Foreign Body in Throat information

1. Foreign Body in
Throat
Dr. Vishal Sharma

2. Aspirated (Airway)
Foreign Body

3. Clinical Staging
1. Initial phase: choking, coughing, wheezing,
gagging
2. Asymptomatic phase: due to mucosal adaptation
3. Late phase: Laryngeal / Tracheal / Bronchial
4. Complication phase: pneumonia, emphysema,
lung abscess, atelectasis

4. Late Clinical Features
a. Laryngeal: partial or total airway obstruction,
hoarseness, aphonia, hemoptysis
b. Tracheal: airway obstruction, hemoptysis,
wheezing, palpatory thud, auscultatory slap
c. Bronchial: cough, ipsilateral wheezing,
ipsilateral decreased breath sounds

5. Bypass valve & Stop valve effect
Partial Obstruction Total Obstruction
Wheezing Late Atelectasis

6. Check valve effect
No Expiration No Inspiration
Emphysema Early Atelectasis

7. Clinical Diagnosis
Conscious pt:
1. Hoarseness / aphonia
2. Respiratory distress
Unconscious pt:
1. No chest movement
2. No air exchange at nose /
mouth. 3. Cyanosis.

8. Radio-opaque F.B. larynx

9. Radio-opaque F.B. Bronchus

10. Radio-lucent F.B.
Right Lung collapse & Left emphysema

11. Management of choking in
an unconscious patient
1. Patient placed in supine position
2. Open airway + mouth to mouth ventilation
3. Correct airway obstruction

12. Opening the airway
1. Head-tilt:
Extension of neck
by backward
pressure on
forehead

13. Opening the airway
2. Head-tilt, chin-lift:
Extension of neck
by backward
pressure on
forehead + lift pt’s
chin keeping mouth
open.

14. Opening the airway
3. Head-tilt, neck-lift:
Lift pt’s neck while
pushing down on
forehead. Prevents
falling back of
tongue.

15. Opening the airway
4. Modified jaw-thrust:
For pt with neck /
spinal injuries. Push
patient’s jaw forward
by applying pressure
at angle of mandible.
Avoid head tilt.

16. Correcting airway obstruction
 Back blows
 Abdominal thrusts
 Chest thrusts (for pregnancy, age < 8 yrs)
All 3 raise subglottic pressure, to dislodge out FB
 Open pt’s mouth
 Blind finger sweeps in mouth

17. Back blows
Place pt in lateral
position, supporting pt’s
chest against your knees.
Use free hand to deliver
five rapid blows to spinal
Area b/w scapulae, to
dislodge F.B.

18. Abdominal thrusts
Straddle supine pt at his hip.
Place your hand heel b/w pt’s
umbilicus & ribcage, in midline.
 Hold that hand with your other
hand & apply 5 rapid, inward +
upward thrusts, to dislodge FB.

19. Chest thrusts
Kneel beside supine pt at
chest level. Place hand
heel on centre of pt’s
sternum.
Lock hands. Apply 5
rapid downward thrusts.
Only 2 fingers used for a
small child.

20. Opening patient’s mouth
Tongue-jaw lift technique:
 Hold pt’s tongue + lower jaw
b/w your thumb & fingers.
 Lift pt’s tongue to move it
away from pharyngeal wall.

21. Opening patient’s mouth
Crossed-finger technique:
Cross your thumb under
your index finger.
Place your thumb against
pt’s lower lip & index finger
against his upper teeth.
Uncross your fingers to
open pt’s mouth.

22. Blind finger sweeps
 Open pt’s mouth. Insert index
finger of free hand into pt’s mouth,
along pt’s cheek, till tongue base.
Use it as a hook to roll out FB.
 Avoid pushing FB further back.
Avoid blind sweeps in a child.
Attempt to remove visible FB only.

23. Correcting airway obstruction
in an unconscious pt
5 Back blows
 failure
5 Abdominal thrusts Or 5 Chest thrusts
 failure
Open pt’s mouth + blind finger sweeps.
Continue this sequence till FB is removed or pt
is ready to be shifted to operation theatre.

24. Management of choking in
a conscious pt
 If patient can speak, cough, or breathe:
Do not interfere. Patient to be examined by an
ENT specialist as soon as possible.
 If the patient cannot speak, cough, or breathe:
Begin treatment for obstructed airway.

