Answer& Explaination
1) Foreign body aspiration.
Patients with FBA often do not have obvious symptoms, physical manifestations, or radiographic findings. A high index of suspicion should be given to a history of choking episode followed by coughing spells.
Patient typically presented with stridor@ wheezing (depend on location of obstruction), cough, cyanosed (severe airflow obstruction).
2) Need to know the urgency vs emergency of the cases. Most of the diagnosis can be made through history taking.
a) Chest x-ray may show air trapping, atelectasis, infiltrates or consolidation. Lateral view is more valuable than PA as it differentiates foreign body in the airway versus the esophagus. A “double lumen” sign of a round object on x-ray should alert clinicians to the possibility of a battery in the aerodigestive tract, a true emergency that warrants urgent bronchoscopic evaluation to avoid the dreadful complications of mucosal burn, pressure necrosis, and tracheoesophageal fistula.
b) Fluoroscopy
c) CT scan
3) First of all, do not reach for the foreign body with the fingers.
a) Pulse oximetry to measure O2 sat.
b) Bronchoscopy
c) Tracheastomy with anesthesia if significant laryngeal edema
d) Post operative care
- Admit to ward for admission
- Clear liquid diet
- Chest x-ray
- Chest physiotherapy
- Antibiotics in case of delayed diagnosis.
4) Complication
a) Mortality after bronchoscopy <>
b) Bronchiectasis
c) Pneumonia / bronchitis
d) Subcutaneous Emphysema
e) Pneumothorax / pneumomediastinum
f) Granulation tissue and hemorrhage
g) Cartilage destruction
h) Airway compromise
i) Death
Reference: Foreign Body Aspiration, Ki-Hong Kevin Ho, MD & Harold Pine, MD, University of Texas Medical Branch Department of Otolaryngology Grand Rounds Presentation, February 25, 2009
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