Foreign Body Aspiration is a potentially life-threatening emergency that remains one of the major causes of death in children, especially those between the age of 1 to 3 years. Unfortunately, that’s true not only in the U.S. but also worldwide.
The emergency occurs when a foreign body gets lodged in the upper or lower airway, leading to partial or complete airway obstruction. The event might lead to breathing problems, cyanosis, and suffocation. It is often managed through first-aid drills operations like CPR and sometimes emergency airway removal procedures.
This article will discuss everything about foreign body aspiration or foreign body inhalation, from its signs and symptoms to treatment. Then, stick around for more info!
What Is Foreign Body Aspiration?
Foreign body aspiration, also referred to as pulmonary aspiration, happens when a foreign body, like raisin or coins, gets inhaled accidentally into an individual’s airways. It leads to the partial or complete obstruction or blockage of a specific area along the respiratory tract, including:
· The larynx: Also known as the voice box, the larynx is the region between the pharynx and trachea.
· The trachea: It’s a long tube that connects the larynx to the bronchi.
· The bronchi: These are two large passageways that carry air from your trachea to the lungs.
Regardless of the type of foreign object, any aspiration can prove life-threatening and requires timely recognition and management to reduce complications. Unfortunately, children often fall victim to foreign body aspiration, although it can happen to adults too.
The lodged object can cause respiratory distress, cyanosis, suffocation, and sometimes death. As a fact, in 2018, 2,700 deaths resulted from foreign body aspiration.
Signs and Symptoms
The signs and symptoms of foreign body obstruction depend on three major factors:
· The site of obstructions: 80% of the objects get lodged in the main and intermediate bronchi (lower airway). 20% become lodged in the larynx or trachea (upper airway), and the obstruction is usually severe.
· Size of the foreign object: Big or small, hard or soft, blunt or sharp
· Time passed since inhalation occurred within the last few minutes or past few days or weeks.
The signs and symptoms of affected individuals occur immediately and often include:
· Choking
· Recurrent Coughing
· Wheezing
· Abnormal breathing sounds
· Speaking difficulties
· Drooling
· Bluish tinge to the skin or cyanosis
Sometimes the symptoms can take time to occur, particularly if the foreign object partially blocks the airway. But if it causes complete obstruction, these symptoms will occur in quick succession. If the object does not get dislodged immediately, the individual will lose consciousness and eventually die.
If an individual is choking but can still breathe and talk, this shows a mild obstruction. If he continues coughing, chances are he might dislodge the object. But if the person is wheezing after accidentally inhaling an object. It’s a sign that the foreign body has lodged in the upper airway. The individual requires immediate medical help.
If a mild obstruction is left untreated, it can cause obstructive pneumonia or even lung abscess. In addition, the signs and symptoms of mild foreign body aspiration can mimic those of asthma, lung cancer, COPD, especially in adults.
Causes
Children tend to put small objects in their noses and mouth. If they accidentally inhale the foreign object, it can block their airways.
Most common aspirated objects include edibles like nuts, popcorn kernels, raisins, sweets, beans, berries, grapes, etc. Besides blocking airflow, edibles like beans and corns can absorb water and swell up, increasing the severity of obstruction.
Children can also aspirate liquids like water or soda into the airways. Other non-edible objects that can get aspirated include:
· Latex balloons: They usually conform to the shape of the trachea, obstructing airways when inhaled. Latex balloons account for 29% of aspiration deaths in kids.
· Coins
· Dental appliances like retainers, fillings, crowns, and so on
· Pins
· Small toys like marbles
Luckily, some items like ball pen caps have tiny holes. This comes in handy, especially when children inhale them by accident. The hole allows air passage, reducing the chances of suffocation.
Foreign body aspiration also occurs among adults. In addition, it is common in individuals with health conditions that damage their swallow mechanisms, such as neurological disorders. Alcohol use and age can also contribute to impaired swallowing.
Diagnosis
Immediate diagnosis is vital in foreign body aspiration. That’s because the more the object stays lodged inside the airways, it increases the risk of suffocation and even death.
If the signs and symptoms show severe airway obstructions, the doctor will immediately begin treatment to dislodge and remove the foreign object. However, if the affected individual shows symptoms of mild obstruction, a physician might have to conduct some exams and tests, including:
Physical Examination
The examination will involve checking the breathing function of the patient, plus speech and voice function. The doctor might check the affected person’s pulse, blood pressure, temperature, and blood oxygen levels.
Imaging Tests
The doctor might suggest imaging tests to get a better internal view of the body to determine if an object is lodged in the airways. Such tests include Chest X-rays and CT scans for more explicit images.
Bronchoscopy and Micro-laryngoscopy
Sometimes the X-ray films might fail to capture food, vegetable matter, or plastic object obstructing the airways. A doctor might have to conduct a bronchoscopy and micro-laryngoscopy exam if this happens. These exams provide them with a detailed view of the voice box, trachea, and bronchi.
Usually, the specialist installs a bronchoscope, a long, thin tube with a light source and camera through the mouth for an up-close view. Besides diagnosis, a bronchoscope can help in physically removing the object.
Treatment
Foreign body aspiration treatment often involves managing the affected person’s ability to breathe until the removal of the object. The first step of treatment is emergency first aid maneuvers that encourage an individual to keep coughing to clear the blockage.
If coughing doesn’t work, ask the patient to lean forward and deliver five sharp blows to the area between the shoulders using the heel of your hand. Do this while supporting the individual chest with your other hand.
A different approach is using the Heimlich maneuver, which includes delivering five abdominal thrusts. First, you will need to stand behind the person and wrap both your arms around his or her waist. Next, clasp a fist in one hand and cover it using your other hand. From there, position your hands above their navel and pull inwards and upwards as sharp as possible.
If these methods fail, an emergency medical treatment like endotracheal intubation might come in handy. Here, a medical specialist will pass an endotracheal tube through the affected person’s mouth into the airways. The tube will open the airways, allowing oxygen flow. It can also help in removing the obstruction.
In other cases, a doctor might consider an emergency tracheotomy. Here, the physician creates a tiny opening at the front of the neck and inserts a tube inside the opening, allowing the patient to breathe. However, this procedure is usually rare.
Bronchoscopy treatment helps mostly with the treatment of mild foreign body aspiration. First, an anesthesiologist will place the kid or adult into a deep sleep. The doctor then inserts a bronchoscope inside the airways to locate the obstruction. The specialist inserts optical forceps into the airway to remove the object when found.
Final Thoughts
While foreign body aspiration can occur in adults, it’s most common in kids under three years. Therefore, it’s wise to keep small items like coins, marbles, beans, and others from children. Also, teach your kid not to eat foreign objects to reduce the risk of foreign body aspiration. In case your kid inhales a foreign object, seek medical help immediately.
