Foreign Body Airway    Obstruction

 

Clinical Indications:

 

  • Sudden onset of respiratory distress often with coughing, wheezing, gagging, or stridor due to a foreign-body obstruction of the upper airway.

 

Procedure:

 

  1. Assess the degree of foreign body obstruction.
    1. Do not interfere with a mild obstruction allowing the patient to clear their airway by coughing.
    2. In severe foreign body obstructions, the patient may not be able to make a sound. The victim may clutch his/her neck in the universal choking sign.
  2. For an infant, deliver 5 back blows (slaps) followed by 5 chest thrusts repeatedly until the object is expelled or the victim becomes unresponsive.
  3. For a child, perform a sub-diaphragmatic abdominal thrust (Heimlich maneuver) until the object is expelled or the victim becomes unresponsive.
  4. For adults , a combination of maneuvers may be required.
    1. First, sub-diaphragmatic abdominal thrusts (Heimlich maneuver) should be used in rapid sequence until the obstruction is relieved.
    2. If abdominal thrusts are ineffective, chest thrusts should be used. Chest thrusts should be used primarily in morbidly obese patients and in the patients who are in the late stages of pregnancy.
  5. If the victim becomes unresponsive, begin CPR immediately but look in the mouth before administering any ventilations. If a foreign body is visible, remove it.
  6. Do not perform blind finger sweeps in the mouth and posterior pharynx. This may push the object farther into the airway.
  7. In unresponsive patients, Paramedic level professionals should visualize the posterior pharynx with a laryngoscope to potentially identify and remove the foreign body using Magill® forceps.
  8. Document the methods used and result of these procedures in the patient care report (PCR).

 

Certification Requirements:

 

  • Maintain knowledge of the indications, contraindications technique, and possible complications of the procedure.  Assessment of this knowledge may be accomplished via quality assurance mechanisms, classroom demonstrations, skills stations or other mechanisms as deemed appropriate by medical control.