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Foreign Body Aspiration

The diagnosis of foreign body aspiration requires a high index of suspicion because the diagnosis is often not obvious. Ninety percent of deaths from foreign body aspiration occur in patients who are younger than 5 years, and two thirds of these deaths occur in infants.

Aspiration of foreign bodies is most common in children 3 months to 6 years of age. Fifty percent of incidents occur in children younger than 2 years, and 90% of incidents occur in children younger than 4 years. Balloons, balls, and small parts are the most commonly aspirated items. Food, particularly hot dogs and peanuts, are frequently aspirated by toddlers.

Upper airway involvement may cause complete obstruction at the trachea or larynx, or it may only cause an abnormality of the voice. Complete obstruction of a bronchus will cause atelectasis, while partial obstruction may cause emphysema, pneumothorax, or pneumomediastinum. Vegetable matter may produce a chronic suppurative pneumonitis.

Clinical Evaluation

Aspirated foreign bodies often present with few or no symptoms. Nineteen percent of aspirations are unwitnessed, 57% of the patients are asymp tomatic, and clinical examination findings are normal in 20% of cases. Only 50% of Foreign Body Aspiration cases present with wheezing, cough, and decreased breath sounds.

A positive history can be obtained in 91% of Foreign Body Aspiration children, but the diagnosis is delayed in 18%.

Cough, dysphagia, stridor, and pain will be Foreign Body Aspiration prominent if the object is lodged in the larynx; if lodged in the trachea, stridor, Foreign Body Aspiration dyspnea or obstruc tion will predominate; if the object is lodged in the distal airways, Foreign Body Aspiration cough and wheezing may be appreciated.

Cough will be a presenting sign in 80% of patients; cyanosis, choking, and dyspnea are present in 25%. Air entry is decreased in 65%, tachypnea occurs in 45%, rales in 38%, fever in 36%, and wheezing in 35%. Diagnosis is often delayed in patients who have been treated for asthma.

Radiography

Thirty three percent of patients will have a normal chest radiograph. The majority of aspirated objects are not foreign body aspiration, aspiration radiopaque. Subcutaneous air or pneumomediastinum may be the only sign of an occult foreign body. Complete obstruction foreign body aspiration, aspiration will cause atelectasis of the affected lung. In a partial obstruction of a bronchus, hyperinflation and mediastinal shift to the unaffected side may be apparent. Chronic aspiration of vegetable matter may produce a consolidation of distal lobes.

In cases of partial obstruction of a bronchus, inspiratory and expiratory radiographs may be helpful because foreign body aspiration, aspiration the involved lung will fail to deflate on expiration. Alternatively, in an uncooperative child, an anteroposterior view taken while the child lies on first one side and then the other may reveal an Foreign Body Aspiration obstructed bronchus by allowing visualization of a dependent, yet hyperinflated, lung.

Management

If total obstruction is present and the child is not breathing, abdominal thrusts should be administered. For infants, four back blows are delivered by the heel of the hand to the interscapular area, with the child's head lower than the chest. The child is then turned and four chest compressions are given. The mouth should be inspected for the object. Advanced cardiac life support should be initiated. If unsuccessful, the process is repeated.

If severe symptoms are present, the child should be escorted to the operating room for laryngoscopy and rigid bronchoscopy.

Mild-to-moderate symptoms can allow time for reading of radiographs, followed by rigid bronchoscopy. Antibiotics, chosen with the aid of culture and Gram stain, are indicated if chronic aspiration of vegetable matter foreign body aspiration, aspiration has produced bronchitis or pneumoni tis. Dexamethasone and racemic epinephrine may be helpful if a lengthy bronchoscopic procedure induces inspiratory stridor. After removal of the object, recovery is usually uneventful.