1. Tired of seeing ads? Click here to register today and the ads go away. It's completely FREE, too!
    Dismiss Notice
  2. Can't find what you're looking for? Use the search bar in the upper right corner.
    Dismiss Notice

Choking pt becomes unconscious...inserting an airway?

Discussion in 'BLS Discussion' started by Mya, Oct 3, 2017.

  1. Mya

    Mya Forum Crew Member

    44
    6
    8
    Education:
    EMT
    I recently took a BLS CPR class to renew my cert and the instructor told us that after some time if the patient has no chest rise and fall and the object is still there, that ALS will insert an advanced airway and just push the object into the lungs.

    1. If there's no ALS (I'm an EMT) do we just insert and OPA in this case?

    2. How long do we wait until inserting an airway?
     
  2. luke_31

    luke_31 Forum Asst. Chief

    668
    214
    43
    Education:
    Paramedic
    First off if they are choking don't place an OPA in the airway, it won't move the object into the lungs and allow air to go in. All you will do is block the airway even more, as the object will now have no way to come up as you are doing CPR to try and dislodge it. I'd say I would almost never insert an advanced airway to shove a object further in the lungs, it would make it that much harder for a doctor to get out, plus lead to more complications for the patient. Maybe the instructor was referring to Magil forceps, which can grab a object in the airway if the ALS provider can visualize it with the laryngoscope.
     
    wanderingmedic likes this.
  3. EpiEMS

    EpiEMS Forum Deputy Chief

    3,036
    778
    113
    Education:
    EMT
    I thought it was not uncommon to use the ETT to force an object into the right mainstem bronchus then intubate the left *if all other measures fail*.
     
    Aprz and DesertMedic66 like this.
  4. Chase

    Chase Flight Nurse

    3,046
    647
    113
    Education:
    EMT
    Correct. If patient has FBO that can not be retrieved with Magils the intubate and attempt the push the object distally and ventilate. Happens in pediatrics occasionally.
     
    Aprz, Gurby and DesertMedic66 like this.
  5. DesertMedic66

    DesertMedic66 Forum Troll

    9,463
    2,101
    113
    Education:
    Paramedic
    If you can’t remove the object what is going to be the better option? Not ventilate the patient because of the obstruction so the patient is not getting any oxygen or to either push the object to one side or even push the tube through the object so you can ventilate the patient?
     
  6. luke_31

    luke_31 Forum Asst. Chief

    668
    214
    43
    Education:
    Paramedic
    It's been a while since school and couldn't remember learning that part, but it's not a bad last ditch effort. Not something I'd want to ever have to do but at least it's now in my bag of tricks if it needs to be done.
     
  7. PassionMedic

    PassionMedic Forum Crew Member

    44
    11
    8
    Education:
    Paramedic
    If your patient has gone into respiratory arrest, I would treat by protocol (OPA/NPA) until ALS arrived/you arrive at the hospital. I would NOT wait to insert an airway if your pt isn't breathing. If the obstruction didn't dislodge with Any interventions before unresponsiveness, I doubt it will dislodge on its own, and preventing the tongue from further obstructing the airway and providing supplemental oxygenation/ respirations are the most effective thing an EMT can do for that pt.


    Sent from my iPhone using Tapatalk
     
  8. SpecialK

    SpecialK Forum Captain

    402
    136
    43
    AFAIK most services' in Australasia have moved laryngoscopy for airway obstruction down to base level; honestly it's not hard to do, and the disposable laryngascopes are pretty cheap. It's literally just literally having to look in the larynx for e.g. a big piece of sandwich and hook it out with a pair of forces. For the want of maybe $50 can literally be the difference between life and death.

    I can't see a reason not to do it so you blokes might want to follow suit.
     
  9. Akulahawk

    Akulahawk EMT-P/ED RN Community Leader

    4,084
    665
    113
    Education:
    Paramedic
    At the BLS level, you just keep attempting the BLS maneuvers to clear that airway until ALS shows up. ALS will then attempt to remove the obstruction and if that is not possible, you go to your next best option. That may be doing a needle cric or a surgical cric or if neither is immediately available to you, attempt to shove the obstruction into a mainstem and ventilate the other lung. I would rather have a living patient that needs reasonably immediate surgery to remove the object than a patent that's dead because I wanted to prevent the patient getting an infection or having to undergo emergency surgery.

