Airway foreign body emergencies are most common in children, but can also occur in the elderly and patients with sedative/alcohol use, impaired swallowing, or developmental delays.
If the foreign body is in the upper airway, removal involves the use of laryngoscopy and forceps (Magill, Sponge stick, or Alligator). Suction may be sufficient as well.
Upper airway foreign body (above the glottis)
Inability to visualize the foreign body
Tissue damage, risk of pushing foreign body further down
Do not forget your airway obstruction BLS algorithms: Heimlich maneuver/chest thrusts for conscious patients and CPR for unconscious patients. However, do not perform these interventions on partial obstructions.
If patient is unresponsive and initial attempts of removal during laryngoscopy have been attempted without success, attempt to intubate around the foreign body or push it to the right mainstem.
Cerumen impaction is caused by a buildup of wax within the ear canal and can lead to pain, tinnitus, dizziness, or decreased hearing. Removal can be achieved by manual removal, irrigation, or cerumenolytic agents
Cerumen buildup with symptoms (pain, tinnitus, decreased hearing, etc.), inability to view the full tympanic membrane for diagnostic purposes.
Uncooperative patient, inability to visualize ear canal. Irrigation is contraindicated in the presence or history of perforated TM.
Short-term vertigo, lacerations to ear canal skin, worsening tinnitus.
Removing ear wax is rarely indicated in the emergency department unless you need to view the tympanic membrane for diagnostic purposes.
If irrigating, use warm water (cold water is extremely uncomfortable for the patient)
Epistaxis is acute hemorrhage from the nostril, nasal cavity, or nasopharynx. 90% of bleeds occur from the anterior septum, with 10% in the posterior region. Management techniques include nasal packing vs commercial balloon tamponade devices
Typically occur in children; common foreign bodies include marbles, beans, nuts, beads, magnets, stones, etc. There are several removal techniques (Bulb syringe, manual removal with forceps, “Parent’s Kiss”, balloon catheter)
Known or suspected nasal foreign body (often present with unilateral purulent/bloody nasal discharge or unilateral sinusitis)
Inability to see foreign body, significant inflammation/edema, several failed attempts at removal.
Nasal mucosa injury, aspiration of foreign body, barotrauma (from “parent’s kiss” or BVM technique)
If removing manually or with a catheter, consider pretreating with oxymetazoline (Afrin) or atomized lidocaine.
The “Parent’s Kiss” is most effective when the foreign body occludes the whole nostril.
Peritonsillar abscesses are a complication of tonsillitis; it is the most common deep infection of the head and neck. Drainage is needed to prevent deep neck space infections, sepsis, and carotid artery erosion.