CWI - Choking patient (All ages excluding newborn)

Question 1

What are the indications for the choking patient CWI?

Answer 1

Question 2

What are the contraindications for the choking patient CWI?

Answer 2

Question 3

What are the precautions for the choking patient CWI?

Answer 3

Question 4

What equipment is required for the choking patient CWI?

Answer 4

• Magill’s foreceps
• Laryngoscope
• BVM

Question 5

Recite the choking patient flow chart

Answer 5

Question 6

Recall the steps of the Choking Patient CWI

Answer 6

Question 7

What do you do if the patient is conscious with an effective cough?

Answer 7

1. Allow patient to choose the preferred position. Suitably nurse infant
2. Encourage patient to cough
3. Monitor for deterioration or removal of obstruction

Question 8

What do you do if the patient is conscious with an absent or ineffective cough?

Answer 8

1. Visually inspect airway
2. If FB is visible, position patient head low or laterally
3. Manually clear airway as required

Question 9

What do you do if the patient is Unconscious or Becomes Unconscious (with cardiac output)

Answer 9

1. Position patient supine
2. For adults, lift the occiput of the head by 2-5cm with padding to better align the airway,
3. larger children children may require no padding
4. Infants may require a small 2cm pad under the patients shoulders

Question 10

How do you perform back blows?

Answer 10

1. If obstruction remains administer up to 5 back blocks
2. Monitor for deterioration or removal of obstruction
3. If the patient becomes unconscious, manage as per unconscious choking. Stop if FB is dislodged at any time

Question 11

How do you perform chest thrusts?

Answer 11

1. If obstruction remains, administer up to 5 chest thrusts appropriate for age
2. Monitor for deterioration or removal of obstruction
3. If the patient becomes unconscious, manage as per unconscious choking. Stop if FB is dislodged at any time

Question 12

How do you inspect the airway? How do you clear the FB?

Answer 12

1. Visually inspect airway
2. If FB is visible, position patient laterally and manually clear airway as required
3. Finger sweeps should only be performed if safe to do so.
4. If unable to provide finger sweeps, commence back blows.
5. Do not blind finger sweep as may worsen obstruction or cause injury
6. If unable to visualise or remove obstruction, inspect airway with with laryngoscope
7. If FB sighted, attempt to remove obstruction with suction or Magill’s foreceps
8. If obstruction is removed, provide assisted positive pressure ventilation until return of effective spontaneous ventilation

Question 13

What do you do if despite all efforts, the obstruction still remains

Answer 13

Obstruction remains - Ventilate patient
* If obstruction remains, attempt 5 ventilations

Obstruction remains - Chest compressions
* If obstruction remains, provide 5 chest compressions even is pulse is palpable
* Repeat ‘inspect airway’ (steps 13-15) as above for obstruction
* If obstruction remains continue to alternate 5 chest compressions and inspect airway
* Monitor for deterioration or removal of obstruction
* If obstruction is removed, provide assisted ventilation until effective spontaneous ventilation returns

Question 14

What do you do if the patient becomes unconscious (without cardiac output)

Answer 14

1. If patient loses cardiac output, treat as per appropriate cardiac arrest guideline
2. If airway obstruction is the suspected cause of cardiac arrest, visually inspect the airway when pausing for ventilation efforts. Chest compression may dislodge the object.

• The incidence of cardiac arrest secondary to airway obstruction is low. Prolonged delays in airway visualisation for FB inspection need not occur at all cardiac arrests unless airway obstruction is suspected as arrest cause