FOREIGN BODY AIRWAY OBSTRUCTION

  • Indicated algorithm in the setting of suspected foreign body airway obstruction, e.g. when a patient suddenly develops shortness of breath, coughing, inspiratory stridor, noisy breathing, inability to speak or unconsciousness while eating or drinking.

 

  1. Unconscious?

1.1 Cardiopulmonary resuscitation (CPR) to remove the obstruction as opposed to promoting circulation. CPR is thus indicated even if a pulse is present.

1.2 Laryngoscopy:

  • MaGill forceps to attempt to remove a supraglottic foreign body
  • Cricothyrotomy (> 10 years) or needle cricothyrotomy (< 10 years) if a supraglottic foreign body cannot be removed.
  • Endotracheal intubation in the setting of infraglottic or non-visible foreign body. Push the foreign body into one of the bronchi, withdraw the tube slightly and ventilate the other lung.

 

  1. Ineffective Cough? Unable to Breath? Cyanotic?

2.1 Back blows x 5 delivered with the heel of the hand between the patient’s shoulder blades

2.2 Abdominal thrust x 5 or chest thrusts x 5 for patients < 1 year old and in advanced pregnancy

2.3 Inspect the oral cavity, remove visible foreign body but no blind finger sweep

2.4 Repeat until improvement or unconscious

 

  1. Effective Cough? Can Breath & Talk Between Coughing Spells?

3.1 Encourage coughing. Back blows and chest/abdominal compressions are not indicated

 

  1. Aftercare
  • Patients with residual cough, swallowing difficulty or sensation of a foreign object stuck in the throat may have residual foreign material in the upper or lower airway. Bronchoscopy?
  • Abdominal thrusts and chest compressions may cause internal injuries