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CHOKING-1.pptx
- 1. APPROACH TO CHOKING CHILD/ADULT DR. BERTHA VOLEMATOME GIBIL PEDIATRIC SPECIALIST
- 2. Outline Objectives Introduction Risk factors Pathophysiology Clinical features Management Prevention Conclusion
- 3. Objectives To recognize a choking child Identify risk factors Emergency management of choking child
- 4. Introduction Leading cause of morbidity and mortality in children <4yrs Common objects Food items eg. Nuts , seeds (59.5%-81% of cases of choking) Inorganic objects eg coins, button batteries, toys,pins Round object are esp hazardous(ability to occlude airway) 1.7times commoner in males than females
- 5. Why children are prone to FB aspiration Curious and explore Distracted whiles eating Improper mastication Underdeveloped swallowing, fuction of larynx not fully developed Smaller airway diameter Ineffective cough
- 6. Risk factors Developmental delays/disorders with neurological/muscular problem Older children with psychiatric disorders Post natal period Prematurity Tracheo-esophageal fistula Improper feeding practices
- 7. Pathophysiology FB end up on either right or left bronchus in children <15yrs Right bronchus steeper making it easy to lodge on the right (>15yrs) Migration and position change Fragmentation of FB Unsuccessful attempts with removal Hydroscopic FB may absorb water Inflammation and edema
- 8. Clinical features Asymptomatic to severe respiratory distress =>complete airway obstruction =>asphyxia => death 3 stages of symptom progression Initial events ; paroxysms of cough, chocking gagging Asymptomatic interval; FB becomes lodged, reflex fatique+ irritating symptoms subside Complication ; erosion, infections, pneumonia, atelectasis
- 9. Emergency management In responsive patient Assess airway Assess breathing adequacy 5 back blows 5 chest thrust Reassess
- 10. Emergency management in child/adult Assess airway Assess breathing adequacy 5 Abdominal thrust 5 Back blows Reassess
- 11. Emergency management in uncoscious victim Check mouth Open airway 5 rescue breaths 5 Chest thrust 5 Back blows If no response start BLS algorithm
- 12. COMPLICATIONS OF LONG STANDING FB Ulceration Tracheoseophageal fistula Mediastinits Erosion into a major vessel (aortoenteric fistula) stricture
- 13. PREVENTIVE MEASURES Discourage Speaking whilst eating Nuts should be slowly introduced to the diets of children after age 3 Implicated objects should be used only under adult supervision Keep disc bateries away from the reach of children Education of caregivers about providing foods of appropriate size and texture Train caregivers in the methods of clearing the airway ie, Heimlich manuevre, finger sweep
- 14. CONCLUSION Those in nyouger age groups more at risk Coins most common ingested FB Smaller size objects occur in the much younger age grps and lodge more distally Caregiver education on preventive measures and prompt reporting to hospital in event of FB ingestion / aspiration Peripheral facilities to promptly refer for FB removal to avert some of the complications
- 15. THANK YOU
- 16. REFERENCES Theophilus Adjeso, Michael Chanalu Damah, James Patrick Murphy, Theophilus Teddy Kojo Anyomih, "Foreign Body Aspiration in Northern Ghana: A Review of Pediatric Patients", International Journal of Otolaryngology, vol. 2017, Article ID 1478795, 4pages, 2017. https://doi.org/10.1155/2017/1478795 Majola NF, Kong VY, Mangray H, Govindasamy V, Laing GL, Clarke DL. An audit of ingested and aspirated foreign bodies in children at a university hospital in South Africa: The Pietermaritzburg experience. S Afr Med J. 2018;108:205–209. [PubMed] [Google Scholar] Shirkosh S, Nakhjavani N, Esmaeili Dooki MR, et al. Foreign body ingestion and aspiration at a Pediatric Center in northern Iran. Caspian J Pediatr March 2020; 6(1): 399-406. Kliegman, R. Nelson Textbook of Pediatrics 21st edition. Philadelphia, Elsevier, 2020; 2211 -2212, 1942 – 1943, 2183 Azubuike, J. Paediatrics and Child Health in a Tropical Region 3rd edition. Lagos, Educational Printing and Publishing, 2016; 1495 - 1497