Foreign Bodies

- Doyel Mitra
B.sc(N)
5th sem, MNI
 CONTENTS
01 INTRODUCTION

02 DEFINATION

03 EPIDEMIOLOGY

04 Foreign Body Aspiration

05 Common Aspirated Foreign Bodies

06 Risk Factors & Etiology

07 PATHOPHYSIOLOGY

08 Clinical Features

09 DIAGNOSTIC EVALUATION
 CONTENTS
10 MANAGEMENT

11 FOREIGN BODY IN EAR

12 CLINICAL FEATURES

13 Diagnostic evaluation
FOREIGN BODY IN NOSE
14
15 CLINICAL FEATURES

16 MANAGEMENT

17 Pediatric nurse's role

18 DIAGNOSTIC EVALUATION
INTRODUCTION
Children are prone to
injury from foreign
bodies because of their
curiosity and desire to
taste and manipulate
Objects and toys.
Children may either
aspirate any foreign
body or insert it into
body orifice.
 DEFINATION

What is foreign body?

• An object or piece of
extraneous matter that has
entered the body by accident
 EPIDEMIOLOGY

• Possibly 1500 to 3000 deaths per year in U.S.A

• 80 % of cases are pediatric
• < 10 % of pediatric cases have esophageal disease
• Male to female ratio in children is 2:1
• 10 to 20 % require endoscopyo1 % require surgery
 FOREIGN BODY ASPIRATION

FOREIGN BODY ASPIRATION

RESULTS IN AIRWAY
OBSTRUCTION AND HYPOXIA.
IT IS USUALLY SEEN IN
CHILDERN < 5 YEARS OF AGE.
Common Aspirated Foreign Bodies
Round
Candies

Small
Coins Buttons
Toys

Food Plastic
Jewelry Caps
Items
and Lids

Seeds
 Risk Factors & Etiology
Altered level
of
consciousness
Psychiatri Abnormal
c illness deglutition

Developmental Structural
immaturity Dental
Foreign Body Ingestions :Risk
Factors abnormalities
 PATHOPHYSIOLOGY
• Most foreign bodies become lodged in the bronchi.
• The right main bronchus is a more common site than the left
main bronchus because of its anatomic development.
• Objects lodged in the larynx cause edema and inflammation.
• Bronchial obstruction manifests as obstructive emphysema,
pneumonia or atelectasis.
 Clinical Features
Clinical manifestations may vary according
to the location and degree of obstruction.
• Immediate hoarseness
• Stridor
• Inability to speak (aphonia)
• Inflammation at the site of obstruction in trachea are:
leading todyspnea, wheezing, and cyanosis
• Coughing
• Wheezing, if there is partial
airway obstruction.
• Hoarseness and stridor may be
present.
Features of • If there is partial obstruction, the
foreign body child may be able to ventilate
well.
• In case of complete obstruction,
no air bypasses the obstruction,
so no breath sounds are heard.

Features of • Coughing
foreign body • Asthma such as wheezing
• Hoarseness Features of
in larynx are: foreign body
• Stridor
• Dyspnea in bronchi are:
• Cyanosis
 DIAGNOSTIC EVALUATION
• History collection
• Physical examination
• Laryngeal foreign bodies:
-X-ray and direct laryngoscopy reveal the foreign
body.
• Tracheal foreign bodies:
-Bronchoscopy
-Chest X-ray required to find foreign body.
 MANAGEMENT
01 Life Threatening FBA
• Complete airway obstruction:
• Dislodgement using back blows and chest
compressions in infants.
• Heimlich maneuver in older children.
• Oxygenation.
• Intubation as needed.
• Management according to APLS.

• Back blow, chest compressions, and Heimlich maneuver should be

avoided in children who are able to speak or cough since they
may convert a partial to a complete obstruction.
 MANAGEMENT
02 Suspected FBA

• If a history presents, FBA should be presumed despite a negative

CXR.
• Flexible bronchoscopy-only Dx, no Tx.
• Rigid bronchoscopy - standard of care
• Control of the airway
• Good visualization
• Manipulation of the object with a wide variety of forceps,
• Ready management of mucosal hemorrhage
• Thoracotomy-rarely indicated
 FOREIGN BODY IN EAR

Foreign bodies in the ear are very

common and easy to diagnose.
Foreign body may remain in ear for
several days before generating
enough inflammatory response to
alert parents for seeking medical
attention.

Objects commonly put in ears: 1. living foreign bodies

2.Non-living foreign bodies
a. Non hygroscopic foreign bodies- stone, beads
b. Hygroscopic foreign bodies - peas, vegetable pieces
 CLINICAL FEATURES

Ear pain
01

Drainage
02

hearing loss
03

vertigo
04
Diagnostic evaluation - 1.history
of ear pain and drainage
2. Otoscope examination

Management –
Removal of Living and non
living foreign bodies
 FOREIGN BODY IN NOSE

Children can insert foreign bodies

in their nose. The objects that are
commonly inserted in nose are
small beads, nuts, rubber, chalk
piece, etc.
 CLINICAL FEATURES
foul smelling nasal discharge from one nostril
01

Rhinolith
02

Wheezing sound
03

pain in nose
04

Swelling in nose
05

Respiratory obstruction
06
 MANAGEMENT
• The nose is examined by simply lifting the tip of
nose with examiner's thumb.
• Nasal speculum can also be used for examining
the nasal cavity.
• For easily visualized, nonspherical, nonfriable
objects, most physicians prefer direct
instrumentation.
• If the object is poorly visualized or spherical or
cannot be successfully removed by direct
instrumentation, balloon-catheter removal is the
preferred method.
• Large, occlusive nasal foreign bodies may be
removed by either positive pressure technique or
under general anesthesia.
 Pediatric nurse's role
• A major role of nurse is to recognize the signs of foreign body aspiration and implement
immediate measures to relieve
the obstruction.
• Choking on food or other material
should not be fatal.
• Two simple procedures- Back blows
and the Heimlich maneuver which
can used by health professionals can
save lives.
• To aid a child who is choking nurses
need to recognize the signs of
distress.. Not every child who gags
or coughs while eating truly choking
• The most important nursing intervention related foreign body aspiration is prevention.
THANK YOU