Choking child

Question 1

What are the types of acute upper airway obstruction?

Answer 1

Intrinsic (epiglottis)

Extrinsic (foreign body)

Question 2

What is the most likely aspiration in children?

Answer 2

Extrinsic (foreign body)

Question 3

What level do large objects obstruct?

Answer 3

Carina

- Immediate and dramatic

Question 4

How does choking present in children?

Answer 4

Acute
Sudden onset choking
Coughing
Cyanosis

Question 5

What are the clinical features?

Answer 5

FB aspiration
Stridor and malaise - croup or epiglottitis
Cyanosis
Collapse
Stridor
Marked subcostal and intercostal recession
If epiglottitis (hot potato) suspected, do not examine throat

Question 6

How is a choking child managed?

Answer 6

Are you choking? (assess severity)

If coughing, continue. If not call for help.

Question 7

What is the management for infants

<1 who are choking but not coughing?

Answer 7

Seated position, support head downwards (prone position). Place thumb at angle of lower jaw and one or two fingers at side of jaw.

1. 5 SHARP BACK BLOWS - between shoulder blades with heel of palm. Assess if FB dislodged. If not repeat 5 times
2. If unsuccessful, USE CHEST THRUSTS:
   - turn infant supine + support using full arm underneath their back + hold head.
   - place across thigh
   - 5 SHARP CHEST THRUSTS = using 2 fingers (similar to CPR)

Question 8

What is the management for children >1 who are choking but not coughing?

Answer 8

Place small child across lap. If older put them in a forward-leaning position.

1. 5 SHARP BACK BLOWS - between shoulder blades. Repeat 5 times if FB still lodged.
2. If unseccessful, do ABDOMINAL THRUSTS:
   - Stand or kneel behind child
   -Place arms around torso
   Place clenched fist between umbilicus and xiphisternum
   Grasp hand with other hand and pull sharply inwards and upwards
   Repeat up to 5 times

Question 9

What are the complications?

Answer 9

Inhaled FB
Iatrogenic
Hypoxic brain injury and death

Question 10

Why is ‘inhalded FB’ a type of complication?

Answer 10

Can cause bronchiectasis or lung abscess. 
Persistent cough
Difficulty swallowing
Can feel the FB
SEND TO A&E

Question 11

What test is done to determine inhaled FB?

Answer 11

CXR and bronchoscopy

Question 12

Why is ‘iatrogenic’ a type of complication?

Answer 12

Abdominal thrusts can cause gastric and splenic rupture.

Do abdo exam