Pediatric emergency medicine trisk 0682 0682
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mild or no symptoms and no focal findings on physical examination, then
discharge with follow-up in a few days is appropriate. If the diagnosis is still
unclear after plain films and there is a historical or clinical suspicion of
aspiration, fluoroscopy or chest CT may be considered, though is not always
necessary. In some instances, despite normal radiographic or fluoroscopic
findings, bronchoscopy is indicated to confirm the presence or absence of a
foreign body when there is a high clinical index of suspicion. It is reasonable to
proceed directly to bronchoscopy if there is an acute onset of focal physical
findings (unilateral wheeze, decreased aeration) or a convincing aspiration history
(witnessed event, choking history with typically aspirated foods: nuts, seeds,
apples).
History of possible foreign body aspiration
(patient NPO until disposition determined)
i
Inspiratory and expiratory chest radiographs3
Normal or Equivocal^ Radiographs
Suggestive Radiographs0
1
History and
physical examination
not suggestive
for aspiration
History or
physical examination
suspicious for
aspiration
Bronchoscopy for
foreign body removal
Consider CT scan or
fluoroscopy^
i
- Observation
- Treat other identified
disease processes
(pneumonia, asthma)
^
- Follow up in 2-3
days; consider repeat
radiograph if
symptoms persist
f
No evidence of
foreign body
Findings suggest
aspirated foreign
body
FIGURE 32.6 Guidelines for management of the child with suspected foreign-body aspiration.
Lateral decubitus chest radiographs may substitute in younger or uncooperative patients. b
Equivocal findings on radiographs include minimal atelectasis or consolidation. c Radiographic
findings suggestive of foreign body include air trapping on expiration, marked focal atelectasis,
or consolidation. d CT or fluoroscopy not necessary if there is an acute onset of focal physical
findings (unilateral wheeze, decreased aeration) or a convincing aspiration history. These
patients may proceed directly to bronchoscopy.
a
Lower Respiratory Tract: Removal
Rigid bronchoscopy performed under general anesthesia is the most common
technique used to remove an airway foreign body with a success rate of more than
98%. Flexible bronchoscopy may be used for diagnostic purposes, but often is not
