Critical Alerts

• Complete airway obstruction is life-threatening: Heimlich maneuver, then airway intervention
• Partial obstruction with stable patient: Allow coughing, minimize intervention
• Right main bronchus is most common location: Due to anatomy
• Negative X-ray does not exclude foreign body: Many are radiolucent
• Delayed presentation is common: May mimic asthma, pneumonia
• Bronchoscopy is diagnostic and therapeutic

Choking Emergency Management

Emergency Treatments

Overview

Foreign body aspiration (FBA) is the inhalation of solid or liquid material into the airways. In adults, it may present acutely with choking or subacutely with cough, wheezing, or recurrent pneumonia. Complete upper airway obstruction is a life-threatening emergency requiring immediate intervention. Most lower airway foreign bodies require bronchoscopy for removal.

Classification

By Location:

Epidemiology

• More common in children (under 3 years)
• Adults: Risk factors include elderly, altered mentation, alcohol, neuromuscular disease
• Right main bronchus: 60% (shorter, wider, more vertical)

Etiology

Common Foreign Bodies:

Risk Factors:

Emergent Intervention Required

Other Causes of Acute Dyspnea/Wheezing

Imaging

Chest X-ray:

Inspiratory/Expiratory Films:

• Air trapping on expiratory film

Lateral Decubitus Films:

• Affected side should deflate; if not, suggests air trapping

CT Chest:

Bronchoscopy

• Diagnostic and therapeutic
• Flexible or rigid bronchoscopy
• Allows direct visualization and removal

Discharge Criteria

• FB removed, symptoms resolved
• No respiratory distress
• Tolerating oral intake
• Follow-up arranged

Admission Criteria

• Retained FB requiring bronchoscopy
• Respiratory distress
• Post-obstructive pneumonia
• Complications (airway edema, injury)

Referral

Condition Explanation

• "You inhaled something into your airway, which is blocking air from getting to your lungs."
• "We need to remove it with a scope to prevent further problems."

Prevention

• Chew food thoroughly
• Avoid talking/laughing while eating
• Cut food into small pieces
• Supervise elderly with swallowing difficulty
• Keep small objects away from children

Warning Signs to Return

• Difficulty breathing
• Coughing up blood
• Fever
• Worsening cough

Elderly

• Higher aspiration risk
• Swallowing dysfunction
• May present late with pneumonia

Neurological Impairment

• Higher aspiration risk
• Consider prophylactic measures

Dental Procedures

• Common source of aspirated objects
• Immediate X-ray if something lost during procedure

Performance Indicators

Documentation Requirements

• Witnessed choking episode
• Type of foreign body if known
• Imaging findings
• Method of removal
• Follow-up plan

Diagnostic Pearls

• Negative X-ray does not exclude FB: Many are radiolucent
• Right main bronchus most common: Due to anatomy
• Unilateral wheezing suggests FB: In appropriate history
• Chronic cough or recurrent pneumonia: Consider delayed FB
• Air trapping on expiratory film: Ball-valve effect
• CT if diagnosis unclear: Better visualization

Treatment Pearls

• Heimlich for complete obstruction: Do not delay
• Do not interfere with effective cough: Let patient cough it out
• Bronchoscopy is diagnostic and therapeutic: First-line for lower FB
• Rigid bronchoscopy for children and large objects
• Steroids for airway edema
• Antibiotics if post-obstructive pneumonia

Disposition Pearls

• Admit if FB not removed or complications
• All lower airway FB need bronchoscopy
• Follow-up after removal to ensure resolution
• Educate on prevention