4.Inhaled Foreign Bodies
Inhaled foreign bodies are commonest in the age group around 3 years. The objects include shiny metal pieces, parts of toys, peanuts and other food particles. The usual history in children is, running around with stuff in their mouth followed by a fall and choking. Adults usually choke while eating. Intractable cough lasting several minutes following a suggestive history should alert the doctor. A chest X-ray would show unilateral air trapping, as well as a radiopaque foreign body. Missed foreign bodies can present as a collapse-consolidation.
These commonly get lodged in the right main broncus, but larger objects may get lodged in the trachea or the subglottis in children, which can be life threatening due to airway obstruction. Some small objects like nuts & lentils can absorb water and swell to obstruct the trachea later. Even foreign bodies lodged in a bronchus can act as a one way valve leading to hyperinflation of the affected side, which can cause mediastinal shift and kinking of major vessels, could be life threatening. Therefore, if immediate bronchoscopy is not possible, monitoring the patient is of crucial importance.
First-aid can be attempted at home, while being taken to hospital as well as while being evaluated by the doctor.
Adult: Give five thumps in between shoulder blades to propel the FB out before attempting Heimlich manoeuvre.
Child: Hold the child as shown in the picture & hit from the base of the palm in between shoulder blades.
Heimlich manoeuvre – Stand behind the patient. Make a fist with one hand, keep in the epigastrium and keep the other hand on top of it. Give a sudden upward & inward abdominal thrust. This may push the FB obstructing the trachea. If it doesn’t, repeat 5 times. Can go back to 5 back thumps on failure.
Removal of the FB is done at the theatre using a Bronchoscope.