    Hopefully the laryngoscope and Macgill foreceps are sufficient!
     
    Gurby likes this.
  10. Specialized

    Specialized Forum Probie

    27
    7
    3
    Education:
    EMT
    If your pt was choking and is now unconscious, yeah as everyone said above follow your local protocol and use BLS adjuncts. Insert your OPA and use high flow O2 via NRB or BVM and provide chest compressions if pt is pulseless and apneic. Hook up to AED and get a shock on board.

    For some reason, the use of an NPA crossed my mind but that wouldn't make any sense in this situation..
     
  11. SpecialK

    SpecialK Forum Captain

    402
    136
    43
    Why piss-arse around with an OPA or bag and mask ventilation? How is the insufflatory volume supposed to get past the obstruction in the larynx?

    As for CPR, yes, CPR is the go-to for an unconscious person; why? because good, hard CPR will decrease the thoracic volume and raise PA above PB which is exactly what we want to happen so whatever ERV or FRC this guy has can be used to dislodge the obstruction.

    Of course, a much better idea is to just get the disposable laryngoscope and forceps for everybody like has been done in Australasia.
     
  12. Remi

    Remi Forum Deputy Chief Premium Member

    3,317
    1,933
    113
    Education:
    Paramedic
    Actually, an NPA makes good sense. It won't relieve the obstruction, but no matter what you need to maintain a patent upper airway. An NPA makes that easier, and is probably a better idea than an OPA because once ALS arrives the first thing they are going to do is laryngoscopy, which would require removal of the OPA anyway.

    How often are you successful in using Magills to relieve a complete airway obstruction that has progressed to unconsciousness? My guess is not very. That's because in adults, any obstruction that can't be dislodged with coughing and abdominal compressions is probably subglottic, which means it can't be reached with Magill forceps. Almost any obstruction at the level of the glottis can be dislodged non-invasively, which is why these are (thankfully) such rare events.
     
    Gurby likes this.
  13. Specialized

    Specialized Forum Probie

    27
    7
    3
    Education:
    EMT
    Oh okay gotcha. However, would this pt still be getting adequate ventilation's if you were bagging them with 21%/100% oxygen? I have this feeling that the foreign object in the airway would be causing some resistance and hinder tidal volume while using a bvm?
     
  14. Remi

    Remi Forum Deputy Chief Premium Member

    3,317
    1,933
    113
    Education:
    Paramedic
    If it is truly a complete obstruction, then no, they won't be getting any gas exchange at all. But you still want to keep the upper airway open in case the obstruction becomes incomplete.
     
    Specialized likes this.
  15. RocketMedic

    RocketMedic Just Like Otters!

    3,424
    741
    113
    Education:
    Paramedic
    The 'definitive fix' here in obstructions that don't move is to cut to air.
     
  16. NPO

    NPO Forum Deputy Chief

    1,086
    472
    83
    Education:
    Paramedic
    In the extreme patient with a FBO that cannot be retrieved, and is in fact pushed past the corina to allow for ventilation, what is the definitive care for the patient? I presume there aren't kids walking around with dimes in their lungs or a piece of turkey, mayo and provolone on wheat bouncing around. Is the FBO surgically removed?
     
    Last edited: Oct 23, 2017 at 1:59 AM
  17. DesertMedic66

    DesertMedic66 Forum Troll

    9,463
    2,101
    113
    Education:
    Paramedic
    I don’t know if it’s physically possible to remove the FBI...

    From what I have seen they are either surgically removed or they will go in with a bronchoscope to attempt to remove it non-surgically
     
  18. SpecialK

    SpecialK Forum Captain

    402
    136
    43
    A timely opportunity to say I learnt the other day a couple of personnel recently hooked a giant obstruction out a bloke's airway using the disposable laryngoscope and forceps introduced about 10 months ago. Had this not been introduced to all personnel, they would not have had access to and would have had to wait for backup. This previously happened about 3-5 times a year and resulted in several preventable deaths. I can categorically say this will save several lives a year.

    So, perhaps those services who do not have this should think again?
     
  19. Mya

    Mya Forum Crew Member

    44
    6
    8
    Education:
    EMT
    Worked with an experienced medic yesterday and she said she'll try a few times to get it out but will NOT waste time and immediately force the object in when intubating. She's done it before. So...yup!
     

Share This Page