Inhaled Foreign Body

• Prevention of inhaled foreign bodies:

  • Use rubber dam, mouth sponges, and instrument chains
  • Ensure that the foreign body has actually been inhaled
• General signs of choking:

  • Attack occurs while eating/misplaced dental instrument/restoration
  • Victim may clutch their neck
• Signs of mild airway obstruction:

  • Response to question "are you choking?"
  • Victim is able to speak, cough and breathe
  • If pt can speak, cough, and breathe -> encourage cough
• Signs of severe airway obstruction:

  • Cannot speak
  • Unable to breathe
  • Breathing sounds wheezy
  • Attempts at coughing are silent
  • Victim may be unconscious
• If CPR needed: seal mouth and nose (mask) and attempt ventilation.

  
• Choking for infants (less than 1 year):

  • A finger sweep should not be performed (risk of pushing foreign body further back) - only in adult if can see
  • Five back blows
• Inhaled foreign body:

  • If a foreign body is in the lung or some part of the airway, it must be removed
  • A bronchoscopy is carried out
  • Fine instruments with small forceps at the end may retrieve the object
  • Rarely, open surgery may be required
• What happens if no ventilation possible in acute situation? (rare):

  • Consideration should be given to a needle cricothyroidotomy if appropriately trained
  • Must in the 'dental' situation continue 'compression only' CPR
• Needle cricothyroidotomy:

  • Pt supine with neck extended
  • Large bore needle needed
  • Neck swabbed
  • Palpate cricothyroid membrane anteriorly between cricoid cartilage & thyroid cartilage
  • Stabilise trachea with thumb & forefinger
  • Puncture skin in midline over cricothyroid membrane - small incision helps
  • Direct needle 45 degrees caudally, applying -ve pressure to syringe
  • Insert needle, aspirate as needle advances
  • Aspiration of air signifies entry into trachea
  • Remove syringe, withdraw stylet & advance catheter - beware of puncturing posterior wall of trachea
  • High flow oxygen is attached
• Problems with cricothyroidotomy:

  • Inadequate ventilation leading to hypoxia and death - in best scenario, only good for 30-45 mins
  • Aspiration (blood)
  • Oesophageal laceration
  • Haematoma
  • Posterior tracheal wall perforation
  • Subcutaneous and/or mediastinal perforation
  • Thyroid perforation
• Tracheostomy is an elective/semi-elective procedure which should be carried out in operating theatre.

  
• Conclusions:

  • If inhalation is suspected, prompt treatment must be instituted
  • Any foreign body must be accounted for, if not the foreign body must be considered to be inhaled until proved otherwise
  • Chest radiography is mandatory
  • The situation can (should) usually be prevented