A 3-year-old child is brought to the emergency department by parents who report the child was playing with small toys and suddenly began coughing violently. Which assessment finding would be MOST indicative of foreign body aspiration in the trachea?
1Inspiratory stridor with suprasternal retractions✓ 정답
2Expiratory wheeze heard bilaterally
3Diminished breath sounds on the right side only
4Productive cough with yellow sputum
해설
Inspiratory stridor with suprasternal retractions is the classic sign of tracheal foreign body aspiration, indicating upper airway obstruction. Other options suggest lower airway involvement or infection, which are less specific for tracheal obstruction.
Clinical Judgment
The core of this question is the ability to differentiate between upper airway obstruction and lower airway obstruction. When a foreign body is located in the trachea, air passing through the narrowed upper airway produces a high-pitched inspiratory stridor. This indicates narrowing of the trachea just below the larynx. Suprasternal retractions are a sign that appears when accessory muscles are excessively used for breathing due to severe airway obstruction. The combination of these two findings best represents an upper airway obstruction requiring immediate emergency intervention.
Memory Tip:
Remember: Inspiratory Stridor = Supraglottic (above the glottis, trachea) foreign body. "If it's stuck in the Trachea, you hear a Stridor during Inspiration."
KR vs US
In Korea, there is a tendency to first perform the Heimlich maneuver or back blows in emergency situations, but in NGN/US guidelines, especially for infants and young children, the emergency response algorithm is clearly differentiated based on whether the patient is conscious or unconscious. Furthermore, as in this question, accurately differentiating signs to estimate the location of the foreign body is essential for providing information to the emergency team and preparing appropriate interventions (such as a tracheostomy).
임상 시나리오
Clinical Practice Guide
Emergency response for foreign body aspiration in children varies depending on the patient's age and level of consciousness.
* Conscious infants (under 1 year): Alternate between back blows and chest thrusts. Abdominal thrusts (Heimlich maneuver) are not recommended.
* Conscious children (1 year and older) and adults: Perform the Heimlich maneuver.
* All unconscious patients: Start CPR immediately, and after every 30 compressions, open the airway and attempt to remove the foreign body if visible.
Caution
In SATA (Select All That Apply) questions, you may list all signs related to "airway foreign body aspiration" (e.g., coughing, cyanosis, sternal retractions, wheezing, etc.). However, if the question asks for the finding that is MOST indicative of a foreign body located in the trachea, inspiratory stridor and suprasternal retractions are the correct answer. Decreased breath sounds on one side is more suggestive of a main bronchus foreign body.
핵심 개념
Foreign Body Aspiration (기도 이물질 흡인) — A small object is sucked into the airway in an emergency situation. It is common in infants and young children, and if not removed immediately, it can lead to choking, hypoxia, and even death.
Inspiratory Stridor (흡기성 천명음) — A high-pitched, harsh sound heard during inhalation. It is a characteristic sign indicating obstruction or narrowing of the upper airway (larynx, trachea).
Suprasternal Retractions (흉골상 함몰) — Suprasternal notch (the hollow above the neck bones) retraction during breathing. This indicates respiratory distress due to severe airway obstruction and use of accessory respiratory muscles.
Upper Airway Obstruction (상기도 폐쇄) — The airway above the glottis, including the larynx and trachea, is obstructed. It is characterized by inspiratory stridor, hoarse voice, and severe respiratory distress, requiring immediate emergency intervention.
Heimlich Maneuver (하임리히 법) — Emergency treatment for a conscious adult or child over 1 year old who is choking on a foreign object in the airway. The abdomen is quickly thrust upward to use air from the lungs to expel the foreign object.