Paediatric Choking Scenario (ECA)

What does this algorithm consist of?

You feel confident you can begin treatment if required. On arrival, you see the patient across one of the parent’s laps while they attempt back blows. They look terrified. They believe the obstruction may be a grape that the child grabbed while they were cutting others. The child appears floppy and cyanotic. What should be your first priority?

You confirm the patient is conscious, but you are concerned you have limited time. Your Paramedic colleague runs to collect additional equipment and update Control. You take a quick look into the airway but cannot see anything, so you start back blows. Nothing happens, so you begin abdominal thrusts. Where should you place your hands when performing abdominal thrusts on a child? 

Your colleague returns with the equipment you need, but you are making no progress. You suddenly feel the child is no longer holding their weight and is no longer attempting to breathe. The child has become unconscious. You lay them flat on the floor. What is your next priority?

Your colleague checks the airway with the laryngoscope and can see the obstruction at the vocal cords. What tools could they use to remove the obstruction?

They ask for the forceps and are able to quickly remove the obstruction, seemingly in its entirety. What would be your next steps?

You start delivering rescue breaths but notice the chest is not rising during the first two breaths. What should you do?

How many attempts at effective ventilation are recommended before you must move on to start CPR?

You quickly reposition the patient’s airway as it appears they may have been hyperextended. You are now able to see chest rise and fall. You begin compressions. What ratio of compressions to ventilations should you use at this stage?

You begin 15:2 CPR. As you do, the other crew arrives and applies defibrillator pads. What is the recommended number of joules when initially defibrillating a paediatric patient?

During your pulse check, your colleague feels a carotid pulse at approximately 20 bpm, which is confirmed on the monitor. There is no respiratory effort. What is your next action?

You continue one more round of CPR as the pulse remains below 60 bpm. The other crew begin planning extrication and gain IV access just before the next rhythm check. At the next check, the patient’s pulse is 75 bpm. What is the next action? 

You record the following observations: HR 90 and increasing, RR 8, SpO2 100%, BP 101/43, Temp 36.1°C, BM 5.8. What actions should you take while preparing the patient for extrication?

As you place the patient into the ambulance, they improve further with near-normal observations for their age. Their GCS also appears to be improving and is now 9. What should be your destination?

Following a life-threatening event involving any child, it is important to complete appropriate safeguarding documentation regardless of the history or background of the family.