# Help! Choking! Nothing is working!



## Hockey (Apr 27, 2009)

You're doing the typical choking protocol.  Lets say its a 95% airway obstruction. Heck, even 100% Nothing is working.

In one of my CPR classes a while back, the instructor said if absolutely necessary, and you have exhausted ALL methods, take a deep breath and blow into that persons mouth trying to "blow the object into their lungs."  

Reasoning?  Because the airway is open now at least, and as she said "we can go in later and get that object out" of the lungs or where ever it wants to travel.

Thought that was odd, but seems like it could work enough to save someones life.  

 Anyone hear of this?  Explain more?  Only for a layperson really?


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## Shishkabob (Apr 27, 2009)

Abd thrust until unconcious, then right in to chest compressions, then the CPR routine takes over where you try to blow in and around the obstruction.


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## JPINFV (Apr 27, 2009)

Err, hasn't unconscious chocking included breaths for a while now (as in pre-2005 guidelines). Essentially it's like rocking a stuck car back and forth until it breaks free.


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## LAS46 (Apr 27, 2009)

Hockey9019 said:


> You're doing the typical choking protocol.  Lets say its a 95% airway obstruction. Heck, even 100% Nothing is working.
> 
> In one of my CPR classes a while back, the instructor said if absolutely necessary, and you have exhausted ALL methods, take a deep breath and blow into that persons mouth trying to "blow the object into their lungs."
> 
> ...



I am sorry but if you blow the object into the lungs intentionally then you are at risk for a law suit... And that object being in the lungs can cause further injuries to the person... depending on what type of object it is, it may even puncture the lung or lungs or any number of things on the way down... I would recommend that you do not do as that instructor said. Follow the AHA protocol on what should be done while a person is choking. 


> AHA Recommendation
> 
> Abdominal thrusts (also known as the “Heimlich maneuver” (HIM'lik mah-NOO'ver) are a series of under-the-diaphragm abdominal thrusts. They’re recommended for helping a person who's choking on a foreign object (foreign-body airway obstruction).
> 
> ...



As also stated by another person above you should give Abd thrusts until the person goes unconscious then switch to CPR. For any children under the age of 1 you must follow the procedure for clearing their airway.

Hope this gives you some information.

Dustin C.
MFR & NREMT-B Student


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## MtJerry (Apr 27, 2009)

Your instructor is an idiot.


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## Mountain Res-Q (Apr 27, 2009)

I'm sorry, but I don't believe this Instructor is completely wrong.  Consider the sequence of events in an unconscious victim:

Attemtp to rouse the pt.  NOTHING.

Look, Listen, Feel for breaths.  NOTHING

Grab an BVM and give two breaths.  Oops!!!  What if the man was down becsaue of a completely obstructed airway?  You could have (doubt it) just launched the item down to the lungs.  Are you gonna get sued for following accepted protocol?

HOWEVER, if the pt was conscious and recieving abdominal thrusts and then goes unconscious, what do you do?

A combination of chest comressions, breaths, and oral checks.  You give the breaths every so often to see if the item dislodged and you can now give the pt life saving oxygen.  What if one of those compressions dislodged the item just enoguh for the breaths to send it down to the lungs (doubt it but it could happen).  Did we screw up?  No, followed the accepted AHA CPR guidelines and we saved a life!!!  

HOWEVER, if this instructor is recommending blowing the item down the throat of a conscious victim, then, yes... IDIOT!!!  FOLLOW ACCEPTED CPR GUIDLINES ALWAYS!!!!!


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## MtJerry (Apr 27, 2009)

Mountain Res-Q said:


> I'm sorry, but I don't believe this Instructor is completely wrong.  Consider the sequence of events in an unconscious victim:
> 
> Attemtp to rouse the pt.  NOTHING.
> 
> ...



I'd be inserting a combi-tube before I started with a BVM ... and I was referring to the instructor as you noted in your last sentence.


