You are a double Paramedic crew responding to a 22 year old male who has difficulty in breathing, query choking. You blue light to the address and arrive within 5 minutes. You enter the terraced house and hear calls of panic, a woman is shouting and screaming for help. You enter the kitchen to find her frantically slapping the back of the patient.
“It’s my son, please help him. He’s been eating some grapes, I think he’s choking, somebody please help him.”
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You look at the patient, he is leaning up against a table, ashen in colour, and is making a hoarse gurgling sound from his throat. He looks at you in panic, it looks like he is trying to speak but no sounds are produced. What level of airway obstruction is this
From your initial assessment you can see this is a severe airway obstruction. Looking into the airway you can’t see anything obvious. What first actions should you do
After 5 back blows you look and there is no relief, what actions do you take next
After the thrusts there is still no relief. Your colleague is setting up kit (airway interventions, defib, etc,), what do you continue to do
There is little response to the manoeuvres, your colleague has cannulated, attached defib pads, got airway kit ready, and is continuing to prepare for the worst. What other considerations might you think of to further plan
You request assistance via the BASICS team, and they advise they are 10 minutes away. The patient slumps to the floor unconscious. You are at the head end and your colleague hands you the prepared airway kit. You quickly glance into the mouth and see nothing has dislodged yet. They look at you unsure and ask what can they do, you advise them to
Your colleague starts compressions, you are at the head end with an airway kit rolled out and ready. What do you do
You visualise the vocal chords and see what seems to be the obstruction, a grape sat on the other side of the chords. With the forceps, you try and grasp it but it’s no good and gets pushed further down. The chest compressions push it back up to the chords but with each attempt you fail to grasp it. What is your next action
You sit there with a needle cricothyroidotomy kit ready to do the procedure, what landmark are you looking to insert the needle into
You successfully create a new airway and ventilate the lungs. The patients colour, sats, and other observations respond well, although he remains unconscious. The BASICS doctor arrives and begins assisting you in the care of the patient. You remove the patient to the ambulance and begin a rapid transport to A & E. What other alternative diagnosis may have caused a similar airway obstruction you may have considered