# Aussies only PLEASE



## akflightmedic (May 26, 2009)

Ok me Aussie mates...heres me problem.

Had a delightful debate today regarding FBAO in the conscious victim.

For this discussion, the airway is totally obstructed, no coughing, no breathing, nothing and the patient is conscious.

We had members of several different nations taking part in this discussion and the one that stood out were the Aussies. I also have a few questions I need direct factual support for, not "I think I know" or "I suppose".

I do have a copy of the Australian Resus Council guidelines and if you go by what is written, this is the procedures to be performed.

1. After safety check and confirming the victim is choking
2. Give 5 back blows...you will check in between each back blow to see if there is relief.
3. If this fails, you go to chest thrusts

Pausing now, because it is the chest thrusts that is the crux of the situation.

One said you lay the victim down and perform it like CPR compressions and the other mentioned a side chest thrust.

While I know what is written and you have guidelines to follow, how in the world are you going to convince a panic stricken, hypoxic person to lay down so you can chest thrust???

I asked the Aussies if you could perform them from a behind position and do it like we would do it on a pregnant woman instead of abdominal thrusts. They supposed you could but stated they were instructed to lay the victim down.

Another medic said what is written and what he would do is two different things. For example, he said if the back blows were ineffective, he admits the victim would not lay down and he would go to abdominal thrusts even though they are NOT recommended in Australia. He said he would document otherwise. Why would a system be in place where in order to do the right thing, one must falsify a document to best serve the patient?

He said his hands are tied, because officially all he can do is back blows and knowing the victim wont lay down, he will have to wait until they get WORSE in order to do something more for them, such as chest thrusts or laryngoscope and magills.

Can you please tell me why Australia no longer recognizes abdominal thrusts?
Can you tell me when Australia did away with abdominal thrusts?
Can you tell me why a medic (if following the guidelines as written) would have to wait for the patient to decompensate before being able to assist if the back blows don't work and they don't lay down?

If you have any further questions, please ask away.

Confused in a far away land....


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## Melclin (May 26, 2009)

Last year we were instructed in the university degree that abdo thrusts were now officially frowned upon, from memory, because it was liable to cause damage. 

One of the other guys is probably better suited to answer for sure, but I feel I can offer something as I'm being taught by the people who are driving the change you're talking about. Besides, not many of the aussies other than melbmica seem to pipe up much. Anyway...

In our guidelines for Ambulance Victoria doesn't seem to have an official CPG for the choking adult, which seems a little odd, but I spose its just one of those things that are considered too obvious to write down in the little book. But it does have one for paeds that says "lateral chest thrusts" which I assume to be the same as the chest thrusts you're talking about. I don't recall ever being taught to lay a person down, or at least, we don't _have_ to. If I remember correctly, you face the person, who is turned side on to you. Put their arm over your shoulder so that you are hugging their chest from the side and their arm isn't in the way, then squeeze in sudden bursts. 

PS: you don't happen to have been flying a black hawk around a certain  medic community website have you?


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## mycrofft (May 26, 2009)

*If it please the original poster....comment from U.S....*

total airway embarassment rapidly leads to unconsciousness.


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## AusMed (Jun 4, 2009)

Hi all. From a NSW perspective, if the pt has a total obstruction (no effective coughing) and is conscious we do the 5 back blows (checking between each one). Is not effective 5 chest thrusts. In a conscious pt these are done sitting in a chair/again a solid surface. We are not trained/taught to do abdominal thrusts. 
If the pt is unconscious then we can do it on the floor in a similar way to chest compressions (but with a bit more force and hopefully have IC on the way to use magills).
If the 5 b/b and 5 c/t are not successful we transport urgently to hospital, alternating between b/b and c/t (5 of each again) whilst enroute.


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## Melbourne MICA (Jun 6, 2009)

*Obstructed airway*

I seem to recall that as a last resort in the absence of dislodgement through back blows and chest thrusts,ventilation should be used to force an obstructing object past the cords (or down the trachea) and into the right main bronchus. If unconscious you would of course be using a laryngo blade with magills at the ready, to examine the airway as well.

This would probably be at the point where the pt is now altered conscious or unconscious due to hypoxia. Nicht Wah?

MM


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## AusMed (Jun 20, 2009)

Melbourne MICA said:


> I seem to recall that as a last resort in the absence of dislodgement through back blows and chest thrusts,ventilation should be used to force an obstructing object past the cords (or down the trachea) and into the right main bronchus. If unconscious you would of course be using a laryngo blade with magills at the ready, to examine the airway as well.
> 
> This would probably be at the point where the pt is now altered conscious or unconscious due to hypoxia. Nicht Wah?
> 
> MM



Not mentioned in our training at all.......:unsure:


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## akflightmedic (Jun 20, 2009)

Cheers mates!

Hoo roo!


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