Scenario — Choking — partial airway obstruction in a child

foundation Respiratory · Pediatric · 8yr · male

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

Scenario Progression and Treatment Objectives

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, auscultate lung fields bilaterally to confirm air entry.
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 for Priority 1 transport with pre-notification of receiving facility.
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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Signs/Symptoms	Coughing, throat discomfort, mild shortness of breath. Able to speak in short sentences. States 'something is stuck in my throat'.
Allergies	Nil known drug or food allergies.
Medications	Nil regular medications.
Pertinent History	No previous choking episodes. No history of dysphagia. No known respiratory conditions.
Last Oral Intake	Sausage sizzle approximately 5 minutes ago.
Events Leading	Pt was running around with friends, came to the canteen, ate a sausage sizzle quickly and began choking shortly after.
Treatment Prior	Father performed two back blows before EHS arrival. No improvement noted.

Onset	Sudden onset approximately 3 minutes ago while eating.
Pain	Discomfort in throat rated 3/10. No chest pain.
Quality	Sensation of obstruction in throat. Intermittent coughing spasms.
Radiates	Nil
Severity	3/10 throat discomfort