Foreign Body in the Airway: Causes, Signs of Recognition, and Treatment Methods

by Johnny Jacks

Foreign bodies in the airway can occur at any age, but are most commonly found in children under the age of four, accounting for up to 75% of cases. It has been observed that boys are twice as likely as girls to experience this condition.

Overview of Foreign Body in the Airway:

A foreign body in the airway refers to a situation where a foreign object becomes lodged in the respiratory tract, from the larynx to the bronchi. This is one of the most common emergency situations in otorhinolaryngology, and if not treated promptly, it can be life-threatening.

Foreign bodies can be of various types and can originate from plants, animals, plastics, or unique foreign bodies such as mud, slime, or liquids like porridge or milk. Depending on the nature, shape, and size of the foreign body, it may become trapped in the larynx, trachea, or bronchi.

Foreign body in the airways in children is very dangerous

Foreign body in the airways in children is very dangerous

Causes of foreign bodies in the airways

There are two main causes of airway foreign bodies. In the West, food items are the most common culprits, with peanuts being the most frequent cause of choking, followed by sausages and hard candy. In addition to food, other small and smooth objects such as marbles and rubber balls are often responsible. Another cause of choking in children is their lack of molars to chew food properly.

About 80 percent of airway foreign body cases occur in children under three years of age, with the highest incidence in the one to two year age group. At this age, children are typically able to stand and walk independently and explore their world through their mouths. They also have good motor skills to put small objects into their mouths, but they do not yet have molars to chew food fully and may have immature or poorly coordinated swallowing mechanisms. Factors that increase the risk of airway foreign body in this age group include access to inappropriate food or objects, activity while eating, and older siblings or caregivers who may put food or objects in the infant or toddler’s mouth. Infants and young children are also more susceptible to airway foreign bodies due to their narrower airway diameter, making them more prone to obstruction.

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Adults, on the other hand, often suffer from airway foreign bodies due to swallowing difficulties caused by throat paralysis or other medical conditions. This condition can also occur in individuals with a history of nasal foreign bodies, neurological disorders, loss of consciousness, or alcohol abuse.

What are the symptoms when a person inhales a foreign body?

The choking reflex in foreign body aspiration

This is a natural protective reflex of the respiratory tract when a foreign body enters. At this point, the patient contracts their trachea to prevent the foreign body from entering further and coughs to expel the foreign body.

During this process, the patient may experience difficulty breathing, eye bulging, and persistent coughing for up to 5-10 minutes. Due to poor air circulation, the patient may also sweat profusely, turn pale, and become restless.

If the foreign body cannot be removed, the patient may die from obstruction. If the foreign body is expelled, the patient may gradually recover.

Localized obstruction syndromes in foreign body aspiration

In cases where the foreign body is in the trachea, the patient may experience breathing difficulties and wheezing. The severity of breathing difficulties may vary depending on how much of the trachea the foreign body is obstructing. Shortly after, the patient may become hoarse or lose their voice.

Foreign bodies in the trachea are usually flat, sharp, or pointed. If a large foreign body becomes lodged in the tracheal opening, it can cause immediate suffocation and death.

For patients with foreign bodies in the bronchi, most of these foreign bodies are mobile and can cause fatal complications if they become trapped in the lower bronchi causing respiratory distress. Bronchial foreign bodies are usually large, round, smooth, and polished.

When a foreign body is in the bronchi, the patient may experience coughing and intermittent difficulty breathing, but may eventually return to normal breathing. When listening to the lungs, characteristic wheezing and crackling sounds may be heard due to the movement of the foreign body.

Foreign body aspiration can be fixed or mobile. In cases where the foreign body is fixed, it can cause lung collapse, inflammation of the bronchial tubes or lung, or pneumothorax. Patients experience sudden coughing fits, difficulty breathing both in and out, and rapid breathing over 20 times per minute. Crackling sounds may be heard in the lungs, indicating a reduction or absence of lung function. If the foreign body is mobile, wheezing sounds can be heard in the lungs, accompanied by violent coughing fits.

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To determine the location of the foreign body in the respiratory tract, X-rays or bronchoscopy may be necessary to determine the appropriate treatment method.

