If the child is cooperative and the foreign body visible, it is possible to remove the object in the emergency department. In small or uncooperative children, a papoose board may be used for patient restraint. The nasal mucosal is generally prepared with vasoconstrictors and anesthetics (1 cc of phenylephrine mixed with 3 cc of 4% xylocaine). In uncooperative children, aerosolized adrenaline (racemic epinephrine) can be used to decongest the nasal mucosa and loosen the foreign body. 9 When administered in the aerosolized form by the parent, it causes little or no distress to the child. Following this, visualization with an appropriate-sized nasal speculum is attempted.
If the object appears loose after vasoconstriction, an attempt to remove it can be made using a number of different techniques including:
• Positive pressure technique.
• Removal by a suction catheter.
• Grasping the object with bayonet or alligator forceps.
• Passing any blunt-hooked instrument beyond the object, rotating the instrument, and pulling the foreign body out.
• Passing a Fogarty vascular catheter past the foreign body, inflating the balloon and removing the catheter and foreign body.
The latter four techniques are all acceptable but require a cooperative child, or conscious sedation, to prevent damage to the nasal mucosa.
Regardless of the technique utilized, the airway must be protected and appropriate material for managing airway obstruction should be immediately available. The examiner should be careful not to advance the foreign body any deeper into the nasopharynx.
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