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Foreign body obstruction

Foreign bodies
Types- inorganic or organic. Inorganic materials -plastic or metal eg; beads and small parts from toys. Organic foreign bodies, including food, rubber, wood, and sponge, - more irritating to the nasal mucosa and thus may produce earlier symptoms.

Etiology:
They lack molars for proper grinding of food. They tend to be running or playing at the time of aspiration. They tend to put objects in their mouth more frequently. They lack coordination of swallowing and glottis closure. Curiosity, boredom

Dignosis
History ABG analysis Chest radiography CT scanning Fluoroscopy Barium or Gastrografin swallow

Foreign bodies in the ear:

Clinical features
May be asymptomatic Some may cause pain in the ear, redness, or drainage. Hearing may be affected if the object is blocking the ear canal.

Treatment:
Emergency department care Patients in extreme distress secondary to an insect in the ear require prompt attention. The insect should be killed prior to removal, using mineral oil or lidocaine (2%).

Treatment:
Methods of removal
Irrigation tympanic membrane intact Irrigation with water is contraindicated - soft objects, organic matter, or seeds Suction Suction the ear with a small catheter held in contact with the object. Avoid any interventions that push the object in deeper.

Nasal foreign bodies (NFBs)

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Pathophysiology
Damage to the nasal cavity and surrounding structures. They can produce local inflammation, which may result in a pressure necrosis. Mucosal ulceration and erosion into blood vessels producing epistaxis. Obstruction to sinus drainage Secondary sinusitis. Firmly impacted and unrecognized foreign bodies can in time become coated with calcium, magnesium, phosphate, or carbonate and become a rhinolith.

Clinical features:
Unilateral nasal discharge. Nasal irritation, epistaxis, sneezing, snoring, sinusitis, stridor, wheezing, or fever. Unusual patient presentations, such as irritability, halitosis, or generalized bromhidrosis (body malodor).

The physical examination otorhinolaryngologic examination. Sedation is often helpful in the pediatric population. positioning children younger than 5 years in a supine lying position and older children in a sitting "sniffing" position to allow optimal visualization. A nasal speculum may also help to view the nasal cavity.

Planning/Pretreatment
Careful planning Necessary instruments at the bedside Emergency airway supplies - readily available foreign body results in aspiration. Pharmacological vasoconstriction of the nasal mucosa can facilitate both examination and removal of a NFB. - 1% lidocaine

Specific Removal Techniques

For easily visualized nonspherical and nonfriable objects, - direct instrumentation. If the object is poorly visualized, spherical, or unsuccessfully removed by direct instrumentation, balloon-catheter removal is a preferred method.

Hemostats

alligator forceps,

bayonet forceps

hooked probes

Direct instrumentation

Direct instrumentation
Balloon catheters Foley catheters (ie, 5, 6, or 8) and the Katz Extractor oto-rhino foreign body remover. Positive pressure Large and occlusive foreign bodies "forced exhalation," "parent's kiss"

Balloon catheters

Direct instrumentation
Suction This technique is ideal for easily visualized smooth or spherical foreign bodies. The catheter tip is placed against the object, and suction is turned on to 100-140 mm Hg (readily supplied by standard medical suction equipment). Irrigation

Journal review
Magnet A case report demonstrated successful removal of a loose ball bearing from a nasal cavity using a household magnet

Foreign body airway obstruction

Site of Lodging of Foreign Body Right Main Bronchus

The diameter of the right main bronchus is larger than the left, The angle of divergence from the tracheal axis is smaller on the right, Airflow through the right lung is greater than through the left, The carina is more likely to be located to the left of midline rather than to the right.

Ref: Shivakumar AM, Naik AS, Shetty KD, Praveen DS. Indian J Pediatr.

Foreign Body Aspiration

Complete airway obstruction
Respiratory distress Inability to speak or cough

Partial airway obstruction

Coughing Gagging Throat clearing Back blows/probing hypopharynx not recommended

Foreign Body Aspiration

Treatment Goal
Prompt endoscopic removal under conditions of maximal safety and minimal trauma

Management
Complete airway obstruction
< one year
Back blows

> one year

Gentle abdominal thrusts while supine

Older children/adults
Heimlich maneuver

Foreign Body Aspiration

Treatment

Infants under 1 year of age: A combination of 5 back blows (with the flat of the hand) and 5 abdominal thrusts (with 2 fingers on the upper abdomen).

Finger sweep

Bronchoscopic removal

Bronchoscopy . Secretions proximal to peanut in left main stem bronchus

Complication
respiratory distress, asphyxia, cardiac arrest, fever, laryngeal edema, pneumothorax, hemoptysis, pneumonia, bronchiectasis, and bronchial stricture surgical emphysema*

Complication

Normal

Shift of mediastinum and flattening of the hemidiaphragm are signs secondary to air trapping.

Esophageal foreign body

Foreign Bodies

Foreign body ingestion Foreign body aspiration Toddlers

Oral exploration Lack posterior dentition Easy distractibility Cognitive development (edible?)

Foreign Body Ingestion

Parental suspicion Symptoms

Choking, coughing, dysphagia, odynophagia Drooling, refuses p.o., fussy child

Physical exam

Respiratory compromise

Diagnosis

Radiopaque

Coins Cartilage/bones Hot dogs

Radiolucent

Barium swallow

Management

Removal

General anesthesia Intubated Esophagoscopy Examine for ulceration/perforation

Smooth-muscle relaxation agents may be used to relax the LES

Foreign Body Ingestion

Balloon Catheter Extraction

Effective in 90% Endoscopy for failures Complications

Emesis Epistaxis Tracheal placement Laryngospasm Airway compromise

Complications
Entrapment of object within a Meckel's diverticulum Perforation leading to peritonitis and advanced sepsis Metal poisoning (coins)

Nursing management

BIBLIOGRAPHY: Wong D.L etal . Essentials Of Paediatric Nursing. 6th edition. Missouri: Mosby;2001 Marlow D.R. Redding B. Textbook of Paediatric nursing. 1st edition.Singapore: Harwourt Brace & company; 1998 Judith S.A. Straight As in Pediatric Nursing. 2nd edition.Lippincott Williams and Wilkins:Philadelphia; 2008 Parthasarathy IAP textbook of Paediatrics. 2nd edition. jaypee: NewDelhi; 2002 Hatfield N.T. Broadribbs introductory Paediatric nursing. 7th edition. Wolters Kluwer: New Delhi; 2009
http://emedicine.medscape.com/article/763767-overview http://www.amazon.com/Delmars-Textbook-Basic-PediatricNursing/dp/0827377177 http://emedicine.medscape.com/article/776566-treatment

Thank Q