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