First Responder Assistance for an Obstructed Airway (Age 1+ Years)
An obstructed (blocked) airway is a medical emergency that requires immediate aid by the closest responder. This situation can occur due to:
- Food during eating (most common)
- Foreign object that is being chewed/placed in mouth
- Trauma to the mouth/neck region
- Internal swelling during an allergic reaction
- Other medical conditions preventing air from reaching the lungs
Note: For this Procedure: person = someone experiencing an obstructed airway
II. Signs and Symptoms
The universal sign that most people will display is clutching at the throat with both hands. Additional active indicators include panic, the inability to cough, blue/gray color of the lips and/or mouth, and the inability to speak. Without intervention, a person will become unconscious in a matter of minutes, will experience significant brain damage near 10 minutes, and will likely die shortly thereafter.
III. Survey the Scene:
IV. Intervention Techniques:
- First and foremost, make sure that the location you are going to be performing assistance is safe. If not, move the person to a safe place to render aid. If after rendering aid, the scene ever becomes unsafe, stop emergency care and find another safe location.
- If possible, determine what type of airway emergency is occurring. If there is an obvious deformity of the upper airway or some type of trauma that will not allow air to travel from the mouth to the lungs, make sure advanced assistance is on the way. Next, consider Technique 3 as this may be the only way to get air into the lungs.
- If this emergency is occurring at a restaurant or social gathering (i.e., a place where people are eating) the emergency is very likely food related. As you begin to render aid, notify others to call for advanced assistance (911) and to locate the nearest AED/dechoker station in the facility to retrieve the dechoker device.
- It is extremely important that advanced assistance be contacted immediately as they will likely be able to perform Techniques 2 and 3, especially if the necessary equipment and skillsets are not available via First Responders.
As stated, it is essential that assistance be provided immediately. The First Responder should consider the following techniques, in this order, as appropriate:
- Abdominal Thrusts
- DeChocker Airway Clearing Device
- Tracheostomy/Cricothyrotomy Procedure
1. Abdominal Thrusts:
Note: While the Red Cross advises a “five-and-five” approach (First, 5 back blows and then 5 abdominal thrusts), the American Heart Association (AHA) does not teach back blows. Given the importance of time to intervention, this procedure and the incorporation of the dechoker device advises the use of the AHA protocol.
2. Dechoker Airway Clearing Device:
- Stand behind the person with a wide stance in case the person becomes unconscious. Wrap your arms around the person’s waist just below the navel (Important: if you are not able to wrap your arms around the person’s waist, go to step “f” OR if the dechoker device is available, proceed to Technique 2).
- With your arms wrapped around the person, make a fist with your non-dominant hand and grasp your fist with your dominant hand. Slightly tilt the person forward if possible
- Using a strong in and upward motion (similar to a J), press hard into the abdomen with quick in and upward thrusts (similar to lifting the person up).
- Perform these thrusts until you hear the object clear the airway (person will noticeably start breathing/make sounds) or after 5 thrusts, do a quick visual check on the mouth to see if the object can be removed.
- If dechoker device is readily available, go to Technique 2. If not, continue with abdominal thrusts and incorporate back blows if properly trained to do so. (Note: it is important to continue abdominal thrusts until the dechoker Device is applied). Continue this process until the person becomes unconscious (go to step “g”).
- If there is no dechoker device available or if you are not able to wrap you your arms around the person, lay the person down and perform abdominal thrusts simulating the same motion you would be making if you were standing behind the person (described above). Continue this process until the person becomes unconscious.
- If the person becomes unconscious, lay the person on the ground and visually examine the airway. Only remove an object that can be manually accessed with a finger sweep. If this can be done with the person laying on their side, this will assist in removal. Extreme care is needed not to push the object further into the airway.
- After examining the airway in the conscious person, start Cardiopulmonary Resuscitation (CPR). The chest compressions of CPR may assist in dislodging the object and these important movements will keep blood moving through the heart until advanced assistance arrives.
- If advanced assistance is expected to be prolonged or is not available and Technique 2 has not provided proper respiration, consider if Technique 3 can be performed and intervene if appropriate. If not, continue with CPR until advanced assistance arrives or for a timespan within your limitations.
Note: Since Technique 1 can typically be the quickest and easiest way to render aid in an airway emergency, it should always be attempted first. However, there are situations in which use of the dechoker Airway Clearing Device is preferred. If the body size of the First Responder or person needing aid are prohibitive with regards to arms being able to go around a person’s waist, force needed to deliver therapeutic Technique 1 contractions, knowledge/confidence in performing Technique 1, or any other unforeseen reason as determined by the First Responder, an available Dechoker Airway Clearing Device will provide significant aid.
