Foreign Body Aspiration (FOB): The Daily PANCE Blueprint
A 3-year-old girl is brought to the ER by her parents due to worsening cough and dyspnea x 3 hours. The symptoms started while the patient was eating lunch. On exam, she is anxious with inspiratory wheezing and diminished breath sounds unilaterally. CXR is unimpressive. Which of the following is the next best step?
A. Needle decompression
B. Thoracentesis
C. Flexible bronchoscopy
D. Bronchodilators
E. Surgery consult
Answer and topic summary
The answer is C. Flexible bronchoscopy
Foreign body aspiration (FBA) is a potentially life-threatening emergency that occurs mostly in children below the age of 3. The foreign body can land in the upper airway (trachea/larynx) which, when completely obstructive, can present as cyanosis and severe respiratory distress. Or the FB can land in the lower airway and cause a partial obstruction, which often presents as coughing, choking, stridor, wheezing, and dyspnea. The right main bronchus is often impacted more than the left because of its more vertical orientation. Airway management / respiratory stabilization is the priority (even over imaging). Management depends on the severity of the obstructive and the patient’s clinical pictures. The gold standard to remove a lower airway FB is bronchoscopy.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Pulmonary ⇒ ⇒
