sharp objects (e.g., bones, needles, pins) may perforate the bowel wall, resulting in peritonitis, abscess formation, or hemorrhage Respiratory Foreign Body Upper Airway Foreign bodies that lodge in the upper airway can be immediately life threatening According to the National Safety Council, choking was the fourth leading cause of unintentional injury death in the United States in 2017, and a leading cause in children under years of age, resulting in 1,124 deaths in this age group Most children with aspirated foreign bodies are younger than years of age The most common foods responsible for fatalities in the United States include hot dogs, candy, meat, and grapes Childhood fatality from aspiration of man-made objects is less common Frequently aspirated objects include balloons, small balls, and beads Children with foreign bodies in the upper airway may present with acute respiratory distress, stridor, or complete obstruction of the upper airway In patients with complete airway obstruction, emergency treatment begins with basic life support skills Back blows and chest compressions are used in infants, and the Heimlich maneuver is used in toddlers, children, and adolescents, if the patient is conscious Cardiopulmonary resuscitation should be initiated if the patient becomes unresponsive If these methods fail to dislodge the foreign body, rapid progression to direct visualization and manual extraction or an emergency airway is necessary (see Chapters Airway and Cardiopulmonary Resuscitation ) FIGURE 32.1 Two-view chest radiograph demonstrating esophageal coin located at level of the thoracic inlet Lower Respiratory Tract