Pediatric emergency medicine trisk 3277 3277

TRAUMA TO THE LARYNX AND TRACHEA Foreign Body Goals of Treatment Laryngeal or tracheal foreign bodies can result in life-threatening partial or complete airway obstruction The goal is to safely remove the object as soon as possible to prevent or reverse any respiratory compromise Care must be taken to avoid converting a partial airway obstruction into complete airway compromise, and to avoid advancing the foreign material with resultant aspiration into the lung CLINICAL PEARLS AND PITFALLS Disc batteries should be removed as soon as possible to avoid caustic injury Clinicians should have a high suspicion for foreign body in a child with sudden onset of stridor, persistent cough, or respiratory distress Back blows and the Heimlich maneuver are not performed on the breathing child as these can cause the object to lodge further into the airway These techniques are reserved for complete airway obstruction Current Evidence Foreign bodies lodged in the laryngeal inlet or trachea cause severe distress and often present with coughing, wheezing, and biphasic stridor Tracheal/bronchial foreign bodies can cause either lung hypoventilation due to compete obstruction or hyperinflation due to a check-valve effect of the object Clinical Considerations Clinical Recognition Foreign bodies trapped in the laryngeal inlet can cause significant acute upper airway obstruction The child usually presents with severe coughing, hoarseness, and significant respiratory distress The larger challenge for emergency clinicians is recognizing foreign body aspiration when the event was not witnessed directly, and the child is not acutely compromised Presenting symptoms such as cough, stridor, and examination findings such as wheezing and decreased aeration are nonspecific and seen commonly in routine pediatric illnesses such as croup, bronchiolitis, and asthma One should be suspicious of airway foreign body in