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## VentMedic (Apr 27, 2009)

Hockey9019 said:


> In one of my CPR classes a while back, the instructor said if absolutely necessary, and *you have exhausted ALL methods,* take a deep breath and blow into that persons mouth trying to "blow the object into their lungs."
> 
> Reasoning? Because the airway is open now at least, and as she said "we can go in later and get that object out" of the lungs or where ever it wants to travel.


 
This would mean the object may already be subglottic and other attempts including forceps can not reach it. The thought behind this is to get the object out of the trachea into one of the bronchi and that may enable you to ventilate one lung. If the object is supraglottic, forceps should be used in an attempt to remove it. 

The next step for ALS would be a cric. If the object is in the trachea below the incision site, it may still have to go into one of the bronchi to achieve some ventilation. 

However, as a layperson and EMT-B, you have few to no options. This method would again only be at a very, very last resort with no ALS available or the ability to move the patient to a higher level of care. 

Yes, in the hospital we do occasionally go in to remove objects that have slipped past the cords, especially in children, to occlude one of the bronchi.


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## Mountain Res-Q (Apr 27, 2009)

MtJerry said:


> I'd be inserting a combi-tube before I started with a BVM ... and I was referring to the instructor as you noted in your last sentence.



No combi-tubes for EMTs in California, sorry.  Exhausting all available methods doesn't include that for me, I'm left to follow good old basic AHA CPR guidelines.

But the instructor is right, *when all else fails*, an obstruction further in the lungs is better than a complete upper airway obstruction.  At least they can now get some O2 moving again.  But it should never be a first option, and I don't think it was taught that way.


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## LAS46 (Apr 27, 2009)

Mountain Res-Q said:


> No combi-tubes for EMTs in California, sorry.  Exhausting all available methods doesn't include that for me, I'm left to follow good old basic AHA CPR guidelines.
> 
> But the instructor is right, *when all else fails*, an obstruction further in the lungs is better than a complete upper airway obstruction.  At least they can now get some O2 moving again.  But it should never be a first option, and I don't think it was taught that way.



If you want full ability to use Advanced Airways, Colorado allows EMT-B and B+ to use Advanced Airways such as, Combi-tubes, LMA's, King Tubes. And I still disagree with 





> an obstruction further in the lungs is better than a complete upper airway obstruction.


because if you do this you may be causing further injury to your patient. You need to think about what is best for your patient, in that case I could use a NPA and a pocket mask and ventilate as best as I could and do a rapid transport or do a hand off to a ALS unit who then has more possibilities for getting the object out or gaining access to the esophagus to ventilate your patient.

If you do as the instructor is tell you to do above then you are at a high risk of law suits and also further injury or even death to your patient.

Dustin C.
MFR, NREMT-B Student


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## Mountain Res-Q (Apr 27, 2009)

LAS46 said:


> *If you want full ability to use Advanced Airways*, Colorado allows EMT-B and B+ to use Advanced Airways such as, Combi-tubes, LMA's, King Tubes. And I still disagree with an obstruction further in the lungs is better than a complete upper airway obstruction.
> 
> because if you do this you may be causing further injury to your patient. You need to *think about what is best for your patient*, in that case I could use a NPA and a pocket mask and ventilate as best as I could and do a rapid transport or do a hand off to a ALS unit who then has more possibilities for getting the object out or gaining access to the esophagus to ventilate your patient.



How does a protocol system set up in Colorado callow me in California to use advanced airways?  

How can you disagree with "an obstruction further in the lungs is better than a complete upper airway obstruction."  A complete airway obstruction results in death if not resolved pretty damn quick... didn't they teach ya that?  What's worse than death?  What is the in the best interests of a patient... to die?  So you us an NPA and a pocket mask (no BVM in your advanced system) with what result?  You either move no air and the pateint eventually dies (same as if you did nothing), or the force of your breaths helps dislodge the object (along with compressions), in which case it is possible that the item could still be kicked down towards the lungs (again, doubtful).  I think you aren't really reading or understanding what was said earlier.  If you have a complete obstruction you do abdominal thrusts until the pateint goes unconscious and then you do a combination of chest compressions and breaths (you should already be using an NPA and BVM to do so at the BLS level and even if you can use combi-tubes... isn't there a chance that you will dislodge the obstruction and push it further down?).  I fail to see much logic in your argument.  Unemployed First Responder, huh...


