What is the appropriate management for a patient presenting with sore throat, cough, congestion, ear pain, body aches, chills, and nausea/vomiting (n/v) after swallowing a foreign object, with no concerns for aspiration?

Management of Upper Respiratory Illness with Foreign Body History

This patient requires symptomatic management of an acute upper respiratory tract infection with supportive care, as the foreign object (wrapper) has already been expelled and there are no signs of aspiration or airway compromise.

Immediate Assessment

Rule out complications from the foreign body incident:

• The patient reports coughing up the wrapper and denies aspiration concerns, making retained foreign body or aspiration pneumonia unlikely 1
• Cough with abrupt onset following foreign body aspiration typically indicates airway irritation, but successful expectoration suggests resolution of the mechanical obstruction 1
• No chest radiograph is immediately necessary if the patient has no respiratory distress, normal oxygen saturation, or signs of postobstructive complications (fever, focal chest findings, hemoptysis) 1

Assess for bacterial superinfection:

• Green or yellow sputum would suggest secondary bacterial infection requiring antibiotic consideration 2
• Ear pain in the context of systemic symptoms (body aches, chills) may indicate otitis media as a complication 1
• The constellation of sore throat, cough, congestion, body aches, chills, and nausea/vomiting is consistent with influenza-like illness 1

Primary Management Strategy

Symptomatic treatment for viral upper respiratory infection:

• Antipyretics (acetaminophen or ibuprofen) for fever, body aches, and sore throat 1
• Adequate fluid intake to prevent dehydration, especially given nausea/vomiting 1
• Rest and supportive care as the mainstay of treatment 2

Cough management:

• For dry, irritating cough: dextromethorphan or codeine-based antitussives are effective, particularly if cough is disturbing sleep 3, 4, 5
• For productive cough: expectorants may help, though evidence is limited 2
• First-generation antihistamines (chlorpheniramine) combined with codeine provide both antitussive and sedative effects beneficial for nighttime cough 3

Antibiotic consideration:

• Antibiotics are NOT indicated for uncomplicated viral upper respiratory infection 1
• Consider antibiotics ONLY if: severe earache persists, vomiting continues >24 hours, breathing difficulties develop, or signs of bacterial pneumonia emerge 1
• If antibiotics become necessary: co-amoxiclav or doxycycline provide coverage for S. pneumoniae, H. influenzae, M. catarrhalis, and S. aureus 1

Red Flags Requiring Escalation

Immediate medical attention if:

• Respiratory distress develops (increased respiratory rate, intercostal retractions, oxygen saturation <90%) 6
• Persistent high fever >38.5°C with worsening symptoms 1
• Hemoptysis occurs (could indicate retained foreign body complications or severe infection) 1
• Signs of dehydration from persistent vomiting 1
• Altered mental status or drowsiness 1

Common Pitfalls to Avoid

• Do not prescribe antibiotics empirically for viral symptoms without evidence of bacterial superinfection—this contributes to resistance and provides no benefit 1
• Do not obtain chest imaging unless there are specific concerns for aspiration pneumonia, retained foreign body, or lower respiratory tract involvement 1
• Avoid combination products with multiple active ingredients that may lead to inadvertent overdosing of acetaminophen or other components 2
• Do not use aspirin in patients under 16 years due to Reye's syndrome risk 1

Follow-up Recommendations

Reassess if symptoms persist beyond 7-10 days or worsen:

• Persistent cough beyond 3 weeks warrants investigation for other causes (post-viral cough hypersensitivity, asthma, gastroesophageal reflux) 4, 5
• Worsening ear pain may require examination for otitis media and potential antibiotic therapy 1