218 / 242
Resident Manual of Trauma to the Face, Head, and Neck
216
Chapter 10: Foreign Bodies and Caustic Ingestion
A. Primary Survey
A foreign body in the airway can cause complete obstruction and can
rapidly progress to an emergent airway, particularly in children. Initial
evaluation should include assessing the patient for level of alertness,
respiratory distress, and hemodynamic stability. If complete obstruction
is suspected the Heimlich maneuver may be attempted in an alert
patient.
Back blows and/or abdominal thrusts should be avoided in coughing/
gagging patients, since they may turn a partially obstructed airway into
a completely obstructed airway. Finger sweeps should never be
attempted, since they could push the object further into the airway.
B. Patient History
The patient’s history is the most important portion of the exam. Adults
often give a history of choking or dysphagia/odynophagia following a
certain event. Pediatric patients are much more challenging, because
only a small percentage will have a witnessed episode.
A foreign body should be suspected when a patient has choking or
severe coughing with respiratory distress. Foreign bodies can also
mimic other conditions. They should be considered in healthy children
with a new onset of wheezing or patients with recurrent asthma or
pneumonia.
1. Phases of Aspiration
There are three phases of aspiration.
y
y
Initially patients choke, gag, and have paroxysms of coughing or
airway obstruction at the inciting event.
y
y
This subsides into an asymptomatic phase after reflexes fatigue,
which can last hours to weeks.
y
y
Complications begin in the third phase when obstruction, erosion, or
infection may cause hemoptysis, pneumonia, atelectasis, abscess, or
fever.
2. Symptoms
Progression of symptoms may aid in localization of a foreign body.
Symptoms may include:
y
y
Fever, chest pain, tachycardia, lethargy, and irritability in children.
y
y
Nasal obstruction, rhinorrhea, epistaxis.
y
y
Shortness of breath.
y
y
Changes in voice.