Foreign bodies

Foreign bodies

Both children and adults may inhale foreign bodies. Y oung children will attempt to swallow a wide variety of objects, but coins, beads and parts of toys are particularly common. In adults, the aspiration is usually food, particularly inadequately chewed bones and meat. This is more common in elderly Henry Jay Heimlich , 1920–2016, thoracic surgeon, Xavier University , Cincinnati, OH, USA. inhaled, particularly in association with road tra ffi c accidents. Clinical features The history is paramount and a history of foreign body inges - tion or inhalation in a child, even though the pain, dysphagia, coughing, etc. may have settled, should always be taken seriously . Adults usually have a clear recall, which facilitates diag - nosis. Fish bones may lodge in the tonsils or base of tongue with minimal symptoms, but small fish bones may give rise to delayed para- and retropharyngeal abscess formation. Examination Examination may be prevented by trismus, pain and anxiety , but the presence of a foreign body may be suspected by salivary pooling within the piriform fossa or adjacent oedema and erythema of the pharyngolaryngeal mucosa. Radiology Radiology may be helpful but is not critical. Fish bones are often invisible on plain radiographs and a normal plain radio - graph does not exclude a foreign body within the pharynx, larynx, oesophagus or lungs. Specialised studies may help in cases of doubt, using a CT - scan or a contrast swallow in the case of a suspected oesoph - ageal foreign body . lottic Treatment In the case of an inhaled foreign body causing severe stridor in a neonate or infant, it may be removed either by hooking - it from the pharynx with a finger or by inverting the child - carefully by the ankles and slapping their back. In a larger child, it may be more appropriate to bend the child over your knee with the child’s head hanging down and again strike the child firmly between the shoulders. In the case of adults, an impacted laryngeal foreign body may be coughed out using abdominal thrusts (often referred to as a Heimlich manoeuvre). This involves standing behind the patient, clasping the arms around the lower thorax, such that the knuckles of the clasped hands come into contact with the patient’s xiphisternum, and then a brief, firm compression of the lower thorax may aid instant expiration of the foreign body . If none of these immediate emergency measures removes the foreign body and the patient is cyanosed and severely stridulous, an immediate cricothyroidotomy or tracheostomy may be necessary . In less - urgent cases, and when a foreign body is strongly suspected, endoscopy under general anaesthesia may be indicated. Foreign bodies

Both children and adults may inhale foreign bodies. Y oung children will attempt to swallow a wide variety of objects, but coins, beads and parts of toys are particularly common. In adults, the aspiration is usually food, particularly inadequately chewed bones and meat. This is more common in elderly Henry Jay Heimlich , 1920–2016, thoracic surgeon, Xavier University , Cincinnati, OH, USA. inhaled, particularly in association with road tra ffi c accidents. Clinical features The history is paramount and a history of foreign body inges - tion or inhalation in a child, even though the pain, dysphagia, coughing, etc. may have settled, should always be taken seriously . Adults usually have a clear recall, which facilitates diag - nosis. Fish bones may lodge in the tonsils or base of tongue with minimal symptoms, but small fish bones may give rise to delayed para- and retropharyngeal abscess formation. Examination Examination may be prevented by trismus, pain and anxiety , but the presence of a foreign body may be suspected by salivary pooling within the piriform fossa or adjacent oedema and erythema of the pharyngolaryngeal mucosa. Radiology Radiology may be helpful but is not critical. Fish bones are often invisible on plain radiographs and a normal plain radio - graph does not exclude a foreign body within the pharynx, larynx, oesophagus or lungs. Specialised studies may help in cases of doubt, using a CT - scan or a contrast swallow in the case of a suspected oesoph - ageal foreign body . lottic Treatment In the case of an inhaled foreign body causing severe stridor in a neonate or infant, it may be removed either by hooking - it from the pharynx with a finger or by inverting the child - carefully by the ankles and slapping their back. In a larger child, it may be more appropriate to bend the child over your knee with the child’s head hanging down and again strike the child firmly between the shoulders. In the case of adults, an impacted laryngeal foreign body may be coughed out using abdominal thrusts (often referred to as a Heimlich manoeuvre). This involves standing behind the patient, clasping the arms around the lower thorax, such that the knuckles of the clasped hands come into contact with the patient’s xiphisternum, and then a brief, firm compression of the lower thorax may aid instant expiration of the foreign body . If none of these immediate emergency measures removes the foreign body and the patient is cyanosed and severely stridulous, an immediate cricothyroidotomy or tracheostomy may be necessary . In less - urgent cases, and when a foreign body is strongly suspected, endoscopy under general anaesthesia may be indicated.