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## daedalus (Apr 27, 2009)

> because if you do this you may be causing further injury to your patient. You need to think about what is best for your patient, in that case I could use a NPA and a pocket mask and ventilate as best as I could and do a rapid transport or do a hand off to a ALS unit who then has more possibilities for getting the object out or gaining access to the esophagus to ventilate your patient.


Lol, would this not be the same thing as what the OP said? The OP said that after a FBAO patient goes unresponsive, that his last resort would be forceful positive pressure ventilation, in a desperate attempt to get air into those lungs. You are saying the same thing he is with the "ventilate as best I could" line. And why would you be concerned about causing injury to lung tissue? If your patient is not breathing, you cannot possibly hurt them more.

Quick lesson. Primum non nocere (First, do no harm) does not apply to situations like this. The philosophy of primum succurrere (First, hasten to help) is used in a situation where potential harm may come to the patient from treatment, but treatment is a matter of life or death.


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## Mountain Res-Q (Apr 27, 2009)

daedalus said:


> *Lol, would this not be the same thing as what the OP said*? The OP said that after a FBAO patient goes unresponsive, that his last resort would be forceful positive pressure ventilation, in a desperate attempt to get air into those lungs. You are saying the same thing he is with the "ventilate as best I could" line. And why would you be concerned about causing injury to lung tissue? If your patient is not breathing, you cannot possibly hurt them more.
> 
> Quick lesson. Primum non nocere (First, do no harm) does not apply to situations like this. The philosophy of primum succurrere (First, hasten to help) is used in a situation where potential harm may come to the patient from treatment, but treatment is a matter of life or death.



Ha, Ha, "But I've got a shinny new MFR card and a brand new EMT-B textbook, so I thought that I understood the protocols and have a beter educated grasp on things than everyone else.  So I had to repeat and agree with what everyone else said while disagreeing with it so that I could flaunt my new found knowledge."

It all boils down to the leser of two evils.  Yes, no one should intentionally try to push he obstruction into the lungs, especially as a first resort.  But, if in the process of following the BLS standards that we all know and certify on every 2 year, we accidnetly send the obstruction down rather than up, so be it... Death is harder to cure than retrieving the object.


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## Shishkabob (Apr 27, 2009)

Dunno about you las, but the esophagus is about the last thing I want to ventilate in a pt, choking or not 


Chrich pressure!!


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## boingo (Apr 27, 2009)

As vent stated, if the object is subglottic, you don't have many options in the field, hell, not many in the ED either.  Attempt to force the obstruction into the R mainstem which will allow you to ventilate one lung, cut the end off an ETT and attach a meconium aspirator and attempt to use suction to grasp the object and remove it, or drive fast.  A surgical approach, at least one at the cricothyroid membrane is unlikely to be effectiv as the obstruction is likely south of your incision.  So, the OP's instructor is more right than not, in my opinion.


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## JPINFV (Apr 27, 2009)

LAS46 said:


> do a hand off to a ALS unit who then has more possibilities for getting the object out or gaining access to the esophagus to ventilate your patient.



Hey, after we get done ventilating the esophagus we can get the ICU to insert a feeding tube down the trachea.


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## LAS46 (Apr 27, 2009)

JPINFV said:


> Hey, after we get done ventilating the esophagus we can get the ICU to insert a feeding tube down the trachea.



I got my words mixed up... I am in the middle of studyin for a test and I seen the word esophagus and got it mixed up... What I meant was trachea... sorry.

Dustin C.
MFR, NREMT-B Student


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## JPINFV (Apr 27, 2009)

LAS46 said:


> I got my words mixed up... I am in the middle of studyin for a test and I seen the word esophagus and got it mixed up... What I meant was trachea... sorry.
> 
> Dustin C.
> MFR, NREMT-B Student



No worries. Don't take junk like that personal. Everyone has made some sort of bone head mixup at some time or another and we all deserve to get called on it and laugh about it.

