Airway obstruction
Roman Štoudek
Airway obstruction2
Learning objectives
̶ Student will learn how to recognize and evaluate airway
obstruction.
̶ Student will learn the algorithm for airway obstruction in adults and
children.
̶ Student will learn the indication and the correct performance of
abdominal/chest thrust.
Airway obstruction3
Foreign body airway obstruction
̶ Airway obstruction by inhaled object or fluid
̶ Full x Partial
̶ Sudden start
̶ History of food intake, play with a small object
̶ A foreign body causes coughing, suffocation, vomiting
̶ The most endangered group are young children, the elderly,
diseases of myasthenia gravis, Guillain-Barre syndrome, etc.
Airway obstruction4
Manifestation
̶ The victim suddenly grabs his neck and cannot speak. Trying to
breathe, we hear an inspirational stridor.
̶ Rapid development of dyspnoea, panic fear, inability to speak,
cyanosis, rise in heart rate, jugulum and intercostal invasion.
̶ If not relieved → victim may turn blue (cyanosis) → veins in face
and neck become more pronounced.
̶ This is followed by unconsciousness from hypoxia, slowing of the
heart frequency → cardiac arrest.
Airway obstruction5
Management
Recognize
obstruction
• Sudden onset
• Cough, sign of suffocation
• Information about food intake or play with small object that preceded the event
State of
consciousness
• Conscious → ask the victim (e.g. „Are you choking?“)
• Unconscious → proceed CPR
Assessment of
severity
• Able to speak, cough and breathe → mild obstruction
• Unable to speak, has a weakening cough, is struggling or unable to breathe → has
severe airway obstruction
Airway obstruction6
Effective and ineffective cough
Ineffective cough
• Unable of speaking
• Quiet or silent
cough
• Decreasing level of
consciousness
• Cyanosis
• Unable of breathe
Effective cough
• Crying or verbal
response
• Loud cough
• Able to take breath
before coughing
• Preserve conscious
• Fully responsive
Obstrukce dýchacích cest7
General principles of treatment
Manoeuvres leading to increase intrathoracic pressure
• A spontaneous cough is likely to be more effective and safer than any manoeuvre you might
perform. Active interventions are required only when coughing becomes ineffective.
• These include back blows and abdominal/chest thrusts
• Whenever the situation allows to alternate after 5 executions until the object is expelled or the
consciousness changes
• All victims successfully treated with these measures should be examined afterwards for injury
State of consciousness
• Regular check, in case of its failure, start CPR by trying 5 rescue breaths
• Never blindly sweep the finger when opening the airway
After successful expulsion
• Always assess condition, part of the object could remain in the airway
Airway obstruction8
Back blows
̶ Stand to the side and slightly behind the victim
̶ Support the chest with one hand and lean the victim well forward
̶ Give up to 5 sharp back blows with the heel of your other hand in
the middle of the back between the shoulder blades
̶ A small child may be placed across the rescuer´s lap
Airway obstruction9
Chest/abdominal thrust
(Heimlich manoeuvre)
̶ Stand behind the victim and put both arms round the upper part
of the abdomen. Lean the victim forwards.
̶ Clench your fist and place it between the umbilicus and the ribcage. Grasp
this hand with your hand and pull sharply inwards and
upwards. Repeat up to five times.
̶ The risk of injury is at all ages, but highest in newborn and
infants, so we do not use it in patients under 1 year of age.
̶ Do not use even in pregnant and severely obese.
̶ Alternative – sharp compression of the chest in place for compression in
CPR.
Airway obstruction10
Infant
Evaluation of
consciousness and
efficacy of cough
Prone position, the
head lower than
chest
Give up to 5 back
blows
Evaluation of
consciousness and
duration of
obstruction
Give up to 5 chest
thrusts
Start CPR if the
victim become
unresponsive
Airway obstruction11
Child
Evaluation of
consciousness
and efficacy of
cough
Prone position,
the head lower
than chest
Give up to 5 back
blows
Evaluation of
consciousness
and duration of
obstruction
Give up to 5
abdominal thrusts
Start CPR if the
victim become
unresponsive
Airway obstruction12
Adult
Suspect
choking
Give up to 5
abdominal
thrusts
Give up to 5
back blows
Give up to 5
back blows
Give up to 5
abdominal
thrusts
Evaluation of
consciousness
and duration of
obstruction
Start CPR if the
victim become
unresponsive
Encourage
to cough
Airway obstruction13
Resources
̶ G.D. Perkins et al. / Resuscitation 95 (2015) 81–99
̶ I.K. Maconochie et al. / Resuscitation 95 (2015) 223–248
Airway obstruction14
Learning outcomes
̶ Student is able to describe the symptoms of severe and mild
airway obstruction.
̶ Student is able to describe the individual steps of the algorithm for
airway obstruction in adults or children.
̶ Student is able to decide for correct abdominal/chest trust.
Simulation Centre, Faculty of Medicine, Masaryk University
2020