Pediatric emergency medicine trisk 0673 0673
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sharp objects (e.g., bones, needles, pins) may perforate the bowel wall, resulting
in peritonitis, abscess formation, or hemorrhage.
Respiratory Foreign Body
Upper Airway
Foreign bodies that lodge in the upper airway can be immediately life threatening.
According to the National Safety Council, choking was the fourth leading cause
of unintentional injury death in the United States in 2017, and a leading cause in
children under 5 years of age, resulting in 1,124 deaths in this age group. Most
children with aspirated foreign bodies are younger than 3 years of age. The most
common foods responsible for fatalities in the United States include hot dogs,
candy, meat, and grapes. Childhood fatality from aspiration of man-made objects
is less common. Frequently aspirated objects include balloons, small balls, and
beads. Children with foreign bodies in the upper airway may present with acute
respiratory distress, stridor, or complete obstruction of the upper airway. In
patients with complete airway obstruction, emergency treatment begins with basic
life support skills. Back blows and chest compressions are used in infants, and the
Heimlich maneuver is used in toddlers, children, and adolescents, if the patient is
conscious. Cardiopulmonary resuscitation should be initiated if the patient
becomes unresponsive. If these methods fail to dislodge the foreign body, rapid
progression to direct visualization and manual extraction or an emergency airway
is necessary (see Chapters 8 Airway and 9 Cardiopulmonary Resuscitation ).
FIGURE 32.1 Two-view chest radiograph demonstrating esophageal coin located at level of
the thoracic inlet.
Lower Respiratory Tract
