You are working alone on an RRV when you are called to a 4-year-old ineffective breathing, choking. On route control update you that there seems to be a lot of panic on the 999-phone call but what is gathered is that a 4-year-old was eating food and has begun choking. Further back up is on route including an Ambulance, Critical Care Paramedic, and BASICS Doctors.
You arrive at scene within 5 minutes to be greeted by a panicked father:
“Please, you have to help, my daughter is in the kitchen. She was eating some chips but she’s started choking. You have to help her please.”
You enter the property with all the kit you can carry and are directed to the kitchen where the child is held over mum’s knees with her patting the girls’ back. Mum is sobbing.
The child is blue around the face with a very poor respiratory effort.
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In classifying the severity of this airway occlusion, what would it be classed as
Looking into the airway there isn’t anything obvious you can see causing a blockage. What is your next action
You give 5 back blows but there is no clearing. What is your next action
Following 5 abdo thrusts there is still no removal of the obstruction. The patient is still somewhat conscious, what do you do next
Following repeat cycles of back blows and abdo thrusts, there has been no clearing of the obstruction, the child is very cyanosed and is now unconscious. What are your next actions
You visualise the vocal cords and see a thick chip wedged in the larynx. Very carefully you use the forceps to grasp the chip and remove it. You manage to clear the obstruction and suction what other bits are present. You begin to reassess the patient again, but they are not breathing and you can’t palpate a pulse.
What do you do now
At what ratio is your CPR
After the initial 5 inflations and 2 minutes of BLS, you check the patient and they are now breathing for themselves and have a palpable pulse. Back up starts arriving and assisting in the treatment and transport of the patient.
In difficult and stressful scenarios, what can help in making treatment organised and structured