Responding to a Choking Patient: Assessing Airway Status and When to Intervene
You’re assessing a conscious patient who informs you he is choking on a piece of food. He grabs your arm in a panic. How should you respond?
- If visible, use magill forceps to pull the object out of his upper airway
- Perform abdominal thrusts
- Apply high-flow O2
- Instruct him to cough, monitor closely
As an EMT, quickly assessing the patient’s airway status and oxygenation is key to providing the right intervention.
Why Instructing the Patient to Cough May Be the Best Initial Response
If the patient is still conscious and appears to be getting adequate air exchange, the first step should be encouraging him to cough forcefully to try to expel the foreign body himself while closely monitoring his condition.
- Coughing generates high intrathoracic pressures which may dislodge an object
- Patient is awake and protecting his airway
However, several signs indicate when a choking patient’s condition could deteriorate quickly due to hypoxia, requiring immediate aid:
- Extreme anxiety
- Pale or cyanotic skin signs
- Loss of consciousness
- No cough despite distress
Once observing these or other signs of severe airway obstruction, abstain from any further “wait and see” approach and intervene.
When Magill Forceps Could Be Utilized
Magill forceps may directly remove an upper airway obstruction if the object is visible without needing to perform blind finger sweeps or abdominal thrusts. Using forceps avoids driving an object deeper and causing further blockage or injury.
- Requires laryngoscope to visualize obstruction
- Works best for solid masses stuck in pharynx/larynx
- Risk of harm if improperly placed
Magill forceps are not helpful for obstruction lower down and are not feasible in many out-of-hospital scenarios. Only attempt if properly trained.
Why Abdominal Thrusts Are the Go-To Obstructed Airway Technique
Once air exchange appears compromised in a choking patient, begin abdominal thrusts to create an artificial cough to expel the blockage.
To perform:
- Stand behind a bent-over patient, wrap arms around upper abdomen
- Create quick upward diaphragmatic compression
This compresses air from lungs to eject object via strong exhaled airflow.
- Fastest way to clear obstruction with no equipment
- Success rate over 50% based on clinical evidence
- Risk of complications if done improperly
Cease thrusts once obstruction relieved or patient becomes unconscious.
High-Flow Oxygen’s Role as a Temporary Stopgap
Applying high-flow oxygen via non-rebreather mask can help treat hypoxia once it sets in, buying precious minutes before airway intervention. However, it may not definitively resolve the underlying obstruction.
Benefits include:
- Helps offset falling oxygen saturation
- Requires no specialized skill or equipment
- May reduce risk of cardiac arrest
But does not treat root cause of hypoxia by itself in most cases. Monitor oxygenation closely even with O2 running.
Takeaway Points on Choking Treatment Approaches
When a choking patient approaches you appearing in distress but still conscious, initially monitor their coughing efforts closely rather than immediately intervening. Have suction and abdominal thrust preparations ready to stimulate an artificial cough at the first sign their air exchange becomes compromised, backed up by high-flow oxygen. Consider visualization and magill forceps only if properly trained and obstruction is visible. Through quickly assessing and thoughtfully escalating your response to a choking patient’s distress, you can help ensure the best possible outcome.
