Help! Choking! Nothing is working!

[Hockey]

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?

 

[Shishkabob]

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.

 

[JPINFV]

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.

 

[LAS46]

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?

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).

To simplify training of cardiopulmonary resuscitation, abdominal thrusts are recommended for rescuers to use in clearing a blocked airway in conscious adults and children over the age of 1. It's not recommended for choking in infants under age 1.

Abdominal thrusts lift the diaphragm and force enough air from the lungs to create an artificial cough. The cough is intended to move and expel an obstructing foreign body in an airway. Each thrust should be given with the intent of removing the 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

 

[MtJerry]

Your instructor is an idiot.

 

[Mountain Res-Q]

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!!!!!

 

[MtJerry]

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!!!!!

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.

 

[VentMedic]

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.

 

[Mountain Res-Q]

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.

 

[LAS46]

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

 

[Mountain Res-Q]

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...

 

[daedalus]

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.

 

[Mountain Res-Q]

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.

 

[Shishkabob]

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


Chrich pressure!!

 

[boingo]

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.

 

[JPINFV]

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.

 

[LAS46]

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

 

[JPINFV]

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.

 

[Jeremy89]

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

 

[ffemt8978]

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.