A Victim With A Foreign Body Airway Obstruction Becomes Unresponsive

Airway obstruction, a life-threatening emergency, can quickly escalate when a victim becomes unresponsive. This comprehensive guide outlines the critical steps required to manage such a situation, blending practical techniques with essential knowledge. Understanding the nuances of foreign body airway obstruction (FBAO) and its management is crucial for anyone who might find themselves in a position to help.

Recognizing the Signs of Airway Obstruction

The initial step in managing any emergency is recognizing the problem. Airway obstruction occurs when a foreign object blocks the passage of air into the lungs. Recognizing the signs quickly can mean the difference between life and death. Here are some key indicators:

• Sudden Inability to Speak: The victim may clutch at their throat and be unable to vocalize.
• Difficulty Breathing: Obvious signs include struggling for air, gasping, and an increased respiratory rate.
• Cyanosis: A bluish discoloration of the skin, especially around the lips and fingertips, indicates a lack of oxygen.
• Universal Choking Sign: The victim may instinctively clutch their neck with one or both hands.
• Loss of Consciousness: If the obstruction is not relieved, the victim will eventually become unresponsive due to lack of oxygen to the brain.

It's important to differentiate between mild and severe airway obstruction. In mild obstruction, the victim can still cough forcefully and speak. Encourage them to continue coughing. However, if the victim is unable to cough effectively, speak, or breathe, the obstruction is severe and requires immediate intervention.

Initial Assessment and Response

When you encounter a victim who appears to be choking and then becomes unresponsive, the following steps are crucial:

1. Assess Responsiveness: Gently tap the victim and shout, "Are you okay?" If there is no response, proceed to the next step.
2. Call for Help: Immediately call emergency services or ask someone else to do so. Provide the dispatcher with the location and a brief description of the situation, emphasizing that the victim is unresponsive and has a suspected airway obstruction.
3. Position the Victim: Carefully lower the victim to the ground, ensuring they are lying on their back on a firm, flat surface.
4. Open the Airway: Use the head-tilt/chin-lift maneuver to open the airway. Place one hand on the victim's forehead and gently tilt the head back. Simultaneously, place the fingers of your other hand under the bony part of the chin and lift it upwards. Be cautious when dealing with potential spinal injuries; in such cases, use the jaw-thrust maneuver instead, lifting the jaw without tilting the head.
5. Look, Listen, and Feel: Place your ear close to the victim's mouth and nose to listen for breathing, look for chest rise, and feel for air on your cheek. Do this for no more than 10 seconds.

Performing Chest Compressions

If the victim is not breathing or is only gasping, begin chest compressions. Chest compressions can help to dislodge the foreign object and provide some circulation.

1. Hand Placement: Kneel beside the victim. Place the heel of one hand in the center of the victim's chest, on the lower half of the breastbone. Place your other hand on top of the first, interlacing your fingers.
2. Compression Technique: Position your body directly over your hands, keeping your arms straight. Compress the chest to a depth of approximately 2 inches (5 cm) for adults.
3. Compression Rate: Perform compressions at a rate of 100-120 compressions per minute. It's crucial to maintain a consistent rate and depth.
4. Cycles of Compressions and Rescue Breaths: After 30 chest compressions, deliver two rescue breaths. To give a rescue breath, ensure the airway is open using the head-tilt/chin-lift maneuver (or jaw-thrust if spinal injury is suspected). Pinch the victim's nose closed, make a complete seal over their mouth with your mouth, and give two breaths, each lasting about one second. Watch for chest rise. If the chest does not rise, reposition the airway and try again.
5. Continue CPR: Continue cycles of 30 compressions and 2 breaths until the victim shows signs of life (e.g., breathing, movement), an AED becomes available, or emergency services arrive.

Checking for the Foreign Object

After each set of chest compressions and before giving rescue breaths, check the victim's mouth for the foreign object.

1. Open the Mouth: Use your thumb and fingers to open the victim's mouth wide.
2. Visual Inspection: Look for the obstructing object. If you see it, carefully remove it with your fingers. Be cautious not to push the object further down the airway.
3. Attempt Rescue Breaths: If the object is removed, attempt rescue breaths again. Watch for chest rise. If the chest still does not rise, continue with chest compressions.

Using an Automated External Defibrillator (AED)

If an Automated External Defibrillator (AED) is available, use it as soon as possible.

1. Turn on the AED: Follow the voice prompts provided by the AED.
2. Apply Pads: Attach the AED pads to the victim's bare chest. One pad should be placed on the upper right side of the chest, and the other on the lower left side.
3. Analyze Rhythm: Ensure that no one is touching the victim while the AED analyzes the heart rhythm.
4. Deliver Shock (if advised): If the AED advises a shock, ensure that everyone is clear of the victim and press the shock button.
5. Continue CPR: After delivering the shock, immediately resume chest compressions, following the AED's prompts. Continue CPR until emergency services arrive or the victim shows signs of life.

Special Considerations

Infants

Managing airway obstruction in infants (under 1 year old) requires modified techniques:

• Back Blows and Chest Thrusts: Hold the infant face down along your forearm, supporting their head and jaw. Deliver five back blows between the shoulder blades using the heel of your hand. Then, turn the infant face up, supporting their head, and give five chest thrusts using two fingers in the center of the chest, just below the nipple line.
• Check the Mouth: After each series of back blows and chest thrusts, check the infant's mouth for the foreign object.
• CPR: If the infant becomes unresponsive, begin CPR with two fingers on the center of the chest, just below the nipple line, compressing approximately 1.5 inches (4 cm) at a rate of 100-120 compressions per minute.
• Rescue Breaths: Deliver gentle rescue breaths, ensuring a good seal over the infant's mouth and nose.

