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 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:
  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.
  4. Positive pressure (bag and mask) ventilation can be tried in an attempt to force the obstruction down in to one main bronchus. If unsuccessful:
  5. 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 potentially dangerous
  • Children with known or suspected infectious causes of obstruction or those in whom the cause of obstruction are unknown may require anaesthetic and/or ENT 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.

Bibliography

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


Endorsed by:  Director, Emergency Department  Date:  Feb 2018


 Review date:   Jun 2020


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