Foreign body aspiration occurs when an object lodges within the airway of a patient thereby causing a complete or partial obstruction of the airway. The foreign body can lodge at any level of the airway and this depends on the size of the object and the age of the patient. This life threatening condition can occur during meals, during dental procedures where the tooth can be aspirated, psychiatric patients and children less than 3 years of age are at a high risk because they put anything they see into their mouth.
Large objects can completely obstruct the airway at the level of the trachea causing immediate asphyxia and death. Objects smaller enough may be trapped within the left or right main bronchus (the incidence is higher for the right main bronchus because it is wider and more vertically placed when compared to the left main bronchus). This may not produce any obvious symptom but it can cause the collapse of the lungs on the affected side, risk of infection and bleeding from injury to the wall of the airway.
Symptoms of foreign body aspiration and obstruction
This is an emergency and most adult patients can identify the offending foreign body. Symptoms will include:
- Excessive cough with the aim of expelling the foreign body
- Difficulty in breathing
- Chest pain
- Most patients will turn blue and dusky (cyanosis) caused by the accumulation of deoxygenated air (carbon dioxide) in the body
- Inability to speak
- Wheezing and sneezing
- Loss of consciousness from hypoxia (low oxygen concentration) affecting the brain
- Death if prompt treatment is not given
Factors increasing the risk of foreign body aspiration
- Infants and toddlers tend to put anything they find into their mouth which may include nuts, candies, coins and stones and they also have an immature coughing reflex
- Mental retardation and other psychiatric condition
- Loss of consciousness
- Alcohol intoxication
Foreign Body Aspiration First Aid Treatment
The patient should be removed from any source of danger and if unconscious, the patient should be place on the ground lying on the back. DO NOT perform a blind finger sweep as studies have shown that doing so may further push the object into the airway. It is advisable to remove only visible foreign objects.
Performing the Heimlich maneuvers
- This is a life saving maneuver which can be perform with the patient lying down, standing or in a sitting position. This aims at the sudden elevation of the diaphragm thus forcing air out of the lungs which dislodges the foreign object.
- You will have to stands behind the patient, wrap both hands around the patient and place the thumb side of your fist against the victim’s abdomen midline just above the level of the umbilicus and well below the xiphoid process (a body landmark just below the breast bone)
- Make a quick upward thrust after holding the fist with the other hand
- This should be repeated several times until the object is dislodged or until the arrival of the paramedics
- For patients who are unconscious, you will have to sit astride of the patient. Place the heel of one hand at a point below the xiphoid process and above the navel and apply an upward thrust
- In infants and toddlers, you will place the child head down lying on your hand and you will deliver five blows to the area between the back bones. Then turn the child to lie with the back on your arm then apply five thrust. This sequence should be continued until the object is dislodge or until when expert care arrives
Most patients recover fully once the foreign body is dislodged but if after dislodging the foreign body and the patients is still unconscious then basic cardiopulmonary resuscitation should be carried out to secure the airway and to establish breathing. Get a nearby person to call 911 for expert care. It is advisable that patients especially children after recovering from acute choking episodes from foreign body obstruction be examined by a physician to exclude possible lung injury.