1. Foreign Body in Throat
Dr. Vishal Sharma

2. Aspirated (Airway) Foreign Body

3. Clinical Staging 1. Initial phase: choking, coughing, wheezing,
gagging
2. Asymptomatic phase: due to mucosal adaptation
3. Late phase: Laryngeal / Tracheal / Bronchial
4. Complication phase: pneumonia, emphysema,
lung abscess, atelectasis

4. Late Clinical Features
a. Laryngeal: partial or total airway obstruction,
hoarseness, aphonia, hemoptysis
b. Tracheal: airway obstruction, hemoptysis,
wheezing, palpatory thud, auscultatory slap
c. Bronchial: cough, ipsilateral wheezing,
ipsilateral decreased breath sounds

5. Bypass valve & Stop valve effect
Partial Obstruction
Total Obstruction
Wheezing
Late Atelectasis

6. Check valve effect No Expiration No Inspiration Early Atelectasis
Emphysema

7. Clinical Diagnosis Conscious pt: 1. Hoarseness / aphonia
2. Respiratory distress
Unconscious pt:
1. No chest movement
2. No air exchange at nose /
mouth. 3. Cyanosis.

8. Radio-opaque F.B. larynx

9. Radio-opaque F.B. Bronchus

10. Right Lung collapse & Left emphysema
Radio-lucent F.B.
Right Lung collapse & Left emphysema

11. Management of choking in an unconscious patient
1. Patient placed in supine position
2. Open airway + mouth to mouth ventilation
3. Correct airway obstruction

12. Opening the airway
Head-tilt: Extension of neck by backward pressure on forehead

13. Opening the airway
2. Head-tilt, chin-lift: Extension of neck by backward pressure on forehead + lift pt’s chin keeping mouth open.

14. Opening the airway
3. Head-tilt, neck-lift: Lift pt’s neck while pushing down on forehead. Prevents falling back of tongue.

15. Opening the airway
4. Modified jaw-thrust: For pt with neck / spinal injuries. Push patient’s jaw forward by applying pressure at angle of mandible. Avoid head tilt.

16. Correcting airway obstruction
Back blows
Abdominal thrusts
Chest thrusts (for pregnancy, age < 8 yrs)
All 3 raise subglottic pressure, to dislodge out FB
Open pt’s mouth
Blind finger sweeps in mouth

17. Back blows Place pt in lateral position, supporting pt’s
chest against your knees.
Use free hand to deliver
five rapid blows to spinal
Area b/w scapulae, to
dislodge F.B.

18. Abdominal thrusts Straddle supine pt at his hip.
Place your hand heel b/w pt’s umbilicus & ribcage, in midline.
Hold that hand with your other hand & apply 5 rapid, inward + upward thrusts, to dislodge FB.

19. Chest thrusts
Kneel beside supine pt at chest level. Place hand heel on centre of pt’s sternum.
Lock hands. Apply 5 rapid downward thrusts.
Only 2 fingers used for a small child.

20. Opening patient’s mouth
Tongue-jaw lift technique:
Hold pt’s tongue + lower jaw b/w your thumb & fingers.
Lift pt’s tongue to move it
away from pharyngeal wall.

21. Opening patient’s mouth
Crossed-finger technique:
Cross your thumb under your index finger.
Place your thumb against pt’s lower lip & index finger against his upper teeth.
Uncross your fingers to open pt’s mouth.

22. Blind finger sweeps
Open pt’s mouth. Insert index finger of free hand into pt’s mouth, along pt’s cheek, till tongue base Use it as a hook to roll out FB.
Avoid pushing FB further back Avoid blind sweeps in a child.
Attempt to remove visible FB only.

23. Correcting airway obstruction in an unconscious pt
5 Back blows
 failure
5 Abdominal thrusts Or 5 Chest thrusts
Open pt’s mouth + blind finger sweeps.
Continue this sequence till FB is removed or pt is ready to be shifted to operation theatre.

24. Management of choking in a conscious pt
If patient can speak, cough, or breathe:
Do not interfere. Patient to be examined by an ENT specialist as soon as possible.
If the patient cannot speak, cough, or breathe: Begin treatment for obstructed airway.

