Section 8. The Acutely Ill Infant and Child >
Part 3. Injuries and Untoward Events >
Chapter 118. Foreign-Body AspirationMargaret A. Kenna
Topics Discussed: acute illness; aspiration of foreign body; choking; foreign body removal.
Excerpt:"The management of foreign-body aspiration (Fig.
118-1) varies according to presentation of the disorder and
age of the patient. If the child presents with acute signs and symptoms of
airway obstruction due to foreign-body aspiration but is conscious
and can cough, breathe, or speak, then the child should proceed
to the hospital for foreign-body removal. However, if the child
appears to have complete obstruction of the airway, and becomes unconscious
and cyanotic, then the rescuer should intervene. Blind finger sweeps
are to be avoided in infants and children because the foreign body
could be pushed back into the airway, causing further obstruction.
If the foreign body can be visualized, it should be manually removed,
using Magill or other large forceps if available. When initial interventions fail,
a jaw thrust should be performed, with the hope of partially relieving
the obstruction. In the unconscious, nonbreathing child, a tongue-jaw
lift can be performed by grasping both the tongue and lower jaw
between the thumb and finger and lifting. If these maneuvers fail,
and based on current American Heart Association recommendations,
the most appropriate intervention for infants under the age of 1
year consists of holding the infant face down along the rescuer's
arm and delivering a series of sharp back blows between the shoulder
blades. For children over the age of 1 year, the Heimlich maneuver
(subdiaphragmatic abdominal thrusts) should be the first mode of intervention.
If all of these methods of..."
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