Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Foreign Body Aspiration

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In one line

·An object is stuck in your airway, blocking the path air normally takes to reach your lungs.

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Normal physiology

·Your airway is a clear, open tube that carries air from your nose and mouth down into your lungs. It is guarded by reflexes that snap the epiglottis shut during swallowing and trigger a powerful cough if anything tries to enter the windpipe. Keep this picture in your head, because all the symptoms make sense only as a change from this normal flow.

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What goes wrong

·An object slips past the epiglottis and larynx reflexes and gets stuck in the airway, blocking the path air normally takes. That one break upstream explains every symptom you see.

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Hallmark signs

·Sudden coughing or gagging that starts while eating or playing
·Wheezing (a high-pitched whistling sound when you breathe)
·A high-pitched noise on breathing in (Stridor) (a harsh, crowing sound when you breathe in)
·Trouble breathing or breathing faster than normal
·Someone saw the person choke or put something in their mouth just before symptoms started
·Drooling or refusing to swallow
·Blue lips or skin (cyanosis)
·Decreased or absent breath sounds on one side of the chest

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Red flags · escalate now

·A high-pitched noise on breathing in (Stridor) (harsh crowing noise when breathing in)—means the object is high in the airway and may fully block it any second
·Severe trouble breathing, blue lips or skin, or can't speak—the airway is nearly or completely blocked and the person is not getting enough oxygen
·Sudden silence after choking (no crying, no coughing)—may mean complete blockage; the person cannot move any air at all
·Fever, thick yellow or green mucus, or worsening cough days after the choking—may mean infection (pneumonia or abscess) has started in the blocked lung

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Workup

·Pulse oximetry (oxygen saturation)
·Chest X-ray (inspiratory and expiratory views)
·Chest CT scan (computed tomography)
·Direct laryngoscopy or rigid bronchoscopy
·Arterial blood gas (ABG) if the child is in severe respiratory distress
·Complete blood count (CBC) if there are signs of infection

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Treatment

·Heimlich maneuver (abdominal thrusts) for children and adults, or back blows and chest thrusts for infants under 1 year
·Do NOT interfere if the person is coughing forcefully and air is still moving in and out
·Rigid bronchoscopy under general anesthesia to visualize and remove the object
·Supplemental oxygen by nasal cannula or face mask during and after the event
·Antibiotics (such as amoxicillin-clavulanate, ceftriaxone, or clindamycin) if pneumonia or lung abscess develops
·Corticosteroids (such as dexamethasone) if there is severe airway swelling after removal

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NCLEX trap

·A wheeze on only one side or a high-pitched noise on breathing in (stridor) (a high squeaky noise) that starts right after sudden choking means something is stuck in the airway, not asthma. Inhalers do not remove a stuck object—they just open the breathing tubes a little. You need bronchoscopy (a tiny camera and tool sent down the airway) to pull the object out.
·If the person is coughing and you can hear or see air moving in and out, let them cough. Their own cough is the best way to push the object up. The Heimlich is only for total blockage—when no air is moving at all and the person cannot make any sound. Pushing too early can shove the object deeper or break it into pieces that spread into both lungs.
·Foreign body aspiration is an emergency. Get a chest X-ray and call the surgery team for bronchoscopy right now. The object will not come out on its own, and the swelling around it can suddenly close off the airway completely.
·Ask: did the child choke and cough right away? If yes, the object went down the windpipe (trachea), not the food pipe (esophagus). A chest X-ray will show where it is. If the object blocks light on the X-ray (radiopaque), you will see it. If it does not (radiolucent, like a peanut or plastic toy), you may only see trapped air on one side.
·The cough in foreign body aspiration is from the object irritating the airway lining, not from infection. Remove the object first. Give antibiotics only if pneumonia develops after removal—signs are fever, a new cloudy spot on the chest X-ray, and continued cough or fast breathing.
·A blind finger sweep can push the object deeper or make it wedge tighter in the airway. You cannot see what you are doing. Only do a finger sweep if you can actually see the object sitting right at the opening of the mouth and you can grab it easily. Otherwise, get the person to the operating room for controlled removal under direct vision with bronchoscopy.

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