Resuscitation
Question 150 of 180
You are called to attend a 34 year old female patient in ED who the nurse suspects is choking on a sandwich. She is talking in short sentences, interspersed with loud coughs and clutching at her neck. Her observations are heart rate 96 beats per minute, RR 25 breaths per minutes and BP 145/89. What is the recommended management for this patient?
Answer:
If the patient shows signs of mild airway obstruction encourage them to continue coughing, but do nothing else.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 |
