Choking in Children

dr. H. Oscar Djauhari, Sp. THT-KL

Patient Identity

• Name : An. E• Sex : Male• Age : 7 tahun• Occupation : Pelajar• Address : Cikole, Kota sukabumi• Religion : Islam

Scenario

Seven years old patient come to our emergency room with sudden dyspneu after eating while playing.

Patient Identity

• Name : An. E• Sex : Male• Age : 7 tahun• Occupation : Pelajar• Address : Cikole, Kota sukabumi• Religion : Islam

Primary Survey

• Airway: – Not Clear

• Breathing:– dyspnue– Oxygen via nasal cannule

• Circulation:

– CRT < 2 second– HR 98 bpm– TD: 110/70 mmHg

• Disability: GCS 15 (E4, M5, V6)

Secondary Survey

• Allergy : -• Medication : -• Past illness: -• Last meal : – 1 hours ago– Patient eat hotdog

• Event :– While patient eating hotdog, patient playing with

his friend and then choking and dyspneu

Secondary Survey

• Is there any witnessed while choking happen?• How long patient has been choking?• What kind of food that patient ate?• What patient did while have eating?• Can patient talking and breathing while

choking?

Physical Examination

• Vital sign examination• ENT examination– Auricle• normotia (+/+)

– External auditory canal• Hyperemic (-/-)• cerumen (-/-)• otorhea (-/-)

Physical Examination

– Thympanic membranes = Intact (+/+)– Nasal Cavity

• Hyperemic (+/+)• Secretion (+/+)• Concha eutrophy (+/+)• Nasal septum not deviated• air passage (N/N)

– Oropharinx• No caries• Tonsil T1/T1, Detritus (-/-), Cripta (-/-)• Pharinx not hyperemic

Physical Examination

– Simetrical maksilo facial– No Limph node swelling

• Chest Examination– Inspection : simetrical or asymetrical– Palpation : vocal fremitus louder– Percution : mass sound– Auscultation: depend on obstruction location

• Stridor larynx• coarse wheeze trachea• Wheezing bronchus

Patient Work-Up

• Laboratories– Complete blood count

• Radiology– Chest x-ray– Neck Soft Tissue– Airway CT Scan

• Broncoscopy

Choking

• is the mechanical obstruction of the flow of air from the environment into the lungs.

• Choking prevents breathing, and can be partial or complete, with partial choking allowing some, although inadequate, flow of air into the lungs.

• Prolonged or complete choking results in asphyxia which leads to anoxia and is potentially fatal.

• Choking can be caused by:– Physical obstruction of the airway by a foreign body.– Respiratory diseases that involve obstruction of the airway.– Compression of the laryngopharynx, larynx or trachea in

trauma or tumor

Symtomps

• Often, the child presents after a sudden episode of coughing or choking while eating with subsequent wheezing, coughing, or stridor.

• in numerous cases, the choking episode is not witnessed• in many cases, the choking episode is not recalled at the

time the history is taken. • the child may present with persistent or recurrent cough,

wheezing, persistent or recurrent pneumonia, lung abscess, focal bronchiectasis, or hemoptysis.

• If the material is in the larynx space, symptoms may include stridor, recurrent or persistent croup, and voice changes.

Symtomps

• One third of parents were unaware of the aspiration or remembered an event that occurred more than a week before the presentation.

• In as many as 25% of cases, aspiration occurred more than one month before presentation.

• In another series of research, from 280 foreign body aspirations:– 47% were detected more than 24 hours after the aspiration– However, 99% had signs or symptoms or abnormal plain

radiographs before the bronchoscopy.

Sign

• new abnormal airway sounds, such as wheezing, stridor, or decreased breath sounds.

• These sounds are often unilateral, but can happen bilateral

• Sounds are inspiratory if the material is in the extrathoracic trachea.

• If the lesion is in the intrathoracic trachea, noises are symmetric but sound more prominent in the central airways. These sounds are a coarse wheeze (sometimes referred to as expiratory stridor) heard with the same intensity all over the chest.

Sign

• Once the foreign body passes the carina, the breath sounds are usually asymmetric.

• However, remember that the young chest transmits sounds very well, and the stethoscope head is often bigger than the lobes. A lack of asymmetry should not dissuade the observer from considering the diagnosis.

• a lack of findings upon physical examination does not preclude the possibility of an airway foreign body.

Jackson CriteriaFor Larynx Obstruction

• Stadium 1– Suprasternal retraction– Patient calm

• Stadium 2– Deeper Suprasternal retraction during inspiration– Epigastrium retraction– Rapid breathing

Jackson CriteriaFor Larynx Obstruction

• Stadium 3– Suprasternal retraction– Epigastrium retraction– Supraclavicula retraction– Infraclavicula retraction– Intercostal retraction

• Stadium 4– Stadium III– More rapid breathing and more dyspneu

Treatment

Invasive Treatment–Tracheostomy• Jackson criteria II and III

–Direct vision removal• Bronchoscopy• Laryngoscopy

Treatment

Non-Invasive Treatment–Encouraging the victim to cough–Back slaps–Abdominal thrusts–Self treatment with abdominal thrusts–Modified chest thrusts–Finger sweeping

Back Blow/Slap

Finger Swab

Abdominal Thrust

Abdominal ThrustOn Unconscious Patient

Tracheostomy

Tracheostomy

Tracheostomy

Bronchoscopy

Bronchoscopy

Complication

• Atelectasis due to prolonged airway obstruction

• Bronchiectasis due to chronic infection• Lung abscess• Pneumomediastinum and pneumothorax (rare

complications of foreign body removal)

THANKYOU