Airway obstruction by a foreign body

Disease Description (Causes and Symptoms)

• Definition: A condition in which a foreign object entering from outside partially or completely blocks the airway (pharynx, larynx, trachea, or bronchi), resulting in breathing difficulties.
• Main causes: Food (in adults); aspiration associated with dentures, alcohol consumption, or eating while talking; and aspiration of small objects in infants and young children (peanuts, toy parts, coins, etc.). Rarely, allergies, tumors, inhalation of chemicals, burns, and other conditions can cause airway obstruction.
• Pathophysiology: When a foreign object in the airway restricts airflow, reduced oxygen supply → hypoxia, cyanosis, altered consciousness, and, in emergencies, possible brain damage and death.
• Representative symptoms:
  • Complete obstruction: Inability to speak or breathe, intense fear, apnea, and possible rapid loss of consciousness.
  • Partial obstruction: Difficulty breathing, coughing, wheezing, inspiratory or expiratory abnormal breath sounds, decreased breath sounds on auscultation, and, in some cases, fever (secondary infection).
  • In severe hypoxia: Cyanosis, decreased consciousness, seizures, and coma.

Treatment Methods

• First aid (priority):
  • Immediately contact the emergency medical system (such as 119).
  • Conscious adults and children (>1 year): Perform the Heimlich maneuver (abdominal thrusts) (repeat continuously 5 times). If repeated attempts are ineffective, continue emergency measures and request rescue assistance.
  • Infants (<1 year): Alternate 5 back blows with 5 chest compressions (chest thrusts). Blind finger sweeps are not recommended when the foreign object is not visible.
  • If loss of consciousness occurs: Begin cardiopulmonary resuscitation (CPR) immediately.
• In-hospital treatment:
  • Airway assessment and conservative treatment: Oxygen administration and airway-status monitoring.
  • Endoscopic removal: Remove the foreign object using laryngoscopy or bronchoscopy (for diagnostic and therapeutic purposes).
  • If securing the airway is impossible: Secure the airway through intubation and, if necessary, a surgical airway incision (cricothyrotomy or tracheostomy).
  • Supportive treatment such as antibiotics and sedation: If pneumonia or inflammation is present, select an appropriate antibiotic.
• Follow-up and lifestyle management:
  • Monitor for airway injury and infection (return to the hospital if fever, coughing, or breathing difficulties worsen).
  • For infants and young children, prevent access to high-risk objects (peanuts, small toys, etc.).
  • Adults: Exercise caution when eating while consuming alcohol, and use properly fitted dentures.
• Complication management:
  • Hypoxic brain injury (if treatment is delayed), pneumonia, bronchitis, and lung abscess caused by downward migration of the foreign object, as well as airway injury and stenosis.

Checklist Before an Outpatient Visit (Including Example Questions)

Items to prepare/bring:

• A record of current symptoms (coughing, difficulty breathing, fever, pain, etc.) and when the symptoms began
• Whether a recent airway foreign-object incident occurred (when, what object, and whether first aid was provided)
• Current medications (including anticoagulants), allergy history, and previous surgery or anesthesia experience
• Whether dentures or prostheses are used, and smoking and alcohol-use history
• Previous chest X-ray or bronchoscopy results, if available (bring copies) Example questions for patients to consider:
• Did the symptoms begin suddenly, or are they gradually worsening?
• Do you have a fever or sputum (pus-like discharge)?
• Have you recently had difficulty swallowing, a foreign-body sensation in the throat, a hoarse voice, or a persistent cough?

Examples of General Questions to Ask the Doctor

• "How are you assessing the current condition of my airway? Do I need any additional tests?"
• "In my case, is endoscopic removal (bronchoscopy/laryngoscopy) necessary? What are the risks?"
• "What safe measures can I take in an emergency, and what actions should I avoid?"
• "How likely are complications (pneumonia, airway stenosis, or brain damage)? For which symptoms should I return to the hospital immediately?"
• "If surgery/anesthesia is necessary, what side effects or recovery period should I expect?"

Examples of Disease-Specific Questions

• Questions for caregivers of infants and young children: "My child is only coughing. Do we need to go to the emergency room immediately, or can we wait at home?"
• Questions related to dentures (adults): "There is a possibility that my denture entered the airway after coming loose. How can this be confirmed, and when should I go to the hospital?"

(Additional Summary)

• In an emergency, rapidly securing the airway and providing oxygen are the top priorities, and CPR should be started immediately if loss of consciousness occurs. For infants and young children, managing small objects is important, and attempting to remove an object that cannot be seen with a finger can be dangerous and may worsen the situation.