Welcome…. : Welcome…. Foreign bodies : Foreign bodies Types- inorganic or organic.
Inorganic materials -plastic or metal eg; beads and small parts from toys.
Organic foreign bodies, including food, rubber, wood, and sponge, - more irritating to the nasal mucosa and thus may produce earlier symptoms. Etiology: : Etiology: They lack molars for proper grinding of food.
They tend to be running or playing at the time of aspiration.
They tend to put objects in their mouth more frequently.
They lack coordination of swallowing and glottis closure.
Curiosity, boredom Dignosis : Dignosis History
Barium or Gastrografin swallow Foreign bodies in the ear: : Foreign bodies in the ear: Clinical features : Clinical features May be asymptomatic
Some may cause pain in the ear, redness, or drainage.
Hearing may be affected if the object is blocking the ear canal. Treatment: : Treatment: Emergency department care
Patients in extreme distress secondary to an insect in the ear require prompt attention.
The insect should be killed prior to removal, using mineral oil or lidocaine (2%). Treatment: : Treatment: Methods of removal
Irrigation tympanic membrane intact
Irrigation with water is contraindicated - soft objects, organic matter, or seeds
Suction the ear with a small catheter held in contact with the object.
Avoid any interventions that push the object in deeper. Nasal foreign bodies (NFBs) : Nasal foreign bodies (NFBs) Pathophysiology : Pathophysiology Damage to the nasal cavity and surrounding structures.
They can produce local inflammation, which may result in a pressure necrosis.
Mucosal ulceration and erosion into blood vessels producing epistaxis.
Obstruction to sinus drainage
Secondary sinusitis.Firmly impacted and unrecognized foreign bodies can in time become coated with calcium, magnesium, phosphate, or carbonate and become a rhinolith. Clinical features: : Clinical features: Unilateral nasal discharge.
Nasal irritation, epistaxis, sneezing, snoring, sinusitis, stridor, wheezing, or fever.
Unusual patient presentations, such as irritability, halitosis, or generalized bromhidrosis (body malodor). The physical examination - : The physical examination - otorhinolaryngologic examination. Sedation is often helpful in the pediatric population.
positioning children younger than 5 years in a supine lying position and older children in a sitting "sniffing" position to allow optimal visualization.
A nasal speculum may also help to view the nasal cavity. Planning/Pretreatment : Planning/Pretreatment Careful planning
Necessary instruments at the bedside
Emergency airway supplies - readily available - foreign body results in aspiration.
Pharmacological vasoconstriction of the nasal mucosa can facilitate both examination and removal of a NFB. - 1% lidocaine Specific Removal Techniques : Specific Removal Techniques For easily visualized nonspherical and nonfriable objects, - direct instrumentation.
If the object is poorly visualized, spherical, or unsuccessfully removed by direct instrumentation, balloon-catheter removal is a preferred method. Slide 16: Hemostats alligator forceps, bayonet forceps hooked probes Direct instrumentation Direct instrumentation : Direct instrumentation Balloon catheters
Foley catheters (ie, 5, 6, or 8) and the Katz Extractor oto-rhino foreign body remover.
Large and occlusive foreign bodies
"parent's kiss" Balloon catheters : Balloon catheters Direct instrumentation : Direct instrumentation Suction
This technique is ideal for easily visualized smooth or spherical foreign bodies.
The catheter tip is placed against the object, and suction is turned on to 100-140 mm Hg (readily supplied by standard medical suction equipment).
Irrigation Journal review : Journal review Magnet
A case report demonstrated successful removal of a loose ball bearing from a nasal cavity using a household magnet Foreign body airway obstruction : Foreign body airway obstruction Site of Lodging of Foreign Body Right Main Bronchus : Site of Lodging of Foreign Body Right Main Bronchus The diameter of the right main bronchus is larger than the left,
The angle of divergence from the tracheal axis is smaller on the right,
Airflow through the right lung is greater than through the left,
The carina is more likely to be located to the left of midline rather than to the right. Slide 23: Ref: Shivakumar AM, Naik AS, Shetty KD, Praveen DS. Indian J Pediatr. 2004 Sep;71(9):849-52. Foreign Body Aspiration : Foreign Body Aspiration Complete airway obstruction
Inability to speak or cough
Partial airway obstruction
Back blows/probing hypopharynx not recommended Foreign Body Aspiration : Foreign Body Aspiration Treatment : Treatment Goal
Prompt endoscopic removal under conditions of maximal safety and minimal trauma Management : Management Complete airway obstruction
< one year
> one year
Gentle abdominal thrusts while supine
Heimlich maneuver Foreign Body Aspiration : Foreign Body Aspiration Slide 29: Infants under 1 year of age:
A combination of 5 back blows (with the flat of the hand) and 5 abdominal thrusts (with 2 fingers on the upper abdomen). Treatment Slide 31: Finger sweep Bronchoscopic removal : Bronchoscopic removal Bronchoscopy . Secretions proximal to peanut in left main stem bronchus Complication : Complication respiratory distress,
and bronchial stricture
surgical emphysema* Complication : Complication Shift of mediastinum and flattening of the hemidiaphragm are signs secondary to air trapping. Normal Esophageal foreign body : Esophageal foreign body Foreign Bodies : Foreign Bodies Foreign body ingestion
Foreign body aspiration
Lack posterior dentition
Cognitive development (edible?) Foreign Body Ingestion : Foreign Body Ingestion Parental suspicion
Choking, coughing, dysphagia, odynophagia
Drooling, refuses p.o., fussy child
Respiratory compromise Diagnosis : Diagnosis Radiopaque
Barium swallow Management : Management Removal
Examine for ulceration/perforation
Smooth-muscle relaxation agents may be used to relax the LES Foreign Body Ingestion : Foreign Body Ingestion Balloon Catheter Extraction
Effective in 90%
Endoscopy for failures
Airway compromise Complications : Complications Entrapment of object within a Meckel's diverticulum
Perforation leading to peritonitis and advanced sepsis
Metal poisoning (coins) Nursing management : Nursing management Slide 43: BIBLIOGRAPHY:
Wong D.L etal . Essentials Of Paediatric Nursing. 6th edition. Missouri: Mosby;2001
Marlow D.R. Redding B. Textbook of Paediatric nursing. 1st edition.Singapore: Harwourt Brace & company; 1998
Judith S.A. Straight A’s in Pediatric Nursing. 2nd edition.Lippincott Williams and Wilkins:Philadelphia; 2008
Parthasarathy IAP textbook of Paediatrics. 2nd edition. jaypee: NewDelhi; 2002
Hatfield N.T. Broadribb’s introductory Paediatric nursing. 7th edition. Wolters Kluwer: New Delhi; 2009 http://emedicine.medscape.com/article/763767-overview
http://emedicine.medscape.com/article/776566-treatment Slide 44: Thank Q