Foreign Body Airway Obstruction

Section 3 - RESPIRATORY

3.03 FOREIGN BODY AIRWAY OBSTRUCTION

• INITIAL MEDICAL CARE (2.01).

IF OBSTRUCTED AND CONSCIOUS:

• Cannot breathe:
  • Abdominal thrusts as necessary or until patient becomes unconscious.
  • Chest thrusts if patient pregnant or obese as necessary or until patient becomes unconscious.
  • 5 back blows and 5 chest thrusts for infants under 1 year of age. Repeat as necessary or until patient becomes unconscious.

IF OBSTRUCTED AND UNCONSCIOUS:

• Clear airway by visualizing with laryngoscope using Magill forceps and / or suction.
• If still obstructed and unconscious:
  • 5 Chest thrusts.
  • 5 Back blows and 5 chest thrusts in infants under 1 year of age.
  • Look for foreign body.
• Repeat steps above.
• If unable to obtain airway after above attempts, perform Cricothyrotomy.

Esophageal Food Bolus Obstruction (“Steakhouse Syndrome”)
Presentation The patient develops symptoms immediately after swallowing a large mouthful, usually of inadequately chewed meat, the result of intoxication, wearing dentures or being too embarrassed to spit out a large piece of gristle. The patient often develops substernal chest pain that may mimic the pain of a myocardial infarction. This discomfort though, increases with swallowing, is followed by retained salivary secretions which, unlike infarction, leads to drooling. The patient usually presents with a receptacle under his mouth into which he is repeatedly spitting. At times these secretions will cause paroxysms of coughing, gagging, or choking.
Patients who experience a food bolus obstruction of the esophagus are usually over 60 years old and often have an underlying structural lesion. One of the more common lesions is a benign stricture secondary to reflux esophagitis. Another abnormality, the classic Schatzki's ring (distal esophageal mucosal ring), especially above a hiatal hernia, may present with the "steakhouse syndrome" in which obstruction occurs and is relieved spontaneously. Chicken bones are the FBs that most often cause esophageal perforation in adults. Meat impacted in the proximal two thirds of the esophagus is unlikely to pass and should be removed as soon as possible.
Meat impacted in the lower third frequently does pass spontaneously and the patient can safely wait, under medical observation, up to 12 hours before extraction. Even if a meat bolus does pass spontaneously, endoscopy must still be done later to assess the almost certain (80-90%) underlying pathology.

• Establish and maintain adequate airway and provide oxygen as necessary.
• Keep the patient calm and reassure them of the need for evaluation at the ER.
• Do not ignore a patient’s claims of a foreign body stuck in the esophagus. They are usually right.
• Do not try to force the food bolus down; this may cause an esophageal tear or perforation.
• Do not attempt to remove a hard, sharp, esophageal foreign body, this very likely will cause an esophageal injury.

Treatment:

• If systolic BP > 90 mmHg- Administer NITROGLYCERIN 0.4 mg SL TAB. Have patient expel any saliva from the mouth prior to administration. Nitro is contraindicated if pt states use of any ED class of drugs in the past 24-36 hours. (Document as a pertinent negative).
• If No relief or patient becomes worse, Administer GLUCAGON 1 mg IV or IN, If no response, repeat x 1

Monitor for cardiac arrhythmias and / or arrest.

If airway opened, support ventilations as required and transport ASAP.