As to your posts. You either missed the 'last resort' concept of the original post, or you're failing to understand that not everything can be answered through protocols and 'the book.' Patients are notorious for not reading the book and throwing providers curve balls. Unfortunately, this means that some times a little harm is done for the greater good. Otherwise there wouldn't be surgeries, amputations, blood donations, or a ton of other medical procedures. Heck, even starting an IV could be considered to momentarily harm a patient.  

Heck the 'I'll use a pocket mask and do the best I can do' would get the same result as the actions the OP is asking about.


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## Jeremy89 (Apr 27, 2009)

As I understood it, if the pt goes unconscious, a finger sweep is recommended, as the loss of consciousness may relax the muscles of the pharynx, thus releasing the object.  If nothing is seen or felt, then proceed to give 2 rescue breaths


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## ffemt8978 (Apr 27, 2009)

Jeremy89 said:


> As I understood it, if the pt goes unconscious, a finger sweep is recommended, as the loss of consciousness may relax the muscles of the pharynx, thus releasing the object.  If nothing is seen or felt, then proceed to give 2 rescue breaths



We don't do blind finger sweeps anymore...haven't for several years.  If you see the object, then you can attempt to remove it...otherwise keep your fingers out of their mouth.


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## Mountain Res-Q (Apr 27, 2009)

Jeremy89 said:


> As I understood it, if the pt goes unconscious, a finger sweep is recommended, as the loss of consciousness may relax the muscles of the pharynx, thus releasing the object.  If nothing is seen or felt, then proceed to give 2 rescue breaths



The last time I saw fingure sweeps in protocol was about 7 yers ago, about the same time a good friend of mine, Willaim Rogers, went on medical leave... we call him Two-Fingured-Willy now!  ^_^


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## Jeremy89 (Apr 28, 2009)

ffemt8978 said:


> We don't do blind finger sweeps anymore...haven't for several years.  If you see the object, then you can attempt to remove it...otherwise keep your fingers out of their mouth.



er....uh, yeah, I knew that....


See what happens when you don't use your prehospital skills??


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## LAS46 (Apr 29, 2009)

Jeremy89 said:


> er....uh, yeah, I knew that....
> 
> 
> See what happens when you don't use your prehospital skills??



Don't worry about it Jeremy, We all forget things every now and then.


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## marineman (Apr 29, 2009)

Mt Jerry, what system do you work in that has you inserting a combitube before attempting to give 2 breaths? Has your medical director even had boy scout first aid training?


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## Mountain Res-Q (Apr 29, 2009)

marineman said:


> Mt Jerry, what system do you work in that has you inserting a combitube before attempting to give 2 breaths? Has your medical director even had boy scout first aid training?



Maybe someone is reading the cookbook backwards.


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## SES4 (Apr 29, 2009)

*Woah!*

Woah.  Blow foreign object INTO the lungs?!?!  

Can we say ASPIRATION?!?!  Yikes.  Seriously, it is quite disturbing to me that the instructor would tell you to do this.


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## JPINFV (Apr 29, 2009)

Aspiration or asphyxia. Pick one and only one.


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## Mountain Res-Q (Apr 29, 2009)

JPINFV said:


> Aspiration or asphyxia. Pick one and only one.



I'll take "I don't want to die, and will deal with the apiration" for $200 Alex.  ^_^  What part of "as a last resort" "when all else fails" is in question?


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## SES4 (Apr 29, 2009)

*Just saying LOL*

LMAO. Just saying.... Aspiration here "we" come!  

Hypoxia is NOT my preference either!


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## boingo (Apr 29, 2009)

Well, one of the options will definately kill you....choose the other one.


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## mycrofft (Apr 30, 2009)

*Like daedalus said.*

Maybe the instructor was a little graphic, but if you follow the routine, that will follow if you try to ventilate forcefully enough.
Just don't waste time *****footing around with mousebreaths.
Just as a bolus can be dislodged by CPR compressions if it has truly sealed the airway (no one way valve function).

makes you wish you could adminsiter an oxygenated fluid.

