What is the management plan for a patient with chicken particles in their chest, confirmed by chest x-ray, who is being consulted for G.I. admission?

Management of Foreign Body Aspiration with Chicken Particles in the Chest

Immediate hospitalization and bronchoscopy are required for the removal of aspirated chicken particles visualized on chest x-ray to prevent serious complications including pneumonia, lung abscess, and respiratory failure.

Initial Assessment and Stabilization

• Assess vital signs including respiratory rate, pulse, blood pressure, mental status, and oxygen saturation
• Provide supplemental oxygen to maintain SaO₂ >92% and PaO₂ >8 kPa 1
• Monitor oxygen saturation continuously with pulse oximetry
• Obtain arterial blood gases if there is evidence of respiratory distress or hypoxemia
• Ensure IV access for potential medication administration

Diagnostic Evaluation

• Review the existing chest x-ray that shows chicken particles
• Consider additional imaging:
  • CT chest with contrast to better visualize the location and extent of the foreign body 1
  • Lateral decubitus films if pleural effusion is suspected 1
• Laboratory studies:
  • Complete blood count with differential
  • Basic metabolic panel
  • Blood cultures if infection is suspected

Management Plan

Immediate Interventions

1. Consult Gastroenterology for urgent bronchoscopy

   • Rigid bronchoscopy is the gold standard for removal of food particles from the tracheobronchial tree
   • Flexible bronchoscopy may be considered for smaller particles or diagnostic purposes

2. Consult Pulmonology for co-management of potential respiratory complications

3. Administer empiric antibiotics if there are signs of infection or pneumonia:

   • Combined therapy with amoxicillin and a macrolide (erythromycin or clarithromycin) 1
   • For patients with penicillin allergy, consider a macrolide alone 1

Post-Removal Care

1. Continued monitoring of vital signs and oxygen saturation

   • Monitor temperature, respiratory rate, pulse, blood pressure, and mental status at least twice daily 1
   • More frequent monitoring for patients with respiratory distress

2. Chest physiotherapy to help clear secretions

3. Repeat chest imaging to ensure complete removal of foreign material and assess for complications

   • CRP level should be measured to monitor for inflammation 1

4. Nutritional support if prolonged hospitalization is required 1

Discharge Criteria

Patients may be discharged when:

• Complete removal of chicken particles is confirmed
• No evidence of respiratory distress
• Afebrile for at least 48 hours
• Oxygen saturation is maintained without supplemental oxygen
• Adequate oral intake is established
• Follow-up plan is in place 1

Follow-up Plan

• Clinical review should be arranged for approximately 6 weeks after discharge 1
• Repeat chest radiograph at follow-up, especially if there are persistent symptoms or physical signs 1
• Consider pulmonary function testing if there is concern for residual damage

Potential Complications to Monitor

• Pneumonia (bacterial superinfection)
• Atelectasis
• Bronchiectasis
• Lung abscess
• Respiratory failure
• Granulation tissue formation at the site of foreign body impaction

Special Considerations

• If the patient has pre-existing COPD, oxygen therapy should be guided by repeated arterial blood gas measurements 1
• For elderly patients or those with comorbidities, consider observation in a higher level of care setting initially 2
• Patients with severe respiratory compromise may require intensive care monitoring 1

Foreign body aspiration is a serious condition requiring prompt intervention. The presence of visible food particles on chest x-ray represents a clear indication for bronchoscopic removal to prevent both immediate complications (obstruction, hypoxemia) and delayed complications (infection, granulation tissue formation).