Rescue Training Course
Foreign body Airway Obstruction Management
Lecture No. 4
Basic Life Support with reference to cardiac arrest victim has been discussed in detail in previous lesson. In this lesson we will try to understand, what is meant by Foreign Body Airway Obstruction? How foreign body obstruction can be managed?
Foreign Body Airway Obstruction:
Foreign Body Airway Obstruction (FBAO) also known as choking. This is the physiological response to sudden airways obstruction. It can be partial or complete blockage of the breathing tubes to the lungs due to a foreign body (for example, food, a bead, toy, etc.). The victims with choking are often unable to explain what is happening with them. In this situation victim can be unconscious or go into critical condition if basic life support is not immediately provided to the victim and obstruction is not relieved.
How to recognize victim of the Foreign Body Airway Obstruction?
The timely recognition of any problem is a key to professional handling and successful outcome. It is very important to ask conscious victim, Are you Choking? The victim may not be able to speak and tell about his or her condition but there are chances that he or she could respond by nodding. You may recognize victim of choking by the Episode occurs whilst eating and onset was sudden. The adult victim may clutch his or her neck or point of throat which is also universal sign of choking. The children may be recognized with clues, seen eating or playing with small item like coins just before onset of systems.
How to assess the severity of the Foreign Body Airway Obstruction?
The victims can be categorized with mild obstruction and severe obstruction.
- Mild Obstruction: If the victim is able to breath, cough effectively and speak. In case of children, victim is fully responsive, crying or verbally respond to questions or may have loud cough and breathe comes in the mild obstruction category.
- Severe Obstruction: It is indicated if the victim is with wheezy breath sounds, unable to speak, breathe, coughing attempts are quiet and silent. Cyanosis means bluish color of the skin due to lack of oxygenand diminishing conscious level (particularly in children)
What is the treatment or management of the Foreign Body Airway Obstruction?
The airway obstruction can be treated or managed by using following steps.
- Adults: The Heimlich maneuver.
- Children over 1 year of age: A series of five abdominal thrusts (a children’s version of the Heimlich maneuver).
- Infants under 1 year of age: A combination of 5 back blows (with the flat of the hand) and five abdominal thrusts (with two fingers on the upper abdomen).
Steps from conscious to unconscious (Adult)
Confirm airway obstruction by asking “Are you Choking”
- Encourage the patient to continue coughing, but do nothing else except monitor for deterioration.
- Observe the signs of complete obstruction
Pale to bluish discoloration
Unusual sound; shrill
Unable to cough
- Perform Heimlich Maneuver until patients becomes unconscious. Heimlich maneuver includes
Stand to the side and slightly behind the victim, support the chest with one hand and lean the victim well forwards (so that the obstructing object comes out of the mouth rather than going further down the airway).
- Unfold the victim’s arms which usually make clutch around the neck in case of obstruction.
- Stand behind the victim (who is leaning forward) put both arms around the upper abdomen and clench one fist, grasp it with the other hand and pull sharply inwards and upwards.
- Continue abdominal thrusts until successful or the victim becomes unconscious.
In an unconscious patient:
- Lower the patient to the floor.
- Call an ambulance immediately.
- Begin CPR (even if a pulse is present in the unconscious choking victim).
Points to be Remembered
Chest Compressions and chest thrusts usually generate higher airway pressure as compare to back blows and finger sweeps
Blind finger sweep must be avoided, manually remove solid material in the airway only if it can be seen
Abdominal thrust can cause serious internal injuries and all victims must be get check from hospital for abdominal injuries
The above mentioned procedure will not be performed on obese victim and pregnant lady. In both case chest thrust will be given instead of abdominal thrusts
Steps Pregnant or Obese Responsive Adult
Get in position as mention above
Position your hands between the chest.
Perform a chest thrust
Steps for Child and Infant Airway Obstruction Management
The management of foreign body airway obstruction in children can be categorized by ineffective and effective coughing.
Ineffective coughing: The victims can be with these signs like unable to speak, quiet or silent cough, unable to breath, decreasing level of consciousness and discoloration (Cyanosis).
Provide help to the victim by determining the child conscious level
Give back blows and if it do not then relieve the airway obstruction by giving chest thrust to infants and abdominal thrust to children in conscious victims
These maneuvers increases internal pressure and dislodges the foreign body
In case of unconscious victim:
Place the victim at flat firm surface
Check airway and look for any obvious object, if something is seen remove it with single finger sweep. Do not attempt blind or repeated sweep because these attempts can impact the object.
Effective coughing: The victims can be with signs like crying or verbal response to question, loud cough, able to breath before coughing fully response. In this case encourage the child (victim) to cough and monitor continuously
Steps from conscious to unconscious (Infant)
- Verify complete airway obstruction.
- Position the infant
- Deliver five back blows
- Deliver five chest thrust
- Repeat Back blows and thrust
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