Foreign Body Airway Obstruction

Question 1

What is foreign body airway obstruction (FBAO)?

Answer 1

FBAO is a life-threatening emergency for adults and paediatrics. Although FBAO is more common in the paediatric population, the mortality rate is higher for adults in the prehospital environment.

Question 2

What are the classifications used to describe the severity of a FBAO?

Answer 2

1. Mild airway obstruction:
   - Patients themselves will optimise positioning (e.g. sitting forward)
   - Effective cough
   - Crying or verbal responses present
   - Able to take a breath before coughing
   - Fully responsive
2. Severe airway obstruction:
   - Absent or ineffective cough
   - Unable to vocalise
   - Worsening stridor
   - Quiet or silent chest / unable to breathe
   - Cyanosis
   - Decreasing LOC

Question 3

What are the clinical features that may indicate a FBAO?

Answer 3

History:

• Clutching of the neck
• Sudden dyspnoea, gagging or coughing
• History of playing with / eating small items
• Eating a meal

Examination:

• Respiratory distress with stridor, accessory muscle use, recession & paradoxical breathing
• Restlessness
• Cyanosis
• Unconsciousness
• Bradycardia

Question 4

Outline the standard treatment protocol for FBAO?

Answer 4

Does the patient have an effective cough?

If yes:
Treat as mild airway obstruction:
1. Place patient in a position of comfort
2. Encourage coughing
3. Provide ongoing reassurance
4. Provide supportive cares
5. Closely monitor patient for worsening condition

Question 5

Outline the standard treatment protocol for FBAO?

Answer 5

Does the patient have an effective cough?

If yes,
Manage as mild airway obstruction:
1. Place patient in a position of comfort
2. Encourage coughing
3. Provide ongoing reassurance
4. Provide supportive cares
5. Closely monitor patient for worsening condition

If no,
Manage as severe airway obstruction:
If conscious:
1. Deliver up to 5 back blows 
2. Deliver up to 5 chest thrusts 
3. Repeat if required
4. Ensure ongoing assessment of airway & conscious state 

If unconscious:

1. Remove obstruction under direct visualisation (laryngoscopy/Magills)
2. O2
3. Gently IPPV
4. LMA/ETT
5. Appropriate resuscitation CPG