Treatments for foreign body aspiration

Initial emergency treatment

If the foreign body is a liquid

Difficulty breathing is due to a reflex constriction of the trachea.

Procedure: Hold the child’s two ankles up high, head down, and vigorously tap the child’s back to make them cry loudly.

If the child is still unable to breathe, blowing air and external chest compression may be necessary.

If the foreign body is not a liquid

The emergency measures depend on the patient’s age.

For children under 1 year old

Use the back slap and chest thrust method:

Back slap method: The rescuer can sit or stand, with their legs facing forward. Let the child lie face down on the rescuer’s forearm, with the head lower than the body and the neck extended. Use moderate force to slap the child’s back 5 times in the middle of the two shoulder blades. If the foreign body is still not expelled, use the chest thrust method immediately.

Chest thrust method: Have the child lie on their back on the rescuer’s forearm, head down and neck extended. Then, use two fingers to press the intersection of the line connecting the two nipples and the middle of the sternum 5 times. Alternate between the back slap and chest thrust methods until the foreign body is expelled.

For children over 1 year old and under 8 years old

There are two ways to perform the back slap method: The first method involves the rescuer sitting down and placing the child face down across their thighs, with the head lower than the body and the neck extended. Then, slap the back between the two shoulder blades 5 times and check if the foreign body has been expelled. The second method involves the rescuer kneeling to one side while the child stands with their head down and mouth open. Then, use one hand to support the chest and the other hand to slap the back 5 times as before, and check if the foreign body has been expelled. If the foreign body is still not expelled, the Heimlich maneuver may be used.

Heimlich maneuver: Have the child stand up, bend their head down, and open their mouth. The rescuer should stand behind the child, put their hands around the child’s waist, and press the abdomen forcefully upwards and inwards.

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For individuals over 8 years old and adults

The back slap method is used for choking victims who are standing, bending their head down, mouth open, and the rescuer standing next to the victim. Then, the rescuer places their hand on the victim’s chest and delivers five sharp blows to the middle of the back, between the shoulder blades, to check for foreign objects. If the object is still lodged, the Heimlich maneuver should be used.

The Heimlich maneuver is performed similarly to children aged 1 to 8 years old, but the rescuer may stand. If the foreign object is still lodged in the victim’s airway, the back slap method and abdominal thrusts should be combined until the object is expelled.

Removal of an Adult's Airway Foreign Body

Removal of an Adult’s Airway Foreign Body

laryngoscopy – gas – bronchoscopy to pick up foreign bodies

For lodged objects in the esophagus, trachea, or bronchus, the patient should be taken to the hospital for removal.

Tracheostomy in airway foreign body

Tracheostomy is only indicated when there is difficulty breathing, especially in cases of 2nd or 3rd degree tracheal obstruction.

In addition, tracheostomy is also a step in safely removing foreign objects from the airway.

Surgery to Remove a Foreign Body in the Airway

Surgery to Remove a Foreign Body in the Airway

Tips for Prevention and First Aid when a Child Chokes

Prevention

Pay attention to toys and objects around children that are made of metal, plastic, are small, and can easily be inserted into the mouth. When feeding children small items like peanuts, cashews, grapes, popcorn, or candy, exercise caution as they can cause blockages in the airway and lead to sudden death before reaching the hospital.

First Aid for Choking in Children

If the child is still pink, able to cry or speak, and can breathe:

Sit the child down and take them to a medical facility. Do not attempt to remove the foreign object by poking the throat or using any other methods as this can cause the object to become more lodged.

If the child is turning blue, not breathing, or has weak breaths, call emergency services and perform the following steps:

Lay the child face down, hold their head and neck on your left arm. Cup your right hand and forcefully strike the back of the child between their shoulder blades five times.

Next, turn the child over onto their right side. If the child is still having difficulty breathing and turning blue, place two fingers on the area just below the breastbone and push down firmly five times.

Alternate between back blows and chest thrusts until the object is dislodged, or the child can cry.

These are some basic tips for dealing with choking in children, and we hope they are useful to you.

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