25. Correcting airway obstruction in a conscious pt > 1 yr old
5 Back blows
 failure
5 Abdominal thrusts (Heimlich maneuver)
Or 5 Chest thrusts (for pregnancy, age < 8 yrs)
Continue this sequence till FB is removed or pt
becomes unconscious.

26. Back blows
Place pt in sitting / standing position. Support pt’s chest while bending pt at the waist.
Use your free hand to deliver 5 rapid blows to spinal area b/w two scapulae.

27. Heimlich Maneuver

28. Heimlich Maneuver
Stand behind sitting / standing pt & pass your arms around pt’s waist.
Hold your fist against pt’s abdomen b/w umbilicus & ribcage.
Lock hands & apply 5 rapid, inward + upward thrusts to dislodge FB.

29. Chest thrusts Stand behind standing pt & pass your arms around pt’s
chest. Hold your fist against
pt’s sternum in its centre. Lock
hands & apply 5 rapid, back-
ward thrusts to dislodge FB.

30. Correcting airway obstruction in an infant
5 Back blows
 failure
5 Chest thrusts
Continue this sequence till FB is removed or pt
is ready to be shifted to operation theatre.

31. Back blows in an infant
Straddle infant face down, head lower than trunk, over your forearm, supported on your thigh.
Deliver five rapid back blows, with heel of other hand b/w shoulder blades.

32. Chest thrusts in an infant
Supporting pt’s head, keep
infant supine b/w your
hands, with head lower
than trunk.
Using 2 fingers, deliver 5
rapid backward thrusts on
sternum.

33. Surgical Management For life threatening stridor Cricothyrotomy
Emergency Tracheostomy
For foreign body removal
Direct Laryngoscopy
Rigid Bronchoscopy
Thoracotomy & Bronchotomy

34. Prevention of choking Adults: Infants & Children:
 Cut food into small pieces
 Chew food slowly & thoroughly
 Avoid laughing / talking during eating
 Avoid excess alcohol with / before meals
Infants & Children:
 Keep small objects away from children
 Avoid playing with food or toys in mouth

35. Swallowed Foreign Body

36. Diagnosis
Plain X-ray (PA & Lateral): soft tissue neck, chest, abdomen  for radio-opaque FB
Fluoroscopy with Barium soaked cotton pledget
 for radiolucent FB
Barium Swallow
Flexible Oesophagoscopy

37. Coin in cricopharynx

38. Meat bolus in Cricopharynx

39. Toe ring in cricopharynx

40. Razor blade

41. Open safety pin

42. Barium Swallow

43. Flexible Oesophagoscopy

44. Tooth brush in stomach

45. Pharyngeal FB
Common sites: tonsil, pyriform fossa, vallecula, base tongue
Diagnosis confirmed by indirect laryngoscopy
Usually removed in OPD but may require removal by Hypo-pharyngoscopy  GA

46. Oesophageal & Gastric FB
Common sites: cricopharynx, aortic indentation & cardiac end
Usually removed by rigid oesophagoscopy  GA
Advancement into stomach is safe in difficult FB
Oesophagotomy rarely required for impacted FB
FB reaching stomach, usually passes out in stool
Emetic & Cathartic agents are contraindicated

47. Indications for Immediate Intervention
 Associated respiratory obstruction
 Total oesophageal obstruction
 Disc battery (perforation occurs in 8-12 hrs)
 Sharp, impacted foreign body
 Gastro-intestinal FB > 5 cm in a child < 2 yr
 Gastro-intestinal FB with acute abdominal pain
 No progress of FB in serial X-ray after 24 hr
 Gastric FB with pyloric stenosis

48. Disc battery in stomach

49. Complications of neglected FB
Oesophageal ulceration & stricture
Oesophageal perforation  mediastinitis
Peri-oesophageal cellulitis
Retro-pharyngeal abscess
Respiratory obstruction due to
tracheal compression
laryngeal oedema

50. Retropharyngeal abscess

51. Instruments for FB removal

52. Instruments for FB removal

53. Optical Forceps

54. Net retrieval system

56. Thank You