Complete Airway Obstruction

1. Begin bag-valve-mask ventilation immediately after airway positioning. If patient cannot be adequately ventilated, immediately initiate the Heimlich maneuver in children older than 1 year or age or use back blows and chest thrusts in infants.

2. If these measures fail to dislodge the foreign body, it may be necessary to visualize the foreign body and extract it. If appropriate equipment is available, attempt direct visualization of the oropharynx with a laryngoscope. Use caution to avoid pushing the foreign body further into the airway, leading to complete obstruction. Most foreign bodies are located at the base of the tongue. If the foreign body is visualized, a Magill forceps should be used to extract it.

C. Lower Airway Foreign Body. If suspected, the radiographic workup should begin promptly. If a foreign body is discovered peripherally, bronchoscopy must be performed to remove it. Child should have nothing by mouth in preparation for the procedure. If there is an associated pneumonia, appropriate antibiotics are indicated.

VI. Problem Case Diagnosis. The 2-year-old patient had aspirated a Barbie doll shoe. A chest x-ray revealed right middle lobe air trapping without pneumonia. The object was removed from the right mainstem bronchus using bronchoscopy.

VII. Teaching Pearl: Question. Is it true that most respiratory foreign bodies in children are located in the right mainstem bronchus?

VIII. Teaching Pearl: Answer. There is only a slight preponderance of right bronchial foreign bodies in young children.

â– REFERENCES

Holinger LD. Foreign bodies of the airway. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics, 17th ed. Saunders, 2004:1410-1411.

Poirer MP, Ruddy RM. Acute upper airway foreign body removal: The choking child. In: Henretig FM, King C, eds. Textbook of Pediatric Emergency Procedures. Williams & Wilkins, 1997:621-627.

Stenklyft PH, Cataletto ME, Lee BS. The pediatric airway in health and disease. In: Gausche-Hill M, Fuch S, Yamamoto L, eds. APLS: The Pediatric Emergency Resource, 4th ed. Jones & Bartlett, 2004:64-66.

Swischuck LE, ed. Foreign bodies in the lower airway. In: Emergency Imaging of the Acutely Ill or Injured Child, 4th ed. Lippincott Williams & Wilkins, 2000:88-94.

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