Children

For children (1 year old to puberty), use a combination of techniques similar to adults and infants:

• Abdominal Thrusts (Heimlich Maneuver): If the child is conscious, perform abdominal thrusts. Stand behind the child, place your arms around their waist, make a fist with one hand, and place the thumb side against the child's abdomen, slightly above the navel. Grasp your fist with your other hand and give quick, upward thrusts.
• Chest Thrusts: If the child is too large for abdominal thrusts or if you cannot reach around them, use chest thrusts instead. Place your arms under the child's armpits and encircle their chest. Make a fist and place the thumb side on the middle of the breastbone. Grasp your fist with your other hand and give quick, backward thrusts.
• CPR: If the child becomes unresponsive, begin CPR, compressing the chest approximately 2 inches (5 cm) at a rate of 100-120 compressions per minute.
• Rescue Breaths: Deliver rescue breaths, ensuring a good seal over the child's mouth and nose.

Pregnant or Obese Individuals

For pregnant or obese individuals, abdominal thrusts may be ineffective or dangerous. Use chest thrusts instead. Stand behind the person, place your arms under their armpits and encircle their chest. Make a fist and place the thumb side on the middle of the breastbone. Grasp your fist with your other hand and give quick, backward thrusts.

The Science Behind the Techniques

Understanding the physiological principles behind these techniques can help you perform them more effectively.

• Chest Compressions: Chest compressions increase pressure inside the chest cavity, which can help to force the foreign object out of the airway. They also circulate blood, delivering oxygen to the brain and other vital organs.
• Abdominal Thrusts (Heimlich Maneuver): Abdominal thrusts create a sudden increase in pressure in the abdomen and chest, which can dislodge the foreign object from the airway.
• Back Blows: Back blows create a sharp impact that can help to dislodge the foreign object, especially in infants.
• Rescue Breaths: Rescue breaths provide oxygen to the victim's lungs, which can help to sustain life until the obstruction is relieved or emergency services arrive.

Common Mistakes to Avoid

Even with proper training, mistakes can occur in high-stress situations. Here are some common errors to avoid:

• Delaying Action: Hesitation can be fatal. Start intervention immediately upon recognizing severe airway obstruction.
• Improper Hand Placement: Incorrect hand placement during chest compressions can result in ineffective compressions or injury.
• Insufficient Compression Depth: Not compressing the chest deep enough can reduce the effectiveness of CPR.
• Neglecting to Check the Mouth: Failing to check the mouth for the foreign object can delay its removal and prolong the obstruction.
• Pushing the Object Further Down: Carelessly probing the mouth can push the object further down the airway, worsening the obstruction.
• Panic: Staying calm and focused is crucial for effective intervention.

Prevention Strategies

While knowing how to respond to airway obstruction is essential, preventing it in the first place is even better.

• Cut Food into Small Pieces: Especially for young children and older adults, cut food into small, manageable pieces.
• Chew Food Thoroughly: Encourage everyone to chew food thoroughly before swallowing.
• Avoid Talking or Laughing While Eating: This can increase the risk of food entering the airway.
• Supervise Children While Eating: Keep a close eye on young children while they are eating to ensure they are not putting inappropriate objects in their mouths.
• Keep Small Objects Out of Reach: Store small objects, such as buttons and coins, out of reach of young children.
• Proper Denture Fit: Ensure that dentures fit properly to prevent them from becoming dislodged and obstructing the airway.

Legal and Ethical Considerations

When providing assistance to someone in distress, it's essential to be aware of the legal and ethical considerations.

• Good Samaritan Laws: Most jurisdictions have Good Samaritan laws that protect individuals who provide assistance in an emergency from liability, provided they act in good faith and without gross negligence.
• Duty to Act: In some professions (e.g., healthcare providers, lifeguards), there may be a legal duty to provide assistance.
• Consent: Whenever possible, obtain consent from the victim before providing assistance. However, if the victim is unresponsive, implied consent applies, meaning it is reasonable to assume they would want assistance.
• Confidentiality: Respect the victim's privacy and confidentiality. Do not disclose personal information or details about the incident to others without their consent, unless required by law.

Psychological Impact on Rescuers

Witnessing and responding to a medical emergency can be emotionally challenging. It's important to acknowledge the potential psychological impact on rescuers and seek support if needed.

• Stress and Anxiety: The experience can be stressful and anxiety-provoking, especially if the outcome is uncertain.
• Guilt and Self-Doubt: Rescuers may experience feelings of guilt or self-doubt, especially if the victim does not survive.
• Post-Traumatic Stress: In some cases, the experience can lead to post-traumatic stress symptoms, such as flashbacks, nightmares, and avoidance behaviors.
• Seeking Support: It's important to seek support from friends, family, or mental health professionals if you are struggling to cope with the emotional impact of the experience.

Staying Current with Training

Medical guidelines and best practices for emergency response are constantly evolving. It's essential to stay current with training to ensure that you are providing the most effective care.

• CPR and First Aid Courses: Take regular CPR and first aid courses to learn the latest techniques and guidelines.
• Online Resources: Utilize reputable online resources, such as the American Heart Association and the American Red Cross, to stay informed about current recommendations.
• Continuing Education: Healthcare professionals should participate in continuing education activities to maintain their skills and knowledge.

Conclusion

Responding to an unresponsive victim with a foreign body airway obstruction requires quick thinking, decisive action, and a thorough understanding of the appropriate techniques. By recognizing the signs of airway obstruction, calling for help, performing chest compressions, checking for the foreign object, and using an AED when available, you can significantly increase the victim's chances of survival. Remember to consider special circumstances for infants, children, and pregnant or obese individuals. Staying current with training, avoiding common mistakes, and understanding the legal and ethical considerations are also crucial. With proper knowledge and preparation, you can be a vital link in the chain of survival.