A 2-year-old child is brought with sudden onset choking, wheezing and decreased breath sounds on the right side after playing with peanuts. Chest X-ray shows air trapping on the right side (hyperinflation). The definitive management is:
- A Vigorous back blows and chest thrusts
- B Emergency bronchoscopy under general anaesthesia ✓
- C Antibiotics and chest physiotherapy
- D Flexible nasopharyngoscopy in outpatient setting
Explanation
An airway foreign body in the tracheobronchial tree causing unilateral hyperinflation (ball-valve obstruction) is a life-threatening emergency. The definitive treatment is rigid bronchoscopy under general anaesthesia, which allows controlled airway management and foreign body retrieval with dedicated optical forceps. Chest thrusts/back blows are appropriate for complete upper airway obstruction. Flexible bronchoscopy does not provide the working channel or control needed in a child with a potentially mobile bronchial foreign body. Antibiotics and physiotherapy are inappropriate as definitive management.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.