You are walking home one day when you pass a group of schoolchildren at a bus stop. One of them is coughing and seems to be getting into a panic. As you approach he falls to the ground clutching at his neck. His friends scream and you rush over to help. As you approach the boy he is becoming pale and cyanosed. You can hear an inspiratory ‘whistling’ noise and he is finding it increasingly hard to breathe.
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(a) What immediate actions should you undertake?
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You should follow the ABC approach. Shout for help and ask one of the children to get help. Check it is safe to approach (i.e. stop traffic if he is in the road) and establish whether he has an open airway. If he is still coughing then try to encourage effective coughs. It may be appropriate to try the Heimlich manoeuvre and alternate 5 abdominal thrusts with 5 back blows.
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(b) Now what should you do?
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You need to get an urgent history from his friends as to what happened. This could be choking from an inhaled peanut or could possibly be severe anaphylaxis to peanuts. The latter would be more likely if there was a rash or swollen lips (angio-oedema) and wheeze or a known history (check for Medic-Alert bracelet). The former is more likely in this case with a history of choking and coughing. One of the boys admits they were throwing peanuts up in the air and trying to catch them in their mouths.
As he is now unconscious you need to open his airway (‘sniffing the morning air’ position) and check for breathing. If he is not breathing try to administer 5 rescue breaths by mouth to mouth, while pinching his nose. You should start CPR to try to dislodge the obstruction.
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(c) Now what should you do?
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Once he is breathing he should be put in the recovery position until he regains consciousness. He needs to be taken to hospital urgently by ambulance.
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(d) What investigations might be performed once he reaches hospital?
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A chest radiograph may be indicated to check for signs of aspiration and to exclude a foreign body still being lodged in his lower airway. If there are signs of persistent lobar or lung collapse a bronchoscopy may be needed to retrieve any further foreign body from his lower airway.
