Choking episodes and foreign body aspiration can be life threatening or result in significant morbidity. Choking continues to be a direct cause of death among children, most commonly occurring between the ages of one and four years. Various strategies have been used to decrease choking risks and prevent adverse outcomes. These have included alterations in product design and public education campaigns. Although education has been partially successful, primary care physicians can play a critical role in increasing education efforts during each well child office visit through anticipatory guidance of choking risks. Management of a choking child often involves collaborative efforts from the primary care physician, emergency room physician, otolaryngologist, pulmonologist, and radiologist. The purpose of this brief review is to provide an overview of the epidemiology and pathophysiology of choking and foreign body aspiration in children and to highlight important aspects of prevention and patient education. (PUD,MED.GOV)
Pediatric First Aid/CPR/AED
READY REFERENCEAFTER CHECKING THE SCENE FOR SAFETY, CHECK THE CHILD OR INFANT: CHECK FOR RESPONSIVENESS
Tap the shoulder and shout, “Are you OK?”
■ For an infant, you may flick the bottom
of the foot.
If no response, CALL 9-1-1 or the local emergency number.
■ If an unconscious child or infant is face-down, roll face-up, supporting the head, neck and back in a straight line.
If ALONE—Give about 2 minutes of CARE, then CALL 9-1-1.
If the child or infant responds, CALL 9-1-1 or the local emergency number for any life-threatening conditions and obtain consent to give CARE. CHECK the child from head to toe and ask questions to find out what happened.
• Use disposable gloves and other personal protective
equipment whenever giving care.
• Obtain consent from parent or guardian, if present.
CHECKING AN INJURED
OR ILL CHILD OR INFANT
APPEARS TO BE UNCONSCIOUS
PANEL 2OPEN THE AIRWAY
Tilt head back slightly, lift chin.
CHECK FOR BREATHING
CHECK quickly for no more than 10 seconds.
■ Occasional gasps are not breathing.
■ Infants have periodic breathing, so changes
in breathing pattern are normal for infants.
GIVE 2 RESCUE BREATHS
If no breathing, give 2 rescue breaths.
■ Tilt the head back and lift the chin up.
■ Child: Pinch the nose shut, then make a
complete seal over child’s mouth.
■ Infant: Make complete seal over infant’s
mouth and nose.
■ Blow in for about 1 second to make the
chest clearly rise.
■ Give rescue breaths, one after the other.
QUICKLY SCAN FOR SEVERE BLEEDING
WHAT TO DO NEXT
■ IF THE CHEST STILL DOES NOT CLEARLY RISE AFTER RETILITING HEAD—Go to Unconscious Choking, PANEL 6.
■ IF NO BREATHING—Go to CPR, PANEL 7 or AED, PANEL 8 (if AED is immediately available).
■ IF BREATHING—Monitor breathing and for any changes in condition. TIPS:
• If you witnessed the child or infant suddenly
collapse, skip rescue breaths and start CPR
• If the chest does not rise with rescue breaths,
retilt the head and give another rescue breath.
PANEL 3CONSCIOUS CHOKING—CHILD
CANNOT COUGH, SPEAK OR BREATHE
AFTER CHECKING THE SCENE AND THE INJURED OR ILL CHILD, HAVE SOMEONE CALL 9-1-1 AND GET CONSENT FROM THE PARENT OR GUARDIAN, IF PRESENT. GIVE 5 BACK BLOWS
Bend the child forward at the waist and
give 5 back blows between the shoulder
blades with the heel of one hand.
GIVE 5 ABDOMINAL THRUSTS
■ Place a fist with the thumb side against
the middle of the child’s abdomen, just
above the navel.
■ Cover your fist with your other hand.
■ Give 5 quick, upward abdominal thrusts.
Continue sets of 5 back blows and 5
abdominal thrusts until the:
■ Object is forced out.
■ Child can cough forcefully or breathe.
■ Child becomes unconscious.
WHAT TO DO NEXT
■ IF CHILD BECOMES UNCONSCIOUS—CALL 9-1-1, if not already done. Carefully lower the child to the ground and...