Oh, PS: if it's 100% occluded when they call for help, there's a good likelihood you will not get there in time to save them anyway.


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## Aidey (Apr 30, 2009)

I was taught that in the absence of the ability to crich the patient, inserting a ET tube and forcing the obstruction into the right mainstem and then pulling the ET out enough to ventilate the left lung was an acceptable procedure. Yes you are causing them to aspirate, but as has been said, the alternative is letting them die.


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## AJ Hidell (Apr 30, 2009)

The main problem here is that the instructor is either ignorant of basic respiratory anatomy, or else he failed to use the proper terminology to make a cogent point.  Consequently, people are arguing a moot point.  But even so, he was on the right track.

Anything big enough to block the trachea is not going to get blown into the lungs. The respiratory tract gets smaller as it descends, not bigger. The farthest an object that sie will make it is the mainstem bronchus. Anything small enough to go farther wouldn't have obstructed the trachea in the first place. It won't cause aspiration pneumonia in the bronchus.  And it is easily retrieved by bronchoscopy. But only if they live to make it to the hospital. And in order for that to happen, you have to first get it out of the trachea.  Blowing it down is an acceptable way of doing that when conventional methods fail.

I also like JPs analogy of rocking a stuck car back and forth until it breaks free.  Whether it breaks free north or south, it is still free, and your have established an airway.


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## mycrofft (Apr 30, 2009)

*Many good points.*

We need to remember also that most airway embarassments include or are nearly 100% epiglottal. If a tiny irritant like dust or an errant sip of water can slam it shut, what about a pea-sized...well, PEA!. Or a half-cup of Granny's mashed potatos! The airway clearance protocols are aimed at this vast-majority factor.

What about fluids like vomitus, blood, mucus, water?


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## MtJerry (Apr 30, 2009)

marineman said:


> Mt Jerry, what system do you work in that has you inserting a combitube before attempting to give 2 breaths? Has your medical director even had boy scout first aid training?



You are jumping to conclusions that were not referred to.  I was referring to obtaining a patent airway before using a BVM and nothing more.

In a choking patient, I understand that this may not be possible.

After reading some of the recent posts, i guess I could see the value of asperation vs. death, however, we should be emphasising the need to get the object out if possible.  I think AJ Hidell makes a good point:



> Anything big enough to block the trachea is not going to get blown into the lungs. The respiratory tract gets smaller as it descends, not bigger. The farthest an object that sie will make it is the mainstem bronchus. Anything small enough to go farther wouldn't have obstructed the trachea in the first place.



But I think the original poster was talking about what he was taught by a CPR instructor.  If this were a course for the general public, he is teaching them to do something that could cause them to be sued.  There is NO REFERENCE to this procedure in the materials of the American Red Cross nor the American Heart Association.  If the layperson were to do as he instructed, they would be outside of the protection of the Good Samaritan Laws.


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## VentMedic (Apr 30, 2009)

Aidey said:


> I was taught that in the absence of the ability to crich the patient, inserting a ET tube and forcing the obstruction into the right mainstem and then pulling the ET out enough to ventilate the left lung was an acceptable procedure. Yes you are causing them to aspirate, but as has been said, the alternative is letting them die.


 
To aspirate is to get something below the cords. If you are using an ETT, I would hope you also have forceps to grap anything above the cords. If the object is below the cords, then the patient has already aspirated the object. You are merely trying to dislodge or move the object to a sight that allows you to ventilate.

BTW, this is also why a cuff on a trach or an ETT does not prevent aspiration. If the vomit or whatever makes it to the cuff, it is below the cords and in the lungs.   Having the tube just makes it easier to suction out.


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## zappa26 (Apr 30, 2009)

mycrofft said:


> What about fluids like vomitus, blood, mucus, water?



Suction, no?


