Wk 7 - Foreign Body Airway Obstruction

Airway Position

• neutral (neutral anatomical spinal alignment - external auditory meatus to mid clavicle)

• sniffing (ear in line with sternum)

• lateral (on their side)

Back Blows

• heel of the hand on the patient’s back at the height of the base of the scapulae and in line with the spinal column 

• raise a hand and provide a sharp blow rapidly and forcefully 

• deliver in groups of five 

Chest Thrust (Adult & Child)

• palm where CPR would happen and make a fist 

• push hand back into sternum up to 5 times 

Chest Thrust (Infants)

• use two fingers like in CPR, up to 5 times 

Laryngoscope Measurement

Upper incisor > Mandible Angle 

Choking CWI

There are 3 stages to deglutition (swallowing) what are they ? Briefly describe them

1. Oral, voluntary phase : chewing (mastication) of food

2. Pharyngeal, tactile receptors in oropharynx stimulated

3. Oesophageal , peristalsis

Endogenous Causes of Choking

• airway edema from anaphylaxis

• ACE inhibitor-induced angiodema

• mucus plug

• tongue displacement

• infections such as epiglottitis and croup

• laryngospasm

Exogenous Causes of Choking

• FBAO

• trauma, burns, toxic gases 

Upper Airway Anatomy 

Tracheobronchial Anatomy

Vocal Chord Anatomy 

There are 5 steps involved in the pharyngeal phase of swallowing, name 3

- Tongue blocks oral cavity

- Vocal cords close

- Soft palate blocks nasal cavity

- Larynx moves up

- Epiglottis covers the larynx

What is the point of the epiglottis covering the larynx during swallowing

It prevents food from going into the lungs

There are 3 steps involved in the oesophageal phase of swallowing, name them

- Upper oesophageal sphincter opens

- Involuntary skeletal and smooth muscle moves the food bolus downward

- Once bolus has passed, the epiglottis moves upward and opens up again for respiration

Who is at risk of FBAO

• children (anatomy, cognitive differences)

• people with dysphagia

• acs

• neurological problems

What are some differences between an effective cough and an ineffective cough ?

Effective

- Crying or verbal response to questions

- Loud cough

- Able to breath before coughing

- Fully responsive

- Stridor

Ineffective

- Unable to vocalise

- Quiet or silent cough

- Unable to breath

- Cyanosis

- Decreases level of consciousness

There are 4 potential differentials for FBAO, what are they?

Croup, Epiglottitis, Anaphylaxis , Laryngeal spasm

Whilst there are differentials for FBAO, what is the main differences between them and a FBAO

FBAO is sudden onset, other differentials are gradual

For the adult pt, in the upper airway obstruction CPG, it states adult with audible stridor, then it flows into STOP. What are the 2 points under this section of the CPG

MICA must be requested if pt is having an imminent life threatening airway obstruction

This CPG is not for treating stridor associated with anaphylaxis

If a pt is having a suspected foreign body obstruction and is conscious what does the flow chart look like in the upper airway obstruction CPG ?

1. Encourage pt to cough it able to

2. 5 back blows

3. 5 chest thrusts

Alternate the above and monitor pt for deterioration

If a pt is having a suspected foreign body obstruction and is unconscious what does the flow chart look like in the upper airway obstruction CPG ?

1. Laryngoscope and Magic's forceps (to remove obstruction)

If unsuccessful then

Commence chest compressions

If pt looses cardiac output treat as per cardiac arrest

As per the CWI 129 Choking pts, if pt is unconscious and use of Laryngoscopy and magills were not successful, what is the procedure for chest compressions?

1. Ventilate pt 5 times

2. Provide 5 chest compressions

3. Inspect airway again

4. If obstruction still remains repeat 5 chest compressions and inspect airway again

5. Once obstruction is removed, ventilate until spontaneous ventilation is adequate

What is the rationale behind back blows and chest thrusts

Increases intrathoracic pressure which increases pressure in airway and specifically in trachea which forces the obstruction to be dislodged

How to pick up Magills Forceps

Pick up Magill's with the right hand (left should be holding laryngoscope) and grip with thumb and third or ring finger. Index finger should be used to steady forceps.