Airway Foreign Bodies

Excerpt

The presentation of foreign body aspiration in the emergency department varies greatly and can suffer from incorrect or delayed diagnosis. Factors affecting the acuity of the problem include the object that is aspirated, the location of the aspirated object, whether the event was witnessed, the age of the patient, as well as the timeframe in which aspiration occurred. Acute upper airway compromise may present with classic symptoms of choking including and significant respiratory distress, while a more distal obstruction may present with chronic mild wheezing, cough, a complaint of discomfort, or general shortness of breath, and may mimic asthma or other less acute respiratory illnesses.

Foreign body aspiration is the fourth leading cause of death in preschool and younger age children. It accounts for a significant number of emergency department visits in the United States. As such, it is a leading concern for both prevention and public health as well as critical recognition and treatment. The Consumer Product Safety Commission placed restrictions on items that may confer a choking hazard, and in 1973, federal regulation 15 CFR 1501 introduced the Small Parts Test Fixture which provides measurements for toys designed for children three years and younger.

Although several federal guidelines have been implemented to reduce choking in young children, including package labeling with warnings for small parts and warnings on television and internet advertisements to inform the public of the choking hazards of toys. In the United States, no regulations exist on food items with a potential risk for choking, though many aspirations are organic food material. Peanuts, seeds, and fruits with round shapes are the most often aspirated food in children, while hotdogs and candy account for a majority of deaths from choking. Public education of parents, babysitters, teachers, and caregivers remains an essential factor in preventing airway foreign body aspiration. New onset wheezing, coughing, drooling, voice changes, or posturing should alert practitioners and parents to the possibility of foreign body aspiration, even if the event itself was unwitnessed.