Inhalation of a foreign body into the larynx and respiratory tract.
Symptoms include sudden onset of respiratory distress associated with coughing, gagging, or stridor. Unilateral wheezing suggests partial obstruction of the main or distal bronchi.
Major causes of foreign body aspiration are altered mental status from alcohol or sedative use; seizure; neurological disorders; trauma associated with a decreased level of consciousness; dental procedures; advanced or young age; disorders associated with dysphagia and impaired cough reflex.
Flexible bronchoscopy confirms suspected cases of foreign body aspiration and can be used to attempt removal of the foreign body. Rigid bronchoscopy is performed if flexible bronchoscopy fails.
Foreign body aspiration is the inhalation of a foreign body into the larynx and respiratory tract.
History and exam
Key diagnostic factors
- presence of risk factors
- choking crisis
- unilateral decreased breath sounds
- unilateral wheezing
Other diagnostic factors
- intractable cough
- bilateral wheezing
- decreased level of consciousness (Glasgow coma score <9)
- age <4 years
- age >70 years
- bulbar dysfunction
- male sex
- cerebrovascular disease
1st investigations to order
- chest x-ray
Investigations to consider
- CT chest
- Asthma exacerbation
- Cystic fibrosis with exacerbation
- Acute COPD exacerbation
- European Resuscitation Council guidelines 2021: Executive summary
- Flexible airway endoscopy in children
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