway.

Correcting airway obstruction

in a conscious pt > 1 yr old 5 Back blows

failure

5 Abdominal thrusts (Heimlich maneuver)

Or 5 Chest thrusts (for pregnancy, age < 8 yrs)

Continue this sequence till FB is removed or pt

becomes unconscious.

Back blows

Place pt in sitting / standing

position. Support pt’s chest

while bending pt at the waist.

Use your free hand to deliver

5 rapid blows to spinal area

b/w two scapulae.

Heimlich Maneuver

Heimlich Maneuver

Stand behind sitting / standing pt & pass

your arms around pt’s waist.

Hold your fist against pt’s abdomen b/w

umbilicus & ribcage.

Lock hands & apply 5 rapid, inward +

upward thrusts to dislodge FB.

Chest thrusts

Stand behind standing pt &

pass your arms around pt’s

chest. Hold your fist against

pt’s sternum in its centre. Lock

hands & apply 5 rapid, back-

ward thrusts to dislodge FB.

Correcting airway obstruction in an infant

5 Back blows

failure

5 Chest thrusts

Continue this sequence till FB is removed or pt

is ready to be shifted to operation theatre.

Back blows in an infant

Straddle infant face down,

head lower than trunk, over

your forearm, supported on

your thigh.

Deliver five rapid back

blows, with heel of other

hand b/w shoulder blades.

Chest thrusts in an infantSupporting pt’s head, keep

infant supine b/w your

hands, with head lower

than trunk.

Using 2 fingers, deliver 5

rapid backward thrusts on

sternum.

Surgical ManagementFor life threatening stridor

Cricothyrotomy

Emergency Tracheostomy

For foreign body removal

Direct Laryngoscopy

Rigid Bronchoscopy

Thoracotomy & Bronchotomy

Prevention of chokingAdults:

Cut food into small pieces

Chew food slowly & thoroughly

Avoid laughing / talking during eating

Avoid excess alcohol with / before meals

Infants & Children:

Keep small objects away from children

Avoid playing with food or toys in mouth

Swallowed Foreign Body

Diagnosis Plain X-ray (PA & Lateral): soft tissue neck, chest,

abdomen for radio-opaque FB

Fluoroscopy with Barium soaked cotton pledget

for radiolucent FB

Barium Swallow

Flexible Oesophagoscopy

Coin in cricopharynx

Meat bolus in Cricopharynx

Toe ring in cricopharynx

Razor blade

Open safety pin

Barium Swallow

Flexible Oesophagoscopy

Tooth brush in stomach

Pharyngeal FB Common sites: tonsil, pyriform fossa, vallecula,

base tongue

Diagnosis confirmed by indirect laryngoscopy

Usually removed in OPD but may require

removal by Hypo-pharyngoscopy GA

Oesophageal & Gastric FB Common sites: cricopharynx, aortic indentation &

cardiac end

Usually removed by rigid oesophagoscopy GA

Advancement into stomach is safe in difficult FB

Oesophagotomy rarely required for impacted FB

FB reaching stomach, usually passes out in stool

Emetic & Cathartic agents are contraindicated

Indications for Immediate Intervention

Associated respiratory obstruction

Total oesophageal obstruction

Disc battery (perforation occurs in 8-12 hrs)

Sharp, impacted foreign body

Gastro-intestinal FB > 5 cm in a child < 2 yr

Gastro-intestinal FB with acute abdominal pain

No progress of FB in serial X-ray after 24 hr

Gastric FB with pyloric stenosis

Disc battery in stomach

Complications of neglected FB

1. Oesophageal ulceration & stricture

2. Oesophageal perforation mediastinitis

3. Peri-oesophageal cellulitis

4. Retro-pharyngeal abscess

5. Respiratory obstruction due to

tracheal compression

laryngeal oedema

Retropharyngeal abscess

Instruments for FB removal

Instruments for FB removal

Optical Forceps

Net retrieval system

Thank You