San Mateo County Emergency Medical Services Airway Obstruction/Choking For any upper airway emergency including choking, foreign body, swelling, stridor, croup, and obstructed tracheostomy

History Signs and Symptoms Differential • Sudden onset of shortness of breath/coughing • Sudden onset of coughing, wheezing or gagging • Foreign body aspiration • Recent history of eating or food present • Stridor • Food bolus aspiration • History of stroke or swallowing problems • Inability to talk • Epiglottitis • Past medical history • Universal sign for choking • Syncope • Sudden loss of speech • Panic • Hypoxia • Syncope • Pointing to throat • Asthma/COPD • Syncope • CHF exacerbation • Cyanosis • Anaphylaxis • Massive pulmonary embolus

If SpO ≥ 92% Concern for airway 2 No Routine obstruction? Medical Care

Yes

Assess severity

Mild Severe (Partial obstruction or (significant obstruction or effective cough) ineffective cough)

Encourage coughing If standing, deliver abdominal thrusts or If supine, begin chest compressions SpO2 monitoring E E Supplemental oxygen to Continue until obstruction clears or patient maintain SpO2 ≥ 92% arrests Monitor airway Magill forceps with video laryngoscopy

P Magill forceps with direct laryngoscopy

Monitor and reassess Cardiac monitor Monitor for worsening signs and symptoms

Cardiac Arrest

Notify receiving facility. Consider Base Hospital for medical direction

Pearls • Bag valve mask can force the food obstruction deeper • If unable to bag valve mask, consider a foreign body obstruction, particularly after proper airway maneuvers have been performed • For obese and pregnant victims, put your hands at the base of their breastbones, right where the lowest ribs join together • If foreign body is below cords and chest compressions fail to dislodge obstruction, consider intubation and forcing foreign body into right main stem bronchus. Treatment Protocol R01 Page 1 of 1 Effective November 2018Effective October 2019