Download - Foreign Body in Throat
![Page 1: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/1.jpg)
Foreign Body in Throat
Dr. Vishal Sharma
![Page 2: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/2.jpg)
Aspirated (Airway) Foreign Body
![Page 3: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/3.jpg)
Clinical Staging
1. Initial phase: choking, coughing, wheezing,
gagging
2. Asymptomatic phase: due to mucosal adaptation
3. Late phase: Laryngeal / Tracheal / Bronchial
4. Complication phase: pneumonia, emphysema,
lung abscess, atelectasis
![Page 4: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/4.jpg)
Late Clinical Featuresa. Laryngeal: partial or total airway obstruction,
hoarseness, aphonia, hemoptysis
b. Tracheal: airway obstruction, hemoptysis,
wheezing, palpatory thud, auscultatory slap
c. Bronchial: cough, ipsilateral wheezing,
ipsilateral decreased breath sounds
![Page 5: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/5.jpg)
Bypass valve & Stop valve effectPartial Obstruction Total Obstruction
Wheezing Late Atelectasis
![Page 6: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/6.jpg)
Check valve effectNo Expiration No Inspiration
Emphysema Early Atelectasis
![Page 7: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/7.jpg)
Clinical Diagnosis
Conscious pt:
1. Hoarseness / aphonia
2. Respiratory distress
Unconscious pt:
1. No chest movement
2. No air exchange at nose /
mouth. 3. Cyanosis.
![Page 8: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/8.jpg)
Radio-opaque F.B. larynx
![Page 9: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/9.jpg)
Radio-opaque F.B. Bronchus
![Page 10: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/10.jpg)
Radio-lucent F.B.
Right Lung collapse & Left emphysema
![Page 11: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/11.jpg)
Management of choking in an unconscious patient
1. Patient placed in supine position
2. Open airway + mouth to mouth ventilation
3. Correct airway obstruction
![Page 12: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/12.jpg)
Opening the airway
1. Head-tilt:
Extension of
neck by backward
pressure on
forehead
![Page 13: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/13.jpg)
Opening the airway
2. Head-tilt, chin-lift:
Extension of neck
by backward
pressure on
forehead + lift pt’s
chin keeping mouth
open.
![Page 14: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/14.jpg)
Opening the airway
3. Head-tilt, neck-lift:
Lift pt’s neck
while pushing
down on forehead.
Prevents falling
back of tongue.
![Page 15: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/15.jpg)
Opening the airway
4. Modified jaw-thrust:
For pt with neck /
spinal injuries. Push
patient’s jaw forward
by applying pressure
at angle of mandible.
Avoid head tilt.
![Page 16: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/16.jpg)
Correcting airway obstruction Back blows
Abdominal thrusts
Chest thrusts (for pregnancy, age < 8 yrs)
All 3 raise subglottic pressure, to dislodge out FB
Open pt’s mouth
Blind finger sweeps in mouth
![Page 17: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/17.jpg)
Back blowsPlace pt in lateral
position, supporting pt’s
chest against your knees.
Use free hand to deliver
five rapid blows to spinal
Area b/w scapulae, to
dislodge F.B.
![Page 18: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/18.jpg)
Abdominal thrusts
Straddle supine pt at his hip.
Place your hand heel b/w pt’s
umbilicus & ribcage, in midline.
Hold that hand with your other
hand & apply 5 rapid, inward +
upward thrusts, to dislodge FB.
![Page 19: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/19.jpg)
Chest thrustsKneel beside supine pt at
chest level. Place hand
heel on centre of pt’s
sternum.
Lock hands. Apply 5 rapid
downward thrusts.
Only 2 fingers used for a
small child.
![Page 20: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/20.jpg)
Opening patient’s mouth
Tongue-jaw lift technique:
Hold pt’s tongue + lower jaw b/w your thumb & fingers.
Lift pt’s tongue to move it
away from pharyngeal wall.
![Page 21: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/21.jpg)
Opening patient’s mouth
Crossed-finger technique:
Cross your thumb under
your index finger.
Place your thumb against
pt’s lower lip & index
finger
against his
upper teeth.
Uncross your fingers to
open pt’s
mouth.
![Page 22: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/22.jpg)
Blind finger sweeps
Open pt’s mouth. Insert index
finger of free hand into
pt’s mouth,
along pt’s cheek, till
tongue base.
Use it as a hook to
roll out FB.
Avoid pushing FB further back.
Avoid blind sweeps in a child.
Attempt to remove visible FB only.
![Page 23: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/23.jpg)
Correcting airway obstruction in an unconscious pt
5 Back blows
failure
5 Abdominal thrusts Or 5 Chest thrusts
failure
Open pt’s mouth + blind finger sweeps.
Continue this sequence till FB is removed or pt is ready to be shifted to operation theatre.
![Page 24: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/24.jpg)
Management of choking in a conscious pt
If patient can speak, cough, or breathe:
Do not interfere. Patient to be examined by an
ENT specialist as soon as possible.
If the patient cannot speak, cough, or breathe:
Begin treatment for obstructed airway.
