Foreign body airway obstruction

Foreign Body Airway Obstruction

Foreign body airway obstruction (FBAO) is a medical emergency that occurs when an object becomes lodged in the airway, preventing normal breathing. This condition is most commonly seen in children, but it can occur in individuals of any age. Prompt recognition and management are crucial to prevent serious complications, including death.

Pathophysiology

The airway consists of the upper and lower respiratory tracts. The upper airway includes the nose, mouth, pharynx, and larynx, while the lower airway includes the trachea, bronchi, and lungs. A foreign body can obstruct the airway at any level, but the most common sites are the larynx and the right main bronchus due to its anatomical structure.

When a foreign body obstructs the airway, it can cause partial or complete blockage. A partial obstruction allows some air to pass, but may cause wheezing or stridor. A complete obstruction prevents any air from passing, leading to asphyxia and potentially rapid loss of consciousness.

Causes

Foreign body airway obstruction can be caused by a variety of objects, including:

• Food items, such as nuts, grapes, or pieces of meat
• Small toys or parts of toys
• Coins or other small objects
• Dental appliances

Children are particularly at risk due to their tendency to explore objects with their mouths and their smaller airway size.

Symptoms

The symptoms of FBAO depend on the location and degree of obstruction. Common symptoms include:

• Sudden onset of coughing or choking
• Difficulty breathing or noisy breathing (stridor or wheezing)
• Inability to speak or cry
• Cyanosis (bluish discoloration of the skin)
• Loss of consciousness in severe cases

Diagnosis

Diagnosis of FBAO is primarily clinical, based on the history and physical examination. Imaging studies, such as chest X-rays, may be used to confirm the presence of a foreign body, especially if it is radiopaque. However, not all foreign bodies are visible on X-rays.

Management

The management of FBAO depends on the age of the patient and the severity of the obstruction.

In Adults and Children Over 1 Year

1.Encourage Coughing: If the person is coughing forcefully, encourage them to continue coughing. 2.Heimlich Maneuver (Abdominal Thrusts): If the person cannot cough, speak, or breathe, perform abdominal thrusts. 3.Back Blows and Chest Thrusts: If abdominal thrusts are ineffective, alternate between back blows and chest thrusts.

In Infants Under 1 Year

1.Back Blows: Place the infant face down on your forearm, supporting the head, and deliver five back blows between the shoulder blades. 2.Chest Thrusts: Turn the infant face up and deliver five chest thrusts using two fingers on the lower half of the sternum.

Advanced Medical Intervention

If basic life support measures fail, advanced medical interventions may be necessary, including:

• Laryngoscopy and Bronchoscopy: To visualize and remove the foreign body.
• Surgical Intervention: In rare cases, surgical removal may be required.

Prevention

Preventive measures include:

• Supervising young children during meals and playtime.
• Avoiding giving small, hard foods to young children.
• Keeping small objects out of reach of children.

Also see

• Choking
• Heimlich maneuver
• Airway management
• Respiratory distress