Choking

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Read the full PCH Emergency Department disclaimer.

Aim

To guide PCH ED staff with the assessment and management of a choking child.

Partial obstruction	Complete obstruction
Do not attempt to relieve the obstruction Allow the child to sit upright in the position they feel most comfortable Arrange urgent transfer to theatre for removal under direct vision (laryngoscopy or bronchoscopy)	This is usually a sudden and catastrophic event If obstruction is total the child rapidly progresses to unconsciousness and cardiorespiratory arrest

Total obstruction

Ensure ENT and Anaesthetics are requested urgently

1 .Look in the mouth and throat. If the foreign body is visible try to remove it under direct vision preferably using a laryngoscope and Magill's forceps.

If unsuccessful and patient conscious:

2. Back blows - place the child prone and head down. Apply five (5) back blows with the open hand to the inter-scapular area.

If unsuccessful:

3. Chest thrusts - turn the child face up. Apply five (5) chest thrusts using the same technique as for CPR.

If unsuccessful, repeat step 1.

If patient is unconscious or no signs of life:

Airway opening manoeuvres
Two breaths
- positive pressure (bag and mask) ventilation may force the obstruction down into one of the main bronchus¹
Chest compressions
- may dislodge the foreign body
Continue CPR 15:2

When all else fails an emergency surgical airway may be needed.

General

Upper airway obstruction may be caused by infection (e.g. epiglottitis, croup), and in these cases any attempt to relieve airway obstruction using the methods described are dangerous
Children with known or suspected infectious causes of obstruction or those in whom the cause of obstruction are unknown may require anaesthetic management.

Management

If the child is coughing, this should be encouraged:

No intervention should be attempted unless the cough becomes ineffective (quieter) or the child loses consciousness
A spontaneous cough is more effective than any manoeuvre.

Active attempts to physically clear the airway should only be performed if:

The diagnosis of foreign body aspiration is clear-cut or strongly suspected
The cough is ineffective, dyspnoea is worsening or apnoea or loss of consciousness have occurred
Airway opening manoeuvres fail to maintain an adequate airway.

Choking child algorithm

Bibliography

Textbook of Paediatric Emergency and Critical care procedures :Dieckmann Mosby 1997
Textbook of Paediatric Emergency Medicine 2nd Edition Cameron Elesevier 2012
Nelson Textbook of Pediatrics: 20th Edition Robert M. Kliegman, Bonita M.D. Stanton, Joseph St. Geme, Nina F Schor Publisher: Elsevier 2016
Advanced Paediatric Life Support (APLS) 2017

Reference

Foreign Bodies Inhaled. Clinical Practice Guidelines. Updated March 2021. Royal Children’s Hospital, Melbourne Clinical Practice Guidelines : Foreign bodies inhaled (rch.org.au) (As viewed 29 September 2021)

Endorsed by:	Co-Director, Medical Services	Date:	Aug 2021
		Review date:	Aug 2024

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