Paeds Vivas · respiratory-sleep-and-airway
Foreign-body aspiration — branching viva
Branching viva from the definition and phases of foreign-body aspiration through the choking basic-life-support algorithm, the imaging caveats, rigid bronchoscopy, and the missed retained foreign body presenting as recurrent pneumonia.
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Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in the emergency department. The consultant asks you to talk through four children: a toddler actively choking on a grape, a well toddler after a witnessed choking episode with a normal chest radiograph, a child with recurrent right-lower-lobe pneumonia and a fixed wheeze, and an infant who has just choked and gone limp.
Station opening
Examiner: "Define foreign-body aspiration and describe its three clinical phases." [1]
Strong candidate (must-hit)
- Defines aspiration as the inhalation of a solid or semi-solid object below the larynx into the trachea or bronchi; describes the acute phase of choking, coughing and gagging, the latent phase where the child settles and can be symptom-free for days or weeks, and the delayed phase of recurrent pneumonia, fixed wheeze and eventual bronchiectasis; and stresses that the latent phase is the trap that causes missed diagnoses because a well child can still harbour an object. [1]
Weak candidate
- "It is when a child swallows something and it goes down the wrong way, and we get an x-ray to look for it." [1]
References5ShowHide
- [1]Salih AM; Alfaki M; Alam-Elhuda DM Airway foreign bodies: A critical review for a common pediatric emergency. World J Emerg Med, 2016.PMID 27006731
- [6]Committee on Injury, Violence, and Poison Prevention Prevention of choking among children. Pediatrics, 2010.PMID 20176668
- [7]Zoizner-Agar G; Merchant S; Wang B; April MM Yield of preoperative findings in pediatric airway foreign bodies - A meta-analysis. Int J Pediatr Otorhinolaryngol, 2020.PMID 33068947
- [8]Safia A; Abd Elhadi U; Bader R; Khater A; Karam M; Bishara T; Massoud S; Merchavy S; Farhat R Flexible versus Rigid Bronchoscopy for Tracheobronchial Foreign Body Removal in Children: A Comparative Systematic Review and Meta-Analysis. J Clin Med, 2024.PMID 39337140
- [12]De Palma A; Brascia D; Fiorella A; Quercia R; Garofalo G; Genualdo M; Pizzuto O; Costantino M; Simone V; De Iaco G; Nex G; Maiolino E; Schiavone M; Signore F; Panza T; Cardinale F Endoscopic removal of tracheobronchial foreign bodies: results on a series of 51 pediatric patients. Pediatr Surg Int, 2020.PMID 32468145