Foreign Body at Throat

Subject: Medical and Surgical Nursing II (Theory)

Overview

Foreign items found in the pharynx or throat. Symptoms range from mild discomfort to severe coughing and trouble breathing, depending on the location and size of the foreign body. Suffocation happens when the airway is obstructed, resulting in unconsciousness and death. Hoarseness, aphonia, hemoptysis, airway obstruction, hemoptysis, wheezing, palpatory thud, auscultatory slap and airway obstruction, hemoptysis, wheezing, palpatory thud, auscultatory slap are clinical features of a foreign body at throat. Place the patient in a lateral posture, with your legs supporting the patient's chest. Deliver five fast hits to the spinal area between the scapulae with your free hand.

Foreign items found in the pharynx or throat. Symptoms range from mild discomfort to severe coughing and trouble breathing, depending on the location and size of the foreign body. Suffocation happens when the airway is obstructed, resulting in unconsciousness and death.

Clinical Staging

  • Initial phase: Choking, coughing, wheezing, gagging
  • Asymptomatic phase: due to mucosal adaptation
  • Late phase: Laryngeal/tracheal/bronchial
  • Complication phase: Pneumonia, emphysema, lung abscess, atelectasis

Clinical Features

  1. Laryngeal: Partial or total airway obstruction, hoarseness, aphonia, hemoptysis
  2. Tracheal: Airway obstruction, hemoptysis, wheezing, palpatory thud, auscultatory slap
  3. Bronchial: Airway obstruction, hemoptysis, wheezing, palpatory thud, auscultatory slap

Clinical Diagnosis

Conscious patient:

  • Hoarseness/aphonia
  • Respiratory distress

Unconscious patient:

  • No chest movement
  • No air exchange at nose/mouth
  • Cyanosis

Management of Choking in an Unconscious Patient

  1. Patient placed in supine position.
  2. Open airway + mouth to mouth ventilation.
  3. Correct airway obstruction.

Opening the airway:

  • Head tilt: Backward pressure on the forehead to extend the neck, backward pressure on the forehead to extend the neck + elevate the patient's chin while maintaining the mouth wide.
  • Raise the patient's neck while pressing down on the patient's brow. Prevents the tongue from falling back.
  • For a patient who has suffered neck/spinal injury. Apply pressure at an angle to the mandible to move the patient's jaw forward. Avoid tilting your head.

Correcting airway obstruction:

  • Back blows
  • Abdominal thrusts
  • Chest thrust
  • Back blows
    • Place the patient in a lateral position, with your knees supporting the patient's chest. Deliver five rapid blows to the spinal area between the scapulae with your free hand.

  • Abdominal thrusts

    • Staddle supine patient at hips.
    • Place your hand head between patient’s umbilicus and ribcage, in midline
    • Hold that hand with the other hand and apply five rapid inward and upward thrusts.

  • Chest thrusts

    • Kneel beside supine patient chest level. Place hand heels on a center of pt’s sternum.
    • Lock hands. Apply 5 rapid downward thrusts.
    • Only 2 fingers in case of children

REFERENCE

Black, joyee M. Medical Surgical Nursing. Clinical Management for positive outcome, 6th edition

Brunner and Siddhartha's Medical-surgical Nursing, 9th edition.

Mandal, G.N. Textbook of Adult Nursing. Kathmandu: Makalu Publication House, 2013.

Luckmann, Joan Luckmann & Sorensen’s, Medical Surgical Nursing a Psychology Logic approach, 4th edition

Williams and Wilkins, The Lippincott manual of Nursing practice, 7th edition, International student edition, 2001.

 
Things to remember
  • Foreign items found in the pharynx or throat.
  • Symptoms range from mild discomfort to severe coughing and trouble breathing, depending on the location and size of the foreign body.
  • Suffocation happens when the airway is obstructed, resulting in unconsciousness and death.
  • A foreign body in the throat can cause partial or total airway obstruction, hoarseness, aphonia, hemoptysis, airway obstruction, hemoptysis, wheezing, palpatory thud, auscultatory slap, and airway obstruction, hemoptysis, wheezing, palpatory thud, auscultatory slap and airway obstruction, hemoptysis, wheez
  • Place the patient in a lateral posture, with your legs supporting the patient's chest. Deliver five fast hits to the spinal area between the scapulae with your free hand.
Questions and Answers

Foreign objects in the pharynx or throat. Symptoms range from mild discomfort to severe coughing and difficulty breathing depending on the location and size of the foreign body. Suffocation occurs when the airway is blocked, resulting in unconsciousness and death.

Management of choking in an unconscious patient

  1. Patient placed in supine position.
  2. Open airway + mouth to mouth ventilation.
  3. Correct airway obstruction.

Opening the airway:

  1. Head tilt: extension of neck by backward pressure on forehead,
  2. Extension of the neck by backward pressure on forehead + lift patient’s chin keeping the mouth open.
  3. Lift patients neck while pushing down on a forehead. Prevents falling back of the tongue.
  4. For patient with neck/spinal injuries. Push patient’s jaw forward by applying pressure at an angle of the mandible. Avoid head tilt.

Correcting airway obstruction:

  1. Back blows
  2. Abdominal thrusts
  3. Chest thrust

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