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.
-
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.
-
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
-
Effective Cough? Can Breath & Talk Between Coughing Spells?
3.1 Encourage coughing. Back blows and chest/abdominal compressions are not indicated
-
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
