Foreign Body Obstruction

Question 1

What are high risk objects to ingest?

Answer 1

• Button batteries: immediate removal in oesophagus, benign once in stomach
• Magnets (>1 or 1 + metal object)
○ The attractive force between them can cause local damage
• Lead objects: if they fail to transit through the stomach, can cause acute systemic lead absorption

Question 2

What are medium risk objects to ingest?

Answer 2

• > 6cm long

- >2.5cm diameter

Question 3

Clinical features of foreign body obstruction

Answer 3

• Trouble swallowing food
• Drooling
• Pain in the chest or neck
• Sx/signs of respiratory distress: coughing, trouble breathing, or noisy breathing
• Ongoing vomiting/abdo pain
• Haematemesis or melaena
• Fever

Question 4

Are these radio-opaque or radiolucent:

• Glass
• Metallic objects (except aluminium)
• Plastic
• Most animal bones (except some fish bones)
• Most Fishbones
• Wood

Answer 4

Radioopaque:

• Metallic objects (except aluminium)
• Most animal bones (except some fish bones)
• Glass

Radiolucent:

• Plastic
• Wood
• Glass
• Most Fishbones

Question 5

What do you do if something has been ingested and is at:

• upper oesophagus
• lower oesophagus

Answer 5

• Upper oesophagus: immediately remove button batteries, and refer
• Lower oesophagus: observe and trial dislodgement with fizzy cola, if it fails refer

Question 6

What is the mx of magnets?

Answer 6

• Endoscopic removal if stomach or above

Question 7

What is the mx of a totally obstructed inhaled FO above main bronchus?

Answer 7

1. Open airway and check in mouth under direct vision
   a. If present, remove with magills forceps
   b. If not, 2.
2. Place child prone with the head down and apply 5 blows with the open hand to the interscapular area.
3. Turn child face up and apply 5 chest thrusts using the same technique as for chest compression during CPR.
4. Check in the mouth to see if foreign body has appeared, and remove if possible.
5. If the obstruction is not relieved, continue with alternating back blows and chest thrusts.

Question 8

What may be some clinical features of an inhaled FO below the main bronchus?

Answer 8

• Asymmetrical chest signs
• Tracheal deviation
• Wheeze
• Decreased breath sounds
• Sx: persistent wheeze, cough, fever, dyspnoea

Question 9

What may be some features of an inhaled FO below the main bronchus on CXR?

Answer 9

• an opaque foreign body
• segmental or lobar collapse
• localised emphysema in expiration (ball valve obstruction)

Question 10

Which bronchus is an inhaled FO more like to go down, and why?

Answer 10

Right main bronchus - shorter, wider, more vertical