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## marineman (May 1, 2009)

MtJerry said:


> You are jumping to conclusions that were not referred to.  I was referring to obtaining a patent airway before using a BVM and nothing more.
> 
> In a choking patient, I understand that this may not be possible.
> 
> ...



How do you know it's patent if you don't test with a BVM? 

Not sure what conclusion I jumped to, you quoted a post outlining appropriate ABC assessment, emphasized the section about giving 2 breaths with a BVM and said you would insert a combitube first.


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## BossyCow (May 1, 2009)

I'm amazed at how many taught layperson CPR and FBAO with Red Cross and AHA are coming up with this type of misunderstanding. The rescue breath attempts are not attempts to dislodge the item with your breath or the BVM. These are not pressure washers or air compressors. It is an attempt to determine if there is any air getting around the object. 

If the object is dislodged with a rescue breath, the object should have been able to be dislodged by either the abd thrusts or chest compressions. The current standard for breathing is not a gale force wind but a breath. This is the type of education we get from CPR instructors trained in how to present a video, not on how to perform CPR.


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## cshaw84 (May 1, 2009)

Hello everyone.  I ran across this page while reviewing BLS protocols before my clerkships and I'd like to share a few comments to help defray misconceptions.

*Do not attempt to blow an object into a patient's lungs*
Short version: You are unlikely to progress a tracheal obstruction fully into a bronchus.  By doing so, you make it less likely that you will be able to expel the obstruction by abdominal thrusts.

- Anatomy and Physiology -
From a physiologic standpoint, the idea of pushing an obstruction from the trachea into a bronchus is sound in a 100% blocked situation _with an unconscious patient_.  50% lung capacity is definitely better than no gas exchange at all.  Ultimately, the further down the bronchial tree you can advance the obstruction, the more gas exchange can occur.  

If the patient is conscious, you obviously want to encourage coughing, use abdominal thrusts, and give supplemental oxygen if indicated.  Do not administer artificial ventilation.

AJ Hidell brings up an excellent point that the bronchial tree becomes narrower as you go further down.  This is certainly true.  In fact, it's also likely that you'd get the obstruction stuck at the bifurcation.  On a side note, one should also remember that the tracheal rings and the larger bronchial rings are made of cartilage, which is somewhat flexible.  Furthermore, more terminal bronchi do not have cartilaginous rings.  This isn't to say that you can jam anything down the tubes by simple pressure, but it is possible that a malleable obstruction (ei. food) could be forced down further.

If an obstruction were to be advanced into a main stem bronchus or lesser bronchi, it is statistically more likely to go into the right main stem bronchus and then the right lower lobe for anatomical reasons.  The possible sequelae of an aspirated object within the lungs are obviously minor in comparison to death.  The most common serious outcome would be a bacterial pneumonia, which can ultimately be treated with antibiotics.  The most fatal possibility would be respiratory distress syndrome (RDS), but that is fairly uncommon and, again, is minor in comparison to death.

- Main Point -
Now, in terms of EMS, I would suggest *AGAINST[/U]* such a procedure on the largely grounds of lawsuit and malpractice.  There are also limited chances of being able to progress the obstruction and it could possible limit other advanced therapies.  My recommendation will be to follow your service's protocols.  Now, if you "accidently" blow too hard on a rescue breath, it may or may not be beneficial to the patient, but there is also serious risk of detriment to the patient's condition.  Another danger is the progression of a pre-cricoid or cricoid obstruction further down the esophagus, which could eliminate the possible benefit of a field cricothyrotomy.

Moral of the story:  It may make sense, but don't do it.

I welcome any comments or questions.  
(I was in a hurry, please excuse any typos)

C.S.
Former EMT
3rd year medical student (allopathic)


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## trevor1189 (May 1, 2009)

MtJerry said:


> Your instructor is an idiot.



+1 Oh my god...


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## emt4me (Nov 2, 2010)

*Possibility of using forceps or similar device for retrieval?*

Thank you all for the very interesting thread.

I have a few questions regarding attempting to retrieve a lodged piece of meat in the throat while choking (conscious or unconscious).

