What is the management for a suspected foreign body (FB) in the airway?

Management of Suspected Foreign Body in the Airway

For suspected foreign body airway obstruction (FBAO), immediate intervention is essential with a stepwise approach based on patient consciousness and obstruction severity, starting with encouraging coughing in conscious patients and progressing to back blows, abdominal thrusts, and chest compressions as needed.

Initial Assessment and Management

Conscious Patient with FBAO

• Encourage coughing if the patient has an effective cough, as this is a normal physiological response that may effectively dislodge the foreign body and is unlikely to cause harm 1
• Assess cough effectiveness - if coughing becomes ineffective, proceed immediately with active interventions 1
• Back blows should be administered first when cough becomes ineffective - deliver five sharp blows between the shoulder blades 1
• Abdominal thrusts (Heimlich maneuver) should be performed if back blows are ineffective - deliver five abdominal thrusts 1
• Alternate between back blows and abdominal thrusts until the obstruction is relieved or the patient becomes unconscious 1
• Manual extraction of visible foreign bodies in the mouth should be attempted, but blind finger sweeps should be avoided 1

Unconscious Patient with FBAO

• Position the patient supine and call for emergency medical services 1
• Open the airway using head tilt-chin lift or jaw thrust maneuvers 1
• Check for visible foreign body in the mouth and remove only if clearly visible 1
• Begin chest compressions immediately, as these can create pressure that may dislodge the foreign body 1
• Attempt ventilation after 30 compressions, and if unsuccessful, reposition the head before attempting again 1
• Continue CPR with a compression to ventilation ratio of 30:2 until help arrives 1

Advanced Management Techniques

For Healthcare Providers

• Use Magill forceps to remove visible foreign bodies from the airway under direct visualization 1
• Consider advanced airway management including laryngoscopy and endotracheal intubation if basic maneuvers fail 2, 3
• Emergency bronchoscopy should be considered for persistent obstruction, especially in cardiac arrest situations due to FBAO 2, 3
• Surgical airway (cricothyroidotomy) may be necessary in complete obstruction cases where other methods have failed 3, 4

Special Considerations for Children

Pediatric Approach

• For infants (<1 year): Use back blows and chest thrusts instead of abdominal thrusts 1
• For children (>1 year): Follow the adult protocol with age-appropriate modifications to technique 1
• Hold infants in a head-down position along the forearm or across the thighs while delivering back blows 1
• Chest thrusts for infants should be delivered at the lower third of the sternum, about one finger's breadth below an imaginary line joining the nipples 1

Prevention and Education

• Public education on FBAO recognition and management is crucial for improving outcomes 5
• School-based training programs have shown effectiveness in teaching children to recognize and respond to FBAO situations 5
• Early intervention by bystanders is associated with better outcomes in FBAO cases 1, 5

Common Pitfalls to Avoid

• Do not perform blind finger sweeps as they can push the foreign body deeper or cause injury to the pharynx 1
• Do not delay intervention - bystanders should act as soon as possible after recognizing FBAO 1
• Do not use suction-based airway clearance devices routinely as evidence for their effectiveness is limited 1
• Do not assume a single foreign body - always consider the possibility of multiple foreign bodies, especially in children 6
• Do not overlook recurrent pneumonia as a potential sign of undetected airway foreign body 6