Resuscitation
Question 94 of 180
A 54 year old man presents to the Emergency Department after a choking episode whilst eating. Which of the following is a sign of severe airway obstruction in choking?
Answer:
General signs of choking:- Attack occurs while eating
- Patient may clutch neck
| Mild airway obstruction in choking | Severe airway obstruction in choking |
|---|---|
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Choking
Resuscitation
Last Updated: 4th August 2021
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 |
|---|---|
|
|
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
- Give up to 5 back blows
- 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 |
