FOREIGN BODY ASPIRATION 

1. Definition

It is a true medical emergency and a leading cause of accidental death in children <5 years.

2. Epidemiology

Age Distribution

3. Commonly Aspirated Objects

• Children: peanuts (most common), seeds, beans, toy parts
• Adults: food bolus, dentures, bones, tablets
• ICU: mucus plug, blood clot, broken devices

4. Pathophysiology

Site of Lodgement

5. Clinical Presentation

A. Acute Phase (Choking Episode)

Classic Triad (especially children):

1. Sudden coughing
2. Wheezing
3. Decreased air entry

History of choking = most sensitive clue

B. Symptoms by Location

Laryngeal FBA

• Sudden aphonia
• Inspiratory stridor
• Severe distress
• Cyanosis

Tracheal FBA

• Barking cough
• Positional wheeze
• Audible slap or click

Bronchial FBA

• Unilateral wheeze
• Reduced breath sounds
• Recurrent pneumonia
• Chronic cough

C. Late / Missed FBA

• Persistent cough
• Recurrent pneumonia in same lobe
• Hemoptysis
• Bronchiectasis
• Failure to thrive (children)

6. Physical Examination

### Normal exam does NOT exclude FBA

7. Diagnostic Evaluation

A. Imaging

Chest X-ray (First line)

Expiratory films / lateral decubitus views (children):

• Affected side fails to deflate

CT Chest

• High sensitivity
• Detects radiolucent objects
• Shows airway obstruction, air trapping
• Used when diagnosis unclear

B. Bronchoscopy – GOLD STANDARD

8. Emergency Management (ACLS / PALS Based)

Conscious Patient with Severe Obstruction

##Blind finger sweeps contraindicated

Unconscious Patient

• Begin CPR
• Look for object only if visible
• Attempt ventilation
• Emergency bronchoscopy or cricothyrotomy if needed

9. Definitive Management-Bronchoscopy

Rigid Bronchoscopy (Preferred)

• Children
• Proximal FB
• Better airway control
• Larger working channel

Flexible Bronchoscopy

• Adults
• Distal FB
• Diagnostic uncertainty

ICU Considerations (VERY HIGH-YIELD)

Goals

• Maintain oxygenation
• Avoid distal migration
• Avoid complete obstruction

Key Points

• Spontaneous ventilation preferred
• Avoid muscle relaxants initially
• Inhalational induction (sevoflurane)
• Jet ventilation sometimes used

## Positive pressure ventilation may push FB distally

10. Complications

Early

• Hypoxia
• Cardiac arrest
• Pneumothorax
• Laryngeal edema

Late

• Pneumonia
• Lung abscess
• Bronchiectasis
• Bronchial stenosis
• Hemoptysis

11. Special Situations

Tablet Aspiration

• Iron → chemical pneumonitis
• Potassium chloride → severe necrosis
• Requires urgent removal

BATTERY ASPIRATION

Chest & Neck X-ray (AP + lateral)-

Pathognomonic Signs:

## Any suspected battery = EMERGENCY REMOVAL – imaging should NOT delay bronchoscopy

Surveillance for Delayed Complications (CRITICAL)

13. Battery Aspiration vs Other Foreign Bodies

12. Differential Diagnosis

• Acute asthma
• Croup
• Epiglottitis
• Bronchiolitis
• Vocal cord dysfunction
• Pneumonia

Unilateral wheeze → think FBA until proven otherwise

13. Prognosis

• Excellent if removed early
• Delay >24–48 hrs → ↑ complications
• Mortality mainly due to:
• Delayed diagnosis
• Complete airway obstruction

14. Prevention

Pediatric

• Avoid nuts <3 years
• Supervised feeding
• Age-appropriate toys

Adult

• Proper denture fitting
• Swallow assessment in neuro patients