Resident Manual of Trauma to the Face, Head and Neck

Chapter 10: Foreign Bodies and Caustic Ingestion

ii. Laryngoscope Make sure an age-appropriate laryngoscope is also ready. Iii. Forceps Before bringing the patient into the operating room, select forceps based on the location and type of foreign body. Optical forceps are preferable, because of their visualization capabilities and manipulative characteristics. However, optical forceps may impair ventilation, because of their larger size, which incorporates the optical tract. A Magill forceps and a Miller or Macintosh blade from the anesthesi- ologist are often helpful for foreign bodies above the glottis. c. Procedure i. General anesthesia Use general anesthesia to provide optimal airway control and patient comfort. ii. Esophageal Foreign Body If an esophageal foreign body is suspected, intubate the patient for airway protection, to prevent inadvertent aspiration during attempted removal, and to minimize tracheal compression caused by the rigid esophagoscope. iii. Upper Airway Foreign Bodies For upper airway foreign bodies, keep the patient spontaneously breathing. Topically anesthetize the larynx with 1–4 percent lidocaine, depending on the patient’s size and age, to inhibit laryngeal reflexes and reduce the incidence of laryngospasm. Give preoxygenation and maintain oxygenation by placing a catheter through the nares and into the hypopharynx. iv. Retrieval of the Foreign Body During retrieval of the foreign body, remove the bronchoscope or esophagoscope, forceps, and foreign body as a unit. Upon removal of the foreign body, reexamine the airway or esophagus to look for a second foreign body and to assess any potential damage. Occasionally a foreign body is swallowed or aspirated during induction. If a previously confirmed foreign body is no longer visualized, perform a complete bronchoscopy and esophagoscopy. 3. Controversies in Management: Flexible versus Rigid Endoscopy a. Rigid Endoscopy Traditionally, rigid endoscopy is preferred for its ability to secure the airway and provide control during the removal of foreign bodies. For this

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