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Scenario — 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.
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
Signs/Symptoms
Unable to speak, unable to cough effectively, clutching at throat, cyanosis around lips, paradoxical chest movement, increasing agitation.
Onset
Sudden onset approximately 2 minutes ago whilst eating a sausage sizzle.
Pain
Unable to verbalise — patient shaking head and pointing at throat.
Quality
Nil effective air movement. Silent chest.
Radiates
Nil
Severity
Unable to verbalise — severe distress.
Allergies
Nil known — confirmed by teacher.
Medications
Nil regular medications — confirmed by teacher.
Pertinent History
Nil relevant past medical history. No previous choking episodes. No known swallowing dysfunction.
Last Oral Intake
Sausage sizzle approximately 2 minutes ago — was mid-bite when event occurred.
Treatment
Teacher performed one back blow prior to bringing patient to FAP — no dislodgement.
Events Leading
Isla was eating at the canteen stall during the school carnival lunch break. Mid-bite she suddenly stopped, went silent, and grabbed her throat.
Scenario Progression and Treatment Objectives

((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.))

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

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