Physical Exam Key Points

1. ABCs. Assess airway, breathing, and circulation immediately. In children, foreign bodies are much more often located in a bronchus than in the trachea.

2. General appearance and vital signs. Crucial when assessing child who may have aspirated a foreign body. Patients with foreign bodies in the upper airway may present with acute respiratory failure and cyanosis if there is total obstruction of the larynx.

3. Upper airway. If there is a partial obstruction of the upper airway, patient may demonstrate respiratory distress, including stridor.

4. Lungs. Look for retractions and an increased respiratory rate. Foreign bodies in the lower airway generally present with wheezing that is localized in the early phases. Wheezing may become bilateral as time elapses. Lung exam may demonstrate rales, rhonchi, and retractions. There may only be subtle differences in air entry heard with the stethoscope.

B. Laboratory Data. There is no role for laboratory studies when considering a foreign body in the respiratory tract.

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