![Page 25: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/25.jpg)
Correcting airway obstruction
in a conscious pt > 1 yr old 5 Back blows
failure
5 Abdominal thrusts (Heimlich maneuver)
Or 5 Chest thrusts (for pregnancy, age < 8 yrs)
Continue this sequence till FB is removed or pt
becomes unconscious.
![Page 26: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/26.jpg)
Back blows
Place pt in sitting / standing
position. Support pt’s chest
while bending pt at the waist.
Use your free hand to deliver
5 rapid blows to spinal area
b/w two scapulae.
![Page 27: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/27.jpg)
Heimlich Maneuver
![Page 28: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/28.jpg)
Heimlich Maneuver
Stand behind sitting / standing pt & pass
your arms around pt’s waist.
Hold your fist against pt’s abdomen b/w
umbilicus & ribcage.
Lock hands & apply 5 rapid, inward +
upward thrusts to dislodge FB.
![Page 29: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/29.jpg)
Chest thrusts
Stand behind standing pt &
pass your arms around pt’s
chest. Hold your fist against
pt’s sternum in its centre. Lock
hands & apply 5 rapid, back-
ward thrusts to dislodge FB.
![Page 30: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/30.jpg)
Correcting airway obstruction in an infant
5 Back blows
failure
5 Chest thrusts
Continue this sequence till FB is removed or pt
is ready to be shifted to operation theatre.
![Page 31: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/31.jpg)
Back blows in an infant
Straddle infant face down,
head lower than trunk, over
your forearm, supported on
your thigh.
Deliver five rapid back
blows, with heel of other
hand b/w shoulder blades.
![Page 32: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/32.jpg)
Chest thrusts in an infantSupporting pt’s head, keep
infant supine b/w your
hands, with head lower
than trunk.
Using 2 fingers, deliver 5
rapid backward thrusts on
sternum.
![Page 33: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/33.jpg)
Surgical ManagementFor life threatening stridor
Cricothyrotomy
Emergency Tracheostomy
For foreign body removal
Direct Laryngoscopy
Rigid Bronchoscopy
Thoracotomy & Bronchotomy
![Page 34: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/34.jpg)
Prevention of chokingAdults:
Cut food into small pieces
Chew food slowly & thoroughly
Avoid laughing / talking during eating
Avoid excess alcohol with / before meals
Infants & Children:
Keep small objects away from children
Avoid playing with food or toys in mouth
![Page 35: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/35.jpg)
Swallowed Foreign Body
![Page 36: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/36.jpg)
Diagnosis Plain X-ray (PA & Lateral): soft tissue neck, chest,
abdomen for radio-opaque FB
Fluoroscopy with Barium soaked cotton pledget
for radiolucent FB
Barium Swallow
Flexible Oesophagoscopy
![Page 37: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/37.jpg)
Coin in cricopharynx
![Page 38: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/38.jpg)
Meat bolus in Cricopharynx
![Page 39: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/39.jpg)
Toe ring in cricopharynx
![Page 40: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/40.jpg)
Razor blade
![Page 41: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/41.jpg)
Open safety pin
![Page 42: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/42.jpg)
Barium Swallow
![Page 43: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/43.jpg)
Flexible Oesophagoscopy
![Page 44: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/44.jpg)
Tooth brush in stomach
![Page 45: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/45.jpg)
Pharyngeal FB Common sites: tonsil, pyriform fossa, vallecula,
base tongue
Diagnosis confirmed by indirect laryngoscopy
Usually removed in OPD but may require
removal by Hypo-pharyngoscopy GA
![Page 46: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/46.jpg)
Oesophageal & Gastric FB Common sites: cricopharynx, aortic indentation &
cardiac end
Usually removed by rigid oesophagoscopy GA
Advancement into stomach is safe in difficult FB
Oesophagotomy rarely required for impacted FB
FB reaching stomach, usually passes out in stool
Emetic & Cathartic agents are contraindicated
![Page 47: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/47.jpg)
Indications for Immediate Intervention
Associated respiratory obstruction
Total oesophageal obstruction
Disc battery (perforation occurs in 8-12 hrs)
Sharp, impacted foreign body
Gastro-intestinal FB > 5 cm in a child < 2 yr
Gastro-intestinal FB with acute abdominal pain
No progress of FB in serial X-ray after 24 hr
Gastric FB with pyloric stenosis
![Page 48: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/48.jpg)
Disc battery in stomach
![Page 49: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/49.jpg)
Complications of neglected FB
1. Oesophageal ulceration & stricture
2. Oesophageal perforation mediastinitis
3. Peri-oesophageal cellulitis
4. Retro-pharyngeal abscess
5. Respiratory obstruction due to
tracheal compression
laryngeal oedema
![Page 50: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/50.jpg)
Retropharyngeal abscess
![Page 51: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/51.jpg)
Instruments for FB removal
![Page 52: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/52.jpg)
Instruments for FB removal
![Page 53: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/53.jpg)
Optical Forceps
![Page 54: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/54.jpg)
Net retrieval system
![Page 55: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/55.jpg)
![Page 56: Foreign Body in Throat](https://reader038.vdocuments.mx/reader038/viewer/2022102606/56813e87550346895da8c2a4/html5/thumbnails/56.jpg)
Thank You