Resident Manual of Trauma to the Face, Head and Neck

Chapter 10: Foreign Bodies and Caustic Ingestion

A. Primary Survey A foreign body in the airway can cause complete obstruction and can rapidly progress to an emergent airway, particularly in children. Initial evaluation should include assessing the patient for level of alertness, respiratory distress, and hemodynamic stability. If complete obstruction is suspected the Heimlich maneuver may be attempted in an alert patient. Back blows and/or abdominal thrusts should be avoided in coughing/ gagging patients, since they may turn a partially obstructed airway into a completely obstructed airway. Finger sweeps should never be attempted, since they could push the object further into the airway. B. Patient History The patient’s history is the most important portion of the exam. Adults often give a history of choking or dysphagia/odynophagia following a certain event. Pediatric patients are much more challenging, because only a small percentage will have a witnessed episode. A foreign body should be suspected when a patient has choking or severe coughing with respiratory distress. Foreign bodies can also mimic other conditions. They should be considered in healthy children with a new onset of wheezing or patients with recurrent asthma or pneumonia. 1. Phases of Aspiration There are three phases of aspiration. y y Initially patients choke, gag, and have paroxysms of coughing or airway obstruction at the inciting event. y y This subsides into an asymptomatic phase after reflexes fatigue, which can last hours to weeks. y y Complications begin in the third phase when obstruction, erosion, or infection may cause hemoptysis, pneumonia, atelectasis, abscess, or fever. 2. Symptoms Progression of symptoms may aid in localization of a foreign body. Symptoms may include: y y Fever, chest pain, tachycardia, lethargy, and irritability in children. y y Nasal obstruction, rhinorrhea, epistaxis. y y Shortness of breath. y y Changes in voice.

216

Resident Manual of Trauma to the Face, Head, and Neck