When would you resort to using forceps or alike to attempt to grab the item and how often does this work? Usually, is this effective? What makes this not so effective?

Typically when choking, does the blockage hold the epiglottis closed or does the blockage get past the epiglottis and into the trachea?

Do EMT's have any tools to visualize a blocked airway? Can you look into a victims mouth or generally the back of the throat with a light or such? 

What, if any tools do the emergency rooms have to retrieve items from blocked airways?

How often is Heimlich ineffective?

Thanks for reading... sorry for the vague questions.


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## firetender (Nov 2, 2010)

*Here's a Trick for y'all!*

With a large chunk of something obstructing the airway, McGill forceps are an acceptable tool but forceps of any kind will be a port in a bad storm.

If after all the usual attempts fail (and your patient is getting bluer) position the patient, tilt the head back, open the mouth wide and then have someone press into the patient's abdomen.

The pressure often will make the obstruction (usually meat or something with "body" *bulge out*, allowing you to get a grip with the forceps or, if you have to, whatever.

In this case, anything you can do to promote visualization will help; what  you are actually going for is traction. 

I've used laryngoscope blades for the light, a partner for the pushing and forceps for the snag successfully a couple times.


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## emt4me (Nov 4, 2010)

*more on blocked airways*

firetender... Thank you for the helpful hints.

I am studying blockages in the airway and have yet to have a real case to learn from. My big question is, how often is a bolus of meat (or food) in an airway actually retrieveable.

Does the epiglottis ever preclude traction on the item?

How often can you see the blockage and is it usually holding the epiglottis closed or is it generally completely past the epiglottis and into the larynx (i.e. sitting on top of the vocal cords)?

Thanks.


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## firetender (Nov 4, 2010)

emt4me said:


> firetender... Thank you for the helpful hints.
> 
> I am studying blockages in the airway and have yet to have a real case to learn from. My big question is, how often is a bolus of meat (or food) in an airway actually retrieveable.
> 
> ...


 
The structure of the epiglotis is such that it is a moveable flap OVER the trachea that acts like a hinged garbage lid. Below it is the "hole" of the trachea which has two "ropes" stretching across it, kind of looking like this if you complete the circle, top and bottom.

( I   I ) 

Most obstructions are minor and can be handled without visualization through Heimlich. The ones that are problematical are those where the "bolus" is big enough to be stuck between the vocal cords and press them out to the sides, completely filling the void.

If it's that big, it will usually have gained traction on the vocal cords, therefore have enough of its matter keeping the epiglotis OPEN.

You'll see an opened epiglotis "flap" open wide with NO vocal cords or tissue visible, only the obstruction.

In the unlikely possibility that the epiglotis is held "shut" then you need a laryngoscope to rise the flap and get under it to see what's up...er...what's down...um...what ain't quite in or out.


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## JPINFV (Nov 4, 2010)

^
Since a picture is worth a thousand words, especially when it comes to anatomy...

Link directly to the fiberoptic bronchoscope. 
http://www.youtube.com/watch?v=bDRTzmuwMnQ#t=2m19s

[youtube]http://www.youtube.com/watch?v=bDRTzmuwMnQ#t=2m19s[/youtube]


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## CAOX3 (Nov 5, 2010)

LAS46 said:


> I am sorry but if you blow the object into the lungs intentionally then you are at risk for a law suit... And that object being in the lungs can cause further injuries to the person... depending on what type of object it is, it may even puncture the lung or lungs or any number of things on the way down... I would recommend that you do not do as that instructor said. Follow the AHA protocol on what should be done while a person is choking.


 

Is there further injuries then dead?

If I hear one more thing about avoiding a lawsuit.....My God. How do you do your job if everyone is so worried about being sued all the time?

Do whats best for your patient.


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## firetender (Nov 6, 2010)

JPINFV said:


> ^
> Since a picture is worth a thousand words, especially when it comes to anatomy...


 
Good idea; there I was looking for some dirt to draw on! It was tough enough figuring which symbol most looked like vocal cords!
Was that related to television?

Oh, I hope you told him not to try this at home.


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