Zaupa et al reported an algorithm for managing a pediatric patient with a possible foreign body aspiration. The authors are from the Medical University of Graz in Austria.
Patient selection: child observed to have, or suspected of having, a foreign body in the mouth
Parameters:
(1) clinical findings (wheezing, cough, dyspnea, severe respiratory distress)
(2) X-ray findings (unilateral emphysema, opaque foreign body)
If one or both parameters are present, then bronchoscopy should be performed.
(1) If a foreign body is identified, then it is retrieved, and the patient is discharged the next day.
(2) If a foreign body is not identified, then evaluate for other pulmonary disease.
If neither parameter is present, then the patient should be admitted for observation.
(1) If symptoms develop or a repeat imaging study is positive, then bronchoscopy is performed.
(2) If the child is normal during observation, then the patient can be discharged after instructing the parents about late symptoms such as pneumonia.
MRI or CT may be indicated if a radiolucent foreign body is suspected.