3. Tracheotomy/Cricothryotomy Procedure:
- If Technique 1 has not cleared the airway within a reasonable amount of thrusts (typically 10), use of the dechoker, performing Technique 3, or advanced assistance is needed. Proceed to step “b” if a dechoker device is available. If not, proceed to Technique 3 and ensure that advanced assistance is on the way if possible.
- Remove the dechoker from the package and pull the handle twice to ensure the internal lubrication is properly dispersed along the length of the tube. The handle should then be returned to the fully depressed position before use.
- With the person needing aid laying on their back, tilt their head up with the chin up for direct access to the airway. This is similar to the position used for mouth to mouth air support.
- Identify the proper placement position of the dechoker. You will easily see the indentation for the nose on the respirator face cap. Also, the tube should be facing down and away from the nose indentation. These two landmarks will clearly guide how the dechoker should be place upon the mouth and nose region of the person needing aid.
- Insert the tube into mouth, respirator face cap covering the mouth and nose. Firm contact between the respirator cap portion and the person needing aid is essential to maintain a tight seal. The dechoker uses suction pressure to remove a foreign object in the airway. The force of this suction is directly related to how properly a uniform seal is made where the cap is pressed around the mouth and nose. Specifically, use your non-dominant hand to hold the respirator face cap against the person’s face by applying your thumb at the bottom of the chin and then separating two fingers on either side of the respirator tube. Extremely Important: The First Responder should make sure to place light but constant pressure to maintain this all-important seal for 3 second intervals. Audibly count loudly “One thousand One, One Thousand Two, One Thousand Three” when the respirator face cap is covering the mouth and nose so that it is clear when to remove (after the three second count) and then reposition the face cap.
- While applying light, constant pressure, use your dominant hand to pull up on the plunger with a smooth, quick motion. This will likely dislodge the object and open the airway, so it is important to stay focused on the person’s reactions and ability to suddenly breathe. When the object becomes dislodged, roll the person on their side and assist them as needed to fully evacuate the airway/mouth of the obstruction. Additional considerations:
- The pressure valve on the dechoker allows for multiple handle pulls to be performed during one episode of respirator face cap placement. This may be needed in cases when a single handle pull will not clear the airway.
During the handle pull, the suction that is created may cause the obstruction to be instantly removed and adhere to the end of the tube, preventing the handle from being pulled further. Immediately remove the face cap and examine both the person and airway to see if further treatment is needed.
- Repeat the placement of the respirator face cap, pulling of the handle, and examination of the person needing aid until the airway is cleared. If the patient becomes unresponsive or unconscious, begin performing CPR and consider if Technique 3 is appropriate.
- There are rare cases in which a traumatic injury or allergic reaction has completely debilitated a person’s airway such that air cannot travel from the mouth and into the lungs. When the trachea is in this type of condition, a First Responder should consider if they are able to perform a tracheotomy or cricothyrotomy. Additionally, if Techniques 1 and 2 above have not proven successful in removing a foreign object from the airway, this Technique should be considered. It is important to note that this is a “last-resort” scenario and may involve permanent damage to a person’s trachea and/or larynx (voicebox).
- The important aspect of a tracheotomy is incision location. In order for the incision to be beneficial, it needs to be made at a location below the trauma/malformation. If being done due to a foreign object matter, then the indentation between the Adam’s apple and the first major section of cartilage (Cricoid cartilage) is the best location. This major section can be palpated by moving your fingers downward along the trachea until a significant bump is felt.
- Once the location on the trachea is selected, use a razor blade or other sharp instrument to make a one-half inch horizontal incision (left to right) that is about one inch deep.
- This incision can then be opened by pinching or inserting your index finger to ensure that the incision was deep enough to open into the windpipe (there is typically not much blood during this process).
- Insert a hollow, firm tube into the incision to create a temporary, stable opening for respiration (a hollow pen, thin plastic piping, straw, etc. In extreme cases, the goal is to keep the incision open so in these critical situations, consider other materials, configurations, and essentially, what item is available to save this person’s life).
- Quickly give two breaths and then every five seconds, repeat with two more breaths. Continue to perform this rescue breathing while monitoring the pulse. If the pulse ever stops, chest compressions become the priority. These should be given at the rate of 100 compressions a minute until assistance arrives or for a timespan within your limitations.
After stabilizing the person through Techniques 1, 2, or 3, continue to monitor and care for the person until advanced assistance arrives. Check for secondary issues such as bleeding, hydration, or other matters that require aid.