A 2-year-old had a witnessed choking episode and now has unilateral wheeze and reduced air entry. Inspiratory chest radiography is reported normal. What is the best action?
Most inhaled organic foreign bodies are radiolucent, and a convincing history plus focal signs outweighs a normal film; rigid bronchoscopy permits airway control and removal.
A. Discharge because radiography is normal: A normal radiograph does not exclude an inhaled foreign body.
B. Arrange spirometry: A toddler cannot reliably perform it and testing delays definitive airway assessment.
C. Give repeated salbutamol for presumed asthma: Sudden onset after choking with unilateral findings is not typical asthma.
D. Proceed to urgent specialist assessment for rigid bronchoscopy despite the normal radiograph: Most inhaled organic foreign bodies are radiolucent, and a convincing history plus focal signs outweighs a normal film; rigid bronchoscopy permits airway control and removal.
E. Request MRI under sedation first: Sedation and delay add risk without providing treatment.
If choking had occurred minutes ago with complete obstruction and ineffective cough, immediate age-appropriate basic life support would precede hospital bronchoscopy.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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