Choking — partial airway obstruction in a child

Patient Information

Dispatch: You are called to the canteen area at the school carnival. A parent is waving you down — an 8-year-old boy appears to be choking on food.
Patient: Liam Nguyen — 8yr (26kg)
Incident History: Pt was eating a sausage sizzle when he began coughing forcefully. Parent states he is still coughing and can speak but is very distressed.
Emergency Contact: Minh Nguyen (Father) — 0412 374 891

Initial Rapid Assessment

Response: Alert
Airway: Partial obstruction. Pt coughing forcefully, able to speak in short sentences. Nil stridor at rest. No drooling.
Breathing: Increased work of breathing. Accessory muscle use visible. Coughing is effective. RR elevated.
Circulation: Radial pulse present, strong. Skin pink, warm. Mildly distressed appearance. Nil cyanosis.
Disability: GCS 15 (E4V5M6). Alert and orientated to time, place and person. Anxious but cooperative.
Exposure: No visible injuries. No rashes. Food visible around mouth. No neck swelling.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	95% (RA)	Mild	26	112	106/68	<2s	15	4 4 ++	36.8	–	3
10 mins	99% (O2 simple mask 6L/min)	Nil	18	96	104/66	<2s	15	4 4 ++	36.8	–	0

History Taking

Treatment Response

Diagnosis

This patient is suffering from a mild/partial foreign body airway obstruction secondary to food bolus ingestion.

Facilitator Triggers — if trainees miss a critical step

! (If the trainee does not reassess cough effectiveness within the first 2 minutes, advise the facilitator to inform them that Liam's coughing is becoming weaker and less effective — transition to severe/complete obstruction presentation.)
! (If the trainee attempts a finger sweep, remind them this is contraindicated and can worsen the obstruction and cause local trauma.)
! (If the trainee attempts abdominal thrusts, remind them these are not recommended per CPG due to potential life-threatening complications.)
! (If oxygen is not considered after obstruction resolves, prompt with 'Liam is still looking a little pale — what else might you consider?')
! (If the trainee does not continuously reassure the patient and parent, the facilitator should note the parent is becoming increasingly distressed and demanding action.)

Treatment Objectives

1 Ensure scene safety and don appropriate PPE.
2 Perform Primary Survey — confirm partial airway obstruction with effective cough and ability to speak.
3 Continuously reassure Liam and his father throughout the scenario.
4 Encourage Liam to cough — do NOT interfere with an effective cough.
5 Do NOT perform finger sweep — this is contraindicated in FBAO.
6 Do NOT perform abdominal thrusts — not recommended per CPG.
7 Position Liam to allow gravity to assist if cough becomes ineffective.
8 Maintain constant observation for any sudden deterioration from partial to complete obstruction.
9 Assess Liam's cough effectiveness every 1–2 minutes — rate, strength, ability to speak.
10 Consider oxygen therapy if SpO2 remains below 94% or patient shows signs of distress — apply simple face mask at 5–8 L/min targeting SpO2 94–98%.
11 If obstruction resolves: perform full vital sign survey, perform secondary survey, assess bilateral chest rise to confirm air movement.
12 If obstruction progresses to severe/complete (ineffective cough, unable to speak, cyanosis): immediately transition to FBAO severe protocol — position patient with gravity assistance, deliver up to 5 back blows between the scapulae at 90° angle, check for dislodgement between each blow, if still obstructed perform up to 5 chest thrusts, continue alternating until obstruction dislodges.
13 If patient becomes unconscious at any point: commence CPR as per Cardiac Arrest Guidelines and call CSP for urgent ambulance support with IMISTAMBO handover to CSP.
14 Arrange transport with paramedic backup given paediatric choking presentation — any paediatric choking event warrants medical review.
15 Scenario ends on arrival of ambulance and IMISTAMBO handover.
16 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

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