|Chapter 4 - How to Remove Foreign Bodies||| Print ||
A) Foreign bodies
B) Removing foreign objects from ears
C) Removing foreign objects from nose
D) Foreign bodies in the throat and airway
E) Foreign bodies in other sites
hildren” of all ages may get foreign bodies stuck in the various openings in the body. Most arrive there by accident, and most happen to children.
Each type of foreign object poses its own challenges for removal, but the following hints may be helpful.
Seeds (beans, etc.) are often dry when placed in an ear or a nostril. Because of the moist environment in these areas, they tend to swell, causing a much tighter fit than when first introduced. Because of this, plant objects must be removed as soon as possible.
Sometimes the only symptoms foreign bodies cause are a bad odor, bad breath, etc. Recent onset of foul odor ought to raise suspicion of a possible foreign object in some body orifice.
Bugs sometimes end up in the ear, causing both pain and irritating sounds. To remove, fill the involved ear with oil. It will kill the bug and stop the noise, and often the pain. If the bug does not come out with the oil, a bulb syringe may be used with oil or water to irrigate the ear (Section VIII, chapter 13).
Irrigation may be tried for other small objects or materials that may dissolve or be washed away. It is not usually wise to attempt to remove large solid foreign objects by irrigation. Do not use water to irrigate seeds and similar plant matter that may swell.
Other objects may be removed with a tweezers (forceps). To do so, lay the patient on his/her side with the ear containing the object up. Gently grasp the ear and pull it backwards. This will tend to straighten the canal and allow better visualization. With a bright light, the object may be visualized and grasped with a grasping instrument. Be very cautious when using instruments in the ear to avoid injuring the skin lining the canal, causing bleeding and possible infection. This is especially a concern for children who cannot lie still.
If suction equipment is available, some foreign bodies can be removed by applying suction to the object via small rubber or plastic tubing.
Should professional services be unavailable, one may attempt to place a heavy string into the ear before pouring melted bees wax into the canal (Caution so as not to burn the ear with hot wax). Allow the wax to cool and set before gently pulling on the string.
Cyanoacrylate or other rapid setting glue, placed on a stick, and applied directly to the foreign body may be successful for removing a dry foreign body. One must be very careful not to touch body tissues with the glue.
If the patient can cooperate, foreign bodies in the nose can often be dislodged by pressing the unobstructed nostril closed and having the patient take a deep breath and blow it out through the nostril containing the foreign object.
If this is unsuccessful, one may position the patient in a reclining chair or lying on the back. Using a bright light, carefully examine the nostril to see if the foreign body is visible. If so, grasp the object with a forceps (tweezers) and remove. Bleeding may be profuse if the delicate membranes are injured, so be cautious.
Suction machines, if available, are useful for removing the mucus and for getting hold of the foreign object for removal.
Cyanoacrylate glue on a stick may work.
Foreign bodies in the throat and airway may be life-threatening and must be dealt with promptly and wisely. “Swallowed” objects may indeed be swallowed and go down the esophagus (gullet) to the stomach. More often, foreign objects get “hung up” in the throat, either at the opening of the esophagus or the opening of the trachea (windpipe)—or both. If at the opening of the windpipe, the airway may be blocked, causing rapid asphyxiation unless promptly removed. Objects at the opening of the esophagus may be uncomfortable, but are not as immediately life-threatening as in the airway. If both openings are blocked, the patient can neither swallow nor breathe.
1. Symptoms and findings
Choking, gagging, gasping for breath, or not breathing, and turning blue, stridor or wheezing (whistling or high-pitched breathing sounds).
Coughing, unable to talk, excessive salivation.
2. Treating suspected foreign bodies in the throat
Call for help immediately if symptoms of airway obstruction are present.
If an infant or small child: Depending upon size, grasp firmly around the ankles with one hand and turn the child upside down or at a steep incline. Pat the chest, back, or front, with the free hand with sufficient power to force air from the chest. If the foreign object is not removed by this maneuver, use the free hand to open the mouth and with the index finger, sweep the back of the throat, attempting to free and remove the object. For babies, lay the infant on your forearm in an upside down slant while supporting the neck and head with your fingers. Gently tap first the front of the chest, then, turning the infant over, tap the back, attempting to dislodge the object from the throat. If this is unsuccessful, use the index finger to free the foreign body as described above. Should no foreign body appear, but symptoms and signs of obstruction persist, begin CPR while awaiting emergency services to arrive (Section II, chapter 1).
For larger children and adults that have symptoms and signs of a foreign body in the throat, use the abdominal thrust (Heimlich maneuver) in an attempt to dislodge the foreign object. If unsuccessful, place patient on his/her back and begin CPR while awaiting arrival of emergency vehicle (Section II, chapter 1, D).
For foreign bodies that are not obstructing the airway, emergency X-rays will be indicated to identify the type and location of the object, giving professional personnel information by which to plan removal.
3. What to do if professional help is not available
Proceed as above. If instruments are available for looking into the throat, for grasping foreign bodies, suctioning, etc. use whatever tools and skills you may have in your attempt to restore the airway.
Administer oxygen if available and if patient is exchanging any air at all.