From the Guidelines
If a patient has a foreign body lodged in their throat, the first step is to assess the severity of the airway obstruction and if the patient is unable to make a sound, perform subdiaphragmatic abdominal thrusts (Heimlich maneuver) immediately for children and repeated cycles of 5 back blows followed by 5 chest compressions for infants, as recommended by the American Heart Association guidelines 1. When evaluating a patient with a foreign body in their throat, it's crucial to determine if the obstruction is mild or severe. If the patient can cough and make sounds, it's considered a mild obstruction, and you should not interfere, allowing the patient to clear the airway by coughing while observing for signs of severe obstruction 1. However, if the patient is unable to make a sound, indicating a severe obstruction, immediate action is necessary to relieve the obstruction. Some key points to consider when managing a patient with a foreign body in their throat include:
- For children, perform subdiaphragmatic abdominal thrusts (Heimlich maneuver) until the object is expelled or the victim becomes unresponsive 1.
- For infants, deliver repeated cycles of 5 back blows (slaps) followed by 5 chest compressions until the object is expelled or the victim becomes unresponsive, as abdominal thrusts may damage the infant's liver 1.
- If the victim becomes unresponsive, start CPR with chest compressions, and after 30 chest compressions, open the airway to check for the foreign body and remove it if visible, avoiding blind finger sweeps 1. It's essential to prioritize the patient's airway, breathing, and circulation (ABCs) and activate the emergency response system if necessary, to ensure the best possible outcome in terms of morbidity, mortality, and quality of life.
From the Research
Administration of First Aid for Foreign Body Obstruction
To administer first aid to a patient with a foreign body lodged in her throat, the following steps can be taken:
- Back blows: to generate high initial pressures and dislodge the object from the larynx 2
- Abdominal thrusts (Heimlich maneuver): to generate sustained increases in intrathoracic pressure and move the object out of the larynx 2, 3, 4
- Chest thrusts: as an alternative to abdominal thrusts, especially if the patient is pregnant or obese 2
- Finger probes: to remove the object from the airway if it can be seen 2
Important Considerations
When performing these maneuvers, it is essential to be aware of the potential complications, such as:
- Esophageal rupture 5, 6
- Gastric wall rupture 5
- Rib fracture 5
- Diaphragm rupture 5
- Acute thrombosis of abdominal aortic aneurysm 5
- Mesenteric laceration 5
- Acute pancreatitis with associated pseudocyst formation 6
Effectiveness of Abdominal Thrusts
Studies have shown that abdominal thrusts can be effective in increasing thoracic pressure and dislodging foreign bodies from the airway 3, 4. The angle at which thrusts are performed does not affect intrathoracic pressure, and self-administered abdominal thrusts can produce similar pressures to those performed by another person 4. Chair thrusts, where the subject pushes their upper abdomen against a chair back, can produce higher pressures than other maneuvers 4.