25. Correcting airway obstruction
in a conscious pt > 1 yr old
5 Back blows
 failure
5 Abdominal thrusts (Heimlich maneuver)
Or 5 Chest thrusts (for pregnancy, age < 8 yrs)
Continue this sequence till FB is removed or pt
becomes unconscious.

26. Back blows
 Place pt in sitting / standing
position. Support pt’s chest
while bending pt at the waist.
 Use your free hand to deliver
5 rapid blows to spinal area
b/w two scapulae.

27. Heimlich Maneuver

28. Heimlich Maneuver
 Stand behind sitting / standing pt & pass
your arms around pt’s waist.
 Hold your fist against pt’s abdomen b/w
umbilicus & ribcage.
 Lock hands & apply 5 rapid, inward +
upward thrusts to dislodge FB.

29. Chest thrusts
Stand behind standing pt &
pass your arms around pt’s
chest. Hold your fist against
pt’s sternum in its centre. Lock
hands & apply 5 rapid, back-
ward thrusts to dislodge FB.

30. Correcting airway
obstruction in an infant
5 Back blows
 failure
5 Chest thrusts
Continue this sequence till FB is removed or pt
is ready to be shifted to operation theatre.

31. Back blows in an infant
 Straddle infant face down,
head lower than trunk, over
your forearm, supported on
your thigh.
 Deliver five rapid back
blows, with heel of other
hand b/w shoulder blades.

32. Chest thrusts in an infant
Supporting pt’s head, keep
infant supine b/w your
hands, with head lower
than trunk.
Using 2 fingers, deliver 5
rapid backward thrusts on
sternum.

33. Surgical Management
For life threatening stridor
 Cricothyrotomy
 Emergency Tracheostomy
For foreign body removal
 Direct Laryngoscopy
 Rigid Bronchoscopy
 Thoracotomy & Bronchotomy

34. Prevention of choking
Adults:
 Cut food into small pieces
 Chew food slowly & thoroughly
 Avoid laughing / talking during eating
 Avoid excess alcohol with / before meals
Infants & Children:
 Keep small objects away from children
 Avoid playing with food or toys in mouth

35. Swallowed
Foreign Body

36. Diagnosis
 Plain X-ray (PA & Lateral): soft tissue neck,
chest, abdomen  for radio-opaque FB
 Fluoroscopy with Barium soaked cotton pledget
 for radiolucent FB
 Barium Swallow
 Flexible Oesophagoscopy

37. Coin in cricopharynx

38. Meat bolus in Cricopharynx

39. Toe ring in cricopharynx

40. Razor blade

41. Open safety pin

42. Barium Swallow

43. Flexible Oesophagoscopy

44. Tooth brush in stomach

45. Pharyngeal FB
 Common sites: tonsil, pyriform fossa, vallecula,
base tongue
 Diagnosis confirmed by indirect laryngoscopy
 Usually removed in OPD but may require
removal by Hypo-pharyngoscopy  GA

46. Oesophageal & Gastric FB
 Common sites: cricopharynx, aortic indentation &
cardiac end
 Usually removed by rigid oesophagoscopy  GA
 Advancement into stomach is safe in difficult FB
 Oesophagotomy rarely required for impacted FB
 FB reaching stomach, usually passes out in stool
 Emetic & Cathartic agents are contraindicated

47. Indications for Immediate Intervention
 Associated respiratory obstruction
 Total oesophageal obstruction
 Disc battery (perforation occurs in 8-12 hrs)
 Sharp, impacted foreign body
 Gastro-intestinal FB > 5 cm in a child < 2 yr
 Gastro-intestinal FB with acute abdominal pain
 No progress of FB in serial X-ray after 24 hr
 Gastric FB with pyloric stenosis

48. Disc battery in stomach

49. Complications of neglected FB
1. Oesophageal ulceration & stricture
2. Oesophageal perforation  mediastinitis
3. Peri-oesophageal cellulitis
4. Retro-pharyngeal abscess
5. Respiratory obstruction due to
 tracheal compression
 laryngeal oedema

50. Retropharyngeal abscess

51. Instruments for FB removal

52. Instruments for FB removal

53. Optical Forceps

54. Net retrieval system

56. Thank You