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Old 09-09-2012
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ER Airway Obstruction; What to do?

A 5-year-old boy suddenly begins coughing while eating peanuts. He is choking and gagging. When he is brought to the emergency department, but he is awake and is able to give his name. On physical examination, his vital signs are stable. On examination of the chest, inspiratory stridor and intercostal and suprasternal retractions are apparent. Which of the following is the most appropriate initial step in management?

A. Allow patient to clear foreign object by spontaneous coughing
B. Clear oropharynx with multiple blind sweeps with finger
C. Position patient and perform back blows
D. Stand behind patient and perform abdominal thrusts
E. Perform emergency tracheostomy and take to surgery

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Old 09-09-2012
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This is tough.... I would try to stand behind him if he's big enough so D.
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D. Stand behind patient and perform abdominal thrusts

heimlich maneuver

Back blow is for infants
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i also ans D...but its not right
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Old 09-09-2012
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I feel 5 yr old can't be too big to stand behind and thrust, so I feel back blows, don't remember the source but feel 'it' was recommended for kids in general and not limited to infants.
Hence, C
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The correct answer is
A. Since the patient can cough and breathe, he should be allowed to clear the foreign object spontaneously, if possible. In the management of foreign object obstruction, if the patient can cough and breathe, it is best to initially observe and allow spontaneous resolution, since intervention may actually be damaging.

Often, blind finger sweeps (choice B) may remove the foreign object and resolve the symptoms. Also, this will need to be done if the patient is to be intubated.

The next step would be performing back blows if the patient was less than 1 year of age (choice C).

If the patient were over 1 year old, abdominal thrusts would be the next management option (choice D).

An emergency tracheostomy (choice E) should be the last option and should be undertaken only by a physician trained to perform the procedure.
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Emergency-Medicine, Pediatrics-, Step-2-Questions

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