Pediatric emergency medicine trisk 3278 3278

any child with sudden onset of symptoms or when there is a history consistent with ingestion or aspiration Triage Children with a laryngeal or tracheal foreign body usually present in distress with hoarseness, coughing, stridor, or wheezing If the child is able to phonate, air is moving through his or her larynx, indicating only partial obstruction Efforts should be made to allow the child to assume a position of comfort Invasive examination and interventions such as IV placement should be avoided when possible, as crying may result in worsening of the airway obstruction Complete or near complete obstruction requires emergency airway management Initial Assessment The history may include a witnessed ingestion or sudden onset of the above symptoms with no other etiology noted Examination findings may include stridor with upper airway foreign bodies, and wheezing, persistent cough, focal decreased aeration with lower airway foreign bodies Asymmetric hyperinflation or areas of lung collapse are rarely detectable without radiologic evaluation Management Do not perform back blows or Heimlich maneuver to treat the child who is still breathing as objects may become further lodged in the airway Children in severe distress should be taken to the OR for emergent removal under direct laryngoscopy and bronchoscopy For children who are not breathing, back blows or the Heimlich maneuver should be done If unsuccessful with resultant progression to depressed mental status, laryngoscopy should be performed to assess for glottic foreign material that can be removed with forceps For those in mild or moderate distress, plain films may help identify radiopaque objects or show low lung volumes or hyperinflation in the setting of radiolucent objects (see Fig 106.3 ) A normal chest radiograph does not rule out foreign body In stable patients, fluoroscopy or CT can add diagnostic value though this needs to be balanced against the higher doses of ionizing radiation for these studies, and the likelihood that findings will influence subsequent management Alternatively, if there is high clinical concern for foreign body despite negative radiographs, consideration should be given to urgent bronchoscopy without further imaging Those with low suspicion of foreign body should have thorough follow-up and reevaluation Development of symptoms in the interim period should prompt appropriate further investigations as indicated