A physician receives a call from a parent about a 3-year-old boy who started choking and gagging suddenly while playing with a small toy just a moment ago. The boy is conscious but appears "blue" and is unable to speak. In addition to advising an immediate call to 911, which of the following is the best recommendation?

Question

A physician receives a call from a parent about a 3-year-old boy who started choking and gagging suddenly while playing with a small toy just a moment ago.  The boy is conscious but appears "blue" and is unable to speak.  In addition to advising an immediate call to 911, which of the following is the best recommendation?

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Explanation: 11ec2b69_c07d_c111_8f63_f343f68d8796_MD0005_00 This child's history is consistent with a complete airway obstruction secondary to foreign body aspiration. Children age >1 with complete airway obstruction are initially conscious but may be cyanotic and unable to speak, cough, or breathe. The American Heart Association recommends that abdominal thrusts (ie, Heimlich maneuver) be administered immediately to conscious children with complete obstruction to dislodge the aspirated object. The rescuer should stand behind the child and lean the child forward; abdominal thrusts should be repeated until the object is dislodged or the patient becomes unconscious. As an alternative, the American Red Cross advises 5 back blows alternating with 5 abdominal thrusts with the child leaning forward in front of the rescuer. Children with partial or complete airway obstruction should be given nothing by mouth as this may result in further airway compromise. Heimlich maneuver (Choices A and E) Children with partial obstruction are able to speak but may be coughing or gagging. They should be allowed to cough up the object on their own and taken to a hospital for further evaluation. All children with suspected aspiration should undergo bronchoscopic evaluation of the tracheobronchial tree to assess for retained foreign bodies. This child requires first aid prior to hospital transport. (Choice B) If the patient becomes unconscious, CPR should be started immediately. Before