A 3-year-old boy was playing with his toys on the floor when his sister decided to share some peanuts with him. A few minutes later he started to cough and gave a hoarse cry. The cough then became croupy, and aphonia occurred. The mother, hearing the commotion, rushed into the room and quickly realized what had happened. She turned the child upside down and hit his back several times, but with no effect. The child, now in obvious respiratory distress, was rushed to the local emergency department. On examination, he was tachypneic, with suprasternal retractions. He was not coughing, and although he attempted to cry, there was no sound. He would not tolerate being laid down. On the basis of your knowledge of the anatomy of the airway, where do you think the foreign body was lodged? Describe the normal protective reflexes that exist in the airway to prevent the inhalation of a foreign body. What is the anatomic and physiologic rationale behind the use of back blows, chest thrusts, and abdominal thrusts (Heimlich procedure) in the management of upper airway obstruction? Which of these procedures is most appropriate for a 3-year-old child?

Question

Quizplus · Accepted Answer

The Answer is The presence of severe respiratory distress with suprasternal retractions and aphonia indicates the presence of upper airway obstruction, probably located within the larynx. The airway is protected by a number of important reflexes, including the gag reflex, the laryngeal reflex, and the cough reflex. The gag reflex occurs in response to stimulation of the pharyngeal mucous membrane innervated by the glossopharyngeal nerve. The laryngeal and the cough reflexes are mediated via the vagus nerve. These protective reflexes are lost in descending order as a patient loses consciousness.
All maneuvers that are directed toward freeing an obstruction of the airway by an inhaled foreign body are based on an attempt to increase the intrathoracic pressure by compressing the intrathoracic gas volume, so that the foreign body is expressed from the mouth. The underlying mechanisms involved in the use of back blows, chest thrusts, and abdominal thrusts are discussed in this CD chapter. It is now generally agreed that the best and safest method to use on a 3-year-old child is the abdominal thrust.

A 3-Year-Old Boy Was Playing with His Toys on the Floor