Choking — severe airway obstruction in a child

Patient Information

Dispatch: You are called to a patient at the First Aid Post during the Claremont Showgrounds School Carnival. An 8-year-old female has been brought in by a teacher who states she was eating a sausage sizzle and is now unable to speak or breathe properly.
Patient: Isla Thornton — 8yr (25kg)
Incident History: Pt was eating a sausage sizzle at the canteen stall approximately 2 minutes ago. Teacher states Isla suddenly went quiet mid-bite, clutched at her throat, and has not been able to speak or cough effectively since.
Emergency Contact: Karen Thornton (Mother) — 0412 553 887

Initial Rapid Assessment

Response: Alert
Airway: Severe/complete obstruction. Patient unable to speak or vocalise. Visible distress, clutching at throat. No audible airflow on attempted inspiration.
Breathing: Silent — no effective cough. Nil audible breath sounds. Paradoxical chest movement noted. RR attempts present but no effective air movement. Cyanosis developing around lips.
Circulation: Radial pulse present and rapid. Skin pale, mild central cyanosis developing. No bleeding.
Disability: GCS 14 (E4V1M6) — alert but unable to vocalise. Orientated to place and person. Increasing agitation.
Exposure: No rash, no visible injuries. Partially chewed food visible at mouth on inspection. No external trauma.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	82% (RA)	Severe	28	124	100/65	2s	14	4 4 ++	–	–	–
10 mins	98% (O2 NRB 10L)	Nil	20	98	102/68	<2s	15	4 4 ++	–	–	–

History Taking

Treatment Response

Diagnosis

This patient is suffering from a severe/complete Foreign Body Airway Obstruction (FBAO) secondary to food bolus aspiration, with developing hypoxia and central cyanosis.

Facilitator Triggers — if trainees miss a critical step

! (If the trainee attempts a finger sweep — facilitator states: 'As you attempt to sweep, the food shifts deeper. The patient's SpO2 drops to 76% and she begins to lose consciousness.' Redirect: finger sweeps are NOT to be performed as they can worsen obstruction.)
! (If the trainee does not immediately begin back blows and chest thrusts — facilitator states: 'Isla's cyanosis is worsening. She is now no longer able to remain standing and her GCS drops to 12.' Prompt trainee to commence FBAO skill immediately.)
! (If trainee performs abdominal thrusts — facilitator states: 'This technique is not recommended in SJWA CPGs due to risk of life-threatening complications. What is the correct technique?' Redirect to back blows and chest thrusts.)
! (If trainee does not prepare resuscitation equipment — facilitator states: 'Isla becomes unconscious and falls to the floor.' Trainee must transition to Cardiac Arrest CPG and commence CPR.)
! (If oxygen is not applied following successful dislodgement — SpO2 remains at 87% at 5 minutes. Prompt trainee to consider oxygen therapy.)

Treatment Objectives

1 Ensure scene safety and don appropriate PPE including gloves.
2 Perform rapid primary survey — identify severe/complete airway obstruction: patient unable to speak, silent cough, cyanosis, paradoxical chest movement.
3 Do NOT attempt finger sweep — this can worsen the obstruction and cause local trauma.
4 Do NOT perform abdominal thrusts — not recommended in SJWA CPGs due to risk of life-threatening complications.
5 Position patient to allow gravity to assist — lean Isla forward.
6 Administer up to 5 back blows firmly between the scapulae at 90° to the patient's back — check for dislodgement between each blow.
7 If obstruction not dislodged: perform up to 5 chest thrusts (sharper than CPR compressions) — check for dislodgement between each thrust.
8 Continue alternating 5 back blows with 5 chest thrusts until the object dislodges or the patient becomes unconscious.
9 If patient becomes unconscious: lower to the ground safely, commence CPR as per Paediatric Cardiac Arrest CPG, and call for urgent backup.
10 On successful dislodgement: reassure Isla continuously.
11 Apply oxygen therapy via non-rebreather mask at 10–15 litres per minute — target SpO2 ≥95% for paediatrics.
12 Conduct full vital signs survey post-dislodgement including SpO2, RR, HR, BP, and GCS.
13 Prepare resuscitation equipment (BVM, suction, AED) throughout the event in case of deterioration.
14 Arrange transport to hospital for assessment — all paediatric choking episodes requiring intervention should be evaluated at ED.
15 Conduct continuous observations every 5–10 minutes or as clinically indicated.
16 Notify parent/emergency contact (Karen Thornton — 0412 553 887).
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 · Cardiac Arrest - Paediatric · Primary Survey

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