Airway Obstruction - Emergency Management

Airway Obstruction

·        Always consider in rapid cessation of breathing and unconsciousness. Also consider fainting, stroke, MI, epilepsy and drug overdose

·        In adults especially related to meat, dentures and alcohol.  Will grip throat not chest

Adult obstruction

·        Partial obstruction ® distressed and coughing. If conscious and adequate air ® encourage coughing and spitting – nothing else

·        Ask if they are choking: if can‟t talk, breath or cough then:

o  Remove obvious obstruction from mouth (only if unconscious – may bite). Grasp tongue and mandible between thumb and fingers and lift up. Hook with other hand

o  Back slapping: lean well forward onto one hand, 5 sharp slaps between shoulder blades with heel of other hand. If lying down, roll face down onto your thigh

o  Abdominal thrusts (Heimlich manoeuvre): fists over midline above naval, always below xiphoid process and ribs. Upwards thrust. May vomit. If on ground, lie on back and sit astride their thighs. If pregnant or obese, use chest thrusts

o  If obstruction is not relieved: check mouth, 5 back slaps, 5 abdominal thrusts, repeat

Paediatric Obstruction

·        Suspect in any airway distress with coughing, gagging, or stridor with rapid onset. May also be caused by infections (e.g. croup or epiglottitis). If infective cause then medical emergency

·        Only intervene if child‟s attempts to clear the obstruction are clearly ineffective and there is inadequate respiration

·        For infants (<1 year) and children, 5 back blows with the child‟s head below the level of the chest if possible

·        Then 5 chest thrusts to sternum in supine position: sharp, vigorous and rate of 20 bpm

·        Check mouth: grasp tongue and jaw and lift. Don‟t put finger into mouth unless foreign body is clearly visible

·        Reassess airway.  If not breathing, attempt to ventilate

·        Repeat back slaps, chest thrusts, attempted ventilation. In children, alternate abdominal and chest thrusts