FOREIGN BODIES IN TRACHEA AND BRONCHI

Site of lodgement depends on size and nature of foreign body

A larger one will lodge in the supraglottic area while
smaller one can pass through the larynx to treat and bronchi but foreign
bodies with sharp points such as pins, needles, fish bones etc. can lodge
anywhere
in children younger than 15 years; mainly 1-4
Vegetable matter tends to be the most common; peanuts are the most
common food item aspirated. Also, almond seed, peas, beans , wheat seet , seets
pieces of carrot apples etc
Non vegetable plastic whistle, toys, safety pins, nails, wires etc.
In adults this mainly occurs during coma, deep sleep or intoxication e.g. loose
teeth/ denture
Most foreign bodies get lodged in bronchi 80 %

Nature of object

Non-irritating

Plastic, glass, metallic foreign bodies and can thus remain symptomsless

Irritating

Vegetable causing severe congestion, odema called vegetal bronchitis

Which then causes airway obstruction and later suppuration in lung

Initial phase marked by reflex mechanism such as gagging and coughing

Asymptomatic phase the object is lodged and symptoms are milder or

may decrease significantly

Complication phase/symptomatic phase

Laryngeal : total obstruction may cause to sudden death and would need
resuscitate measures if it is partial pain, horseness, , croupy coughing,
aphonia, dyspnoea , wheezing and haemoptysis

Tracheal a sharp object will cause bleeding and cough

A movable object if small can produce an audible slap as it moves between
the carina and the under surface of the vocal cords+ wheezing can also be heard
when mouth is opened

Bronchial mainly right bronchus producing atelectasis or obstructive

emphysema if it only allows air in but not out
- These emphysema bullae can then rupture causing pneumothorax
- If it is not removed , it may cause pneumonia, bronchiectasis and lung abscess

Diagnosis and treatment

Lateral views and posterior anterior can be helpful

It may show radiopaque object giving info about its size, shape and location
Lobar or segmental atelectasis ( collapse)
Unilateral hyperinflation causing mediastinal shift in the opposite due to the
emphysema mention
Pneumomediastinum and pneumothorax may occurs
Signs of pneumonia and bronchiectasis

Heimlich maneuver has improved the mortality rate if it fails than

tracheostomy
Surgical removal of the object using direct laryngoscopy

Antibiotic therapy +
anti-inflammatory drugs to treat pneumonia
Treatment of other complications such as bleeding and areas in the
surrounding that have been affected
Tracheal and bronchial Can be removed using bronchioscopy under general
aesthesia