Plan

A. Acute Airway Management. May include various combinations of airway endoscopy as well as medical and mechanical control of airway. In some cases, observation is sufficient. Other options include ventilation using a bag-mask system, laryngeal mask airway, intubation with endotracheal tube or ventilating bronchoscope, or, rarely, tracheotomy.

B. Endoscopic Evaluation of Airway. May include fiberoptic or rigid (direct) laryngoscopy or bronchoscopy, or both. Rigid endoscopy, using telescopes and ventilating bronchoscopes, allows control and manipulation of airway and provides ventilation capabilities.

C. Adjunctive Medical Interventions. May include administration of steroids, nebulized racemic epinephrine, nebulized steroids, oxygen or helium-oxygen combinations, or antibiotics.

VI. Problem Case Diagnosis. Lateral neck x-ray demonstrated a radi-olucent foreign body in midtrachea of the 15-year-old boy. The foreign body was removed endoscopically under general anesthesia. Although patient described aspirating an edible item, he actually had aspirated a chewed-up pen cap.

VII. Teaching Pearl: Question. Can a patient with stridor be in significant respiratory distress while displaying a normal pulse-oximetry value?

VIII. Teaching Pearl: Answer. Yes; patients may be able to maintain normal oxygenation until the moment of respiratory collapse. Look for other signs of respiratory failure.

â– REFERENCES

Bluestone CD, Stool SE, Alper CM, et al. Pediatric Otolaryngology, 4th ed. Saunders, 2003.

Snow JB Jr, Ballenger JJ. Ballenger's Otorhinolaryngology Head and Neck Surgery, 16th ed. BC Decker, 2003.

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