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Time Completed: 02:26:35

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Resuscitation

Question 44 of 180

You are called to attend a 21 year old male patient in ED who the nurse suspects is choking on a snack. Initially he is talking and coughing loudly. Suddenly he is unable to talk and his coughs become silent, although he is still conscious. What is the recommended management in this situation?

Answer:

If the patient shows signs of severe airway obstruction and is conscious:
  • Give up to 5 back blows
    • Stand to the side and slightly behind the patient
    • Support the chest with one hand and lean the patient well forwards
    • Give a sharp blow between the scapulae with the heel of the other hand
  • Check to see if each back blow has relieved the airway obstruction
  • If 5 back blows fail to relieve the airway obstruction, give up to 5 abdominal thrusts
    • Stand behind the patient and put both arms round the upper part of his abdomen
    • Placed a clenched fisty just under the xiphisternum; grasp this hand with your other hand and pull sharply inwards and upwards
  • If the obstruction is still not relieved, continue alternating 5 back blows with abdominal thrusts

Choking

Foreign bodies may cause either mild or severe airway obstruction.

Recognition of Choking

General signs of choking:

  • Attack occurs while eating
  • Patient may clutch neck
Mild airway obstruction in choking Severe airway obstruction in choking
  • Patient able to speak
  • Patient able to cough
  • Patient able to breath
  • Patient able to respond
  • Patient unable to speak
  • Attempts at coughing are silent
  • Patient unable to breathe/breathing sounds wheezy
  • Patient may be unconscious

Treatment of Choking

  • If the patient shows signs of mild airway obstruction:
    • Encourage him to continue coughing, but do nothing else
  • If the patient shows signs of severe airway obstruction and is conscious:
    • Give up to 5 back blows
      • Stand to the side and slightly behind the patient
      • Support the chest with one hand and lean the patient well forwards
      • Give a sharp blow between the scapulae with the heel of the other hand
    • Check to see if each back blow has relieved the airway obstruction
    • If 5 back blows fail to relieve the airway obstruction, give up to 5 abdominal thrusts
      • Stand behind the patient and put both arms round the upper part of his abdomen
      • Placed a clenched fisty just under the xiphisternum; grasp this hand with your other hand and pull sharply inwards and upwards
    • If the obstruction is still not relieved, continue alternating 5 back blows with abdominal thrusts
  • If the patient becomes unconscious:
    • Call the resuscitation team and start CPR
    • As soon as an individual with appropriate skills is present, undertake laryngoscopy and attempt to remove any foreign body with Magill's forceps

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l
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