![]() ![]() Abdominal thrusts: place the heel of one hand below the xiphoid, interlace fingers, and use sharp, forceful thrusts to dislodge. Alternatively, if patient is supine, open the airway, and if the object is readily visible, remove it. This maneuver should be repeated if the airway remains obstructed. The other hand should be placed over the fist, and 5 upward-inward thrusts should be performed. The thumb side of one fist should be placed on the abdomen below the xiphoid process. Reassess, repeat as needed.Ĭhildren 1 year and up, conscious – Heimlich maneuver: stand behind patient with arms positioned under the patient’s axilla and encircling the chest. Infants under 1 year of age – back blows: head-down, 5 back-blows (between scapulae), 5 chest-thrusts (sternum). Go to BLS maneuvers if the child decompensates. Foreign body inhalation is the most common cause of accidental death in children less than one year of age. Remember that a foreign body in the mouth or throat can precipitously become a foreign body in the airway. LA GORGE – DER HALS – горло – THE THROAT – LA GARGANTA – 喉 – LA GOLA Before we go further – Be sure to inspect the palate for “vacuum effect”: small or flexible objects may be found on the roof of the mouth, just waiting to be aspirated.Do not push a foreign body down the back of a patient's throat, where it may be aspirated into the trachea.Beware of unilateral nasal discharge in a child – strongly consider retained foreign body.Be ready for the precipitous development of an airway foreign body.Cons: possible posterior displacement of the foreign body. Use 0.5% oxymetolazone (Afrin) spray and a few drops of 2 or 4% Pros: as above. Consider using topical analgesics and vasoconstrictors to reduce pain and swelling – and improve tolerance of/cooperation with the procedure.Highlighted areas indicate points at which nasal foreign bodies may become lodged. LE NEZ – DIE NASE – ніс – THE NOSE – LA NARIZ – 鼻 – IL NASO Essential anatomy: Law of diminishing returns: probability of successful removal of ear foreign bodies declines dramatically after the first attempt.Failure to assess for abrasions, trauma, infection – if any break in skin, give prophylactic antibiotic ear drops.Failure to inspect after removal – is there something else in there?.Vegetable matter? Don’t irrigate it – the organic material will swell against the fixed structure, and cause more pain, make it much harder to extract, and may increase the risk of infection.“In the heat of battle, the patient can become terrorized by the noise and pain and the instrument that you are using is likely to damage the ear canal.” 5,6 Use lidocaine jelly (preferred), viscous lidocaine (2%), lidocaine solution (2 or 4%), isopropyl alcohol, or mineral oil. They will fight for their lives if you try to dismember or take them out. If there is an insect in the external auditory canal, kill it first.Non-graspable: 45% success rate, 70% complication rate 5.Graspable: 64% success rate, 14% complication rate.Ask yourself: is it graspable or non-graspable? 5.4 The lateral 1/3 of the canal is flexible, while the medial 2/3 is fixed in the temporal bone – here is where many foreign bodies are lodged and/or where the clinician may find evidence of trauma. Foreign bodies may become lodged in the narrowing at the bony cartilaginous junction. L’OREILLE – DAS OHR – вухо – THE EAR – LA OREJA – 耳 – L'ORECCHIO Essential anatomy: Position the child accordingly to prevent precipitous foreign body aspiration or occlusion. 3 Remember to plan, think ahead: where could the foreign body may be displaced if something goes wrong? You may have taken away his protective gag reflex with sedation. ![]() Ketamine is an excellent agent, as airway reflexes are maintained. Consider sedation in children with special health care needs who may not be able to cooperate and technically delicate extractions. ![]() Most foreign bodies in the ear, nose, and throat in children can be managed with non-pharmacologic techniques, topical aids, gentle patient protective restraint, and a quick hand. ![]() Quiet room calm parent “burrito wrap” guided imagery have a willing parent restrain the child in his or her lap – an assistant can further restrain the head. The focus should be on engaging, calming, and distracting the child. Limit the number of people in the room, the noise level, and minimize “cross-talk”. Set the scene and control the environment. Anxiety abounds before and during evaluation and management. Children the world over are fascinated with what can possibly “fit” in their orifices. ![]()
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