Choking — food bolus obstruction at community event

Patient Information

Dispatch: A 38YO female has come to the FAP after choking on food at the multicultural food festival. Bystanders report she was eating and suddenly started grabbing at her throat. (Sarah Nguyen)
Patient: Sarah Nguyen — 38yr (65kg)
Incident History: Pt was eating a piece of chicken skewer at a food stall when she suddenly stopped talking mid-sentence and began clutching her throat. Bystanders performed no interventions. Pt walked herself to the FAP assisted by a friend.
Emergency Contact: Michael Nguyen (Husband) — 0412 774 309

Initial Rapid Assessment

Response: Alert
Airway: Partially obstructed. Pt is coughing forcefully and able to produce some audible sounds. No stridor at rest. No drooling.
Breathing: Laboured. Pt is using accessory muscles with each breath. Able to speak in short phrases only. RR elevated. SpO2 94% on room air.
Circulation: Radial pulse rapid and strong. Skin flushed, diaphoretic. No external bleeding.
Disability: GCS 15 (E4V5M6). Alert and orientated to time, place and person. Visibly anxious.
Exposure: No rashes, urticaria or angioedema. No visible foreign body in oral cavity. Nil injuries noted.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	94% (RA)	Moderate	22	108	128/84	<2s	15	4 4 ++	–	–	3
10 mins	99% (O2 simple face mask 6L/min)	Nil	16	88	118/76	<2s	15	4 4 ++	–	–	1

History Taking

Treatment Response

Diagnosis

This patient is suffering from a mild/partial foreign body airway obstruction secondary to food bolus ingestion, presenting with an effective cough and partial ability to speak.

Facilitator Triggers — if trainees miss a critical step

! (If trainee attempts a finger sweep — advise the patient winces and coughs more forcefully; remind trainee that finger sweeps are contraindicated as they can worsen the obstruction and cause local trauma)
! (If trainee does not encourage coughing as the first intervention — patient's cough becomes less effective over the next 60 seconds and she begins to look more distressed; prompt trainee to reassess whether obstruction is worsening)
! (If trainee fails to continuously reassess for deterioration to severe/complete obstruction — after 2 minutes the patient suddenly becomes unable to speak and her cough becomes silent; facilitator prompts trainee: 'Sarah grabs your arm and cannot make any sound')
! (If trainee does not apply oxygen therapy — SpO2 remains at 93–94% and patient reports increasing breathlessness; prompt trainee to consider oxygen delivery)

Treatment Objectives

1 Ensure scene safety and don appropriate PPE including gloves
2 Perform Primary Survey — confirm mild/partial obstruction: patient is alert, able to cough forcefully, able to speak in short phrases
3 Reassure patient continuously throughout management
4 Encourage patient to continue coughing — do NOT perform back blows or chest thrusts while cough remains effective
5 Do NOT perform finger sweep — this is contraindicated and can worsen the obstruction
6 Apply oxygen therapy via simple face mask at 5–8 L/min titrated to SpO2 target 94–98%
7 Position patient in a position of comfort — allow patient to choose their own position; do not force supine
8 Continuously monitor for deterioration to severe/complete obstruction: silent or ineffective cough, inability to speak, cyanosis, decreasing conscious state
9 Obtain vital signs including SpO2, RR, pulse, BP and GCS
10 Take IMISTAMBO history: SAMPLE — allergies nil, medications OCP, no prior swallowing conditions, last oral intake chicken skewer 10 mins ago, events leading as above
11 Perform Secondary Survey including assessment of bilateral chest rise and air movement
12 Assess whether obstruction has cleared: patient able to speak in full sentences, effective cough, improving SpO2, improving RR
13 If obstruction resolves: continue monitoring observations every 5–10 minutes, advise patient to seek further medical review if symptoms recur or she develops ongoing throat discomfort or difficulty swallowing
14 If obstruction deteriorates to severe/complete (patient unable to speak, silent cough, cyanosis): transition immediately to severe obstruction management — follow Foreign Body Airway Obstruction skill: up to 5 back blows between scapulae at 90° angle, check for dislodgement between each; if not dislodged, up to 5 chest thrusts; alternate 5 back blows and 5 chest thrusts until dislodged; request urgent backup and advise CSP of findings
15 If patient loses consciousness: commence CPR as per Cardiac Arrest CPG and call for urgent backup immediately
16 Document all observations, interventions and patient responses on ePCR
17 Scenario ends on arrival of ambulance and IMISTAMBO handover
18 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Choking (Foreign Body Airway Obstruction) · Foreign Body Airway Obstruction · Oxygen Delivery · Primary Survey · Auscultation

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