Pediatric emergency medicine trisk 3277 3277

TRAUMA TO THE LARYNX AND TRACHEA
Foreign Body
Goals of Treatment
Laryngeal or tracheal foreign bodies can result in life-threatening partial or
complete airway obstruction. The goal is to safely remove the object as soon as
possible to prevent or reverse any respiratory compromise. Care must be taken to
avoid converting a partial airway obstruction into complete airway compromise,
and to avoid advancing the foreign material with resultant aspiration into the
lung.
CLINICAL PEARLS AND PITFALLS
Disc batteries should be removed as soon as possible to avoid caustic
injury.
Clinicians should have a high suspicion for foreign body in a child with
sudden onset of stridor, persistent cough, or respiratory distress.
Back blows and the Heimlich maneuver are not performed on the
breathing child as these can cause the object to lodge further into the
airway. These techniques are reserved for complete airway obstruction.

Current Evidence
Foreign bodies lodged in the laryngeal inlet or trachea cause severe distress and
often present with coughing, wheezing, and biphasic stridor. Tracheal/bronchial
foreign bodies can cause either lung hypoventilation due to compete obstruction
or hyperinflation due to a check-valve effect of the object.

Clinical Considerations
Clinical Recognition
Foreign bodies trapped in the laryngeal inlet can cause significant acute upper
airway obstruction. The child usually presents with severe coughing, hoarseness,
and significant respiratory distress. The larger challenge for emergency clinicians
is recognizing foreign body aspiration when the event was not witnessed directly,
and the child is not acutely compromised. Presenting symptoms such as cough,

stridor, and examination findings such as wheezing and decreased aeration are
nonspecific and seen commonly in routine pediatric illnesses such as croup,
bronchiolitis, and asthma. One should be suspicious of airway foreign body in