foriegn body aspiration

8/6/2019 Foriegn Body Aspiration

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Suzanne Bailey

June 13th, 2011

MORNING REPORT


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Operative Report

A 3-7 bronchoscope was then passedinto the subglottis and tracheaThecarina was crisp with no evidence ofabnormality. A foreign body was

visualized within the right main stembronchi, which appeared to be analmondUsing a peanut grasper, theforeign body was then removed.Following removal, the 3-7 bronchoscopewas reintroduced into the trachea. There

was found to be some minimalgranulation tissue at the entrance of theright main stem bronchi where theforeign body had been lodged.

http://www.google.com/imgres?imgurl=http://cfcenter.stanford.edu/education/images/bronchoscope.gif&imgrefurl=http://cfcenter.stanford.edu/education/Bronchoscopy.html&usg=__OMjVwLT6zv3zITdo-8YEtq_yvhw=&h=254&w=290&sz=11&hl=en&start=0&zoom=1&tbnid=szwtXUpjS_2e_M:&tbnh=131&tbnw=150&ei=1SSFTZnWB4eisQOpkYD5AQ&prev=/images%3Fq%3Dbronchoscope%26hl%3Den%26sa%3DG%26biw%3D1276%26bih%3D493%26gbv%3D2%26tbs%3Disch:1&itbs=1&iact=rc&dur=197&oei=1SSFTZnWB4eisQOpkYD5AQ&page=1&ndsp=13&ved=1t:429,r:2,s:0&tx=67&ty=87

http://www.google.com/imgres?imgurl=http://www.obex.co.nz/Shared/Products/Images/Thumbnails/Direct%2520Drive%2520Graspers.jpg&imgrefurl=http://www.obex.co.nz/ViewSubcategory.aspx%3Fid%3D76&usg=__9S19oqbcrQaCcBgJPKFLkmhCCuE=&h=142&w=142&sz=5&hl=en&start=0&zoom=1&tbnid=bCEZtZ-

E3iw1PM:&tbnh=102&tbnw=99&ei=YCWFTeraI4SgsQOmy92JAg&prev=/images%3Fq%3Dpeanut%2Bgrasper%26hl%3Den%26biw%3D1276%26bih%3D493%26gbv%3D2%26tbs%3Disch:1&itbs=1&iact=rc&dur=426&oei=YCWFTeraI4SgsQOmy92JAg&page=1&ndsp=24&ved=1t:429,r:8,s:0&tx=66&ty=24


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Epidemiology

y In 2000, FBA caused 17,000 ED visit in kids 50% mortality rate

y In the US, 3700 fatal episodes in 2007

y 5th most common cause of unintentional-injurymortality and the most common cause ofunintentional-injury mortality in kids


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What do kids swallowy Food items in infants and toddlers

y Non food items in older kids

y Peanuts: 36-55%

y Other nuts

y Seeds (watermelon seeds in the Middle East)

y Popcorn

y Food particles

y Hardware

y Pieces of toys: balloons most common object in

fatal FBAs, balls, marbles, etc

y Most dangerous:y Round: complete obstruction and asphyxiation

y Failure to break apart easily

y Compressibility

y

Smooth, slippery surface

FIGURE 2. A. Frontal radiograph of a 2-year-old boywho experienced a sudden onset of coughing. Airtrapping in the right hemithorax is evident, withshift of the mediastinum to he left. B. Rigidbronchoscopy under general anesthesia revealed a

peanut lodged in the right mainstem bronchus,which was removed successfully with a peanut

grasper.

http://pedsinreview.aappublications.org/cgi/reprint/21/3/86


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Where do FBAs go

y Bronchi

y 1160 suspected FBA in kids,FB was removed in 1068 kidsy Larynx: 3 percent

y Trachea/carina: 13 percent

y Right lung: 60 percent (52percent in the main bronchus,6 percent in the lower lobebronchus, and


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Presentation

y Choking: sensitivity of 76- 92% for diagnosis FBA

y Depends on locationy Laryngotracheal: acute resp distress, stridor,

hoarseness, increased resp effort, obstructiony Lower airway: little distress after initial choking

Bronchial: coughing, wheezing, hemopytisis, dyspnea,choking, SOB, resp distress, decreased breath sounds,fever, cyanosis

y Laryngeal FBs, or large penetrating FBs with sharpedges may cause symptoms related to theesophagus.


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Diagnosis/Treatment

yX-ray:

y radio opaque 3-10% of the time

y normal 10-30%

Retrospective series 1068 FBA: nml xray 2/3

y hyperinflated lung, atelectasis 18%, mediastinal shift55%, and pneumonia 26%

y sensitivity 68-76%

y specificity 45-67 %

y Expiratory X-ray or fluoroscopy


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Legislation

y 1927 Federal Caustic Act

y Federal Hazardous Substances Act 1979

y Small Parts Test Fixture, a cylinder with a diameter of

3.17 cm and a depth between 2.54 and 5.71 cm

y Labeling, 1995: balls with diameters


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Resources

y Holroyd, J. Foreign body aspiration: potential cause ofcoughing and wheezing. Pediatr. Rev. 1988;10;59-63.

y Louie, M and Bradin, S. Foreign body ingestion andaspiration. Pediatrics in Review Vol.30 No.8 August2009: 295-301.

y Rovin, J and Rodger, B. Pediatric foreign bodyaspiration. Pediatr, Rev. 2000;21;86-90.

y Ruiz, F. Airway foreign bodies in children. Up-to-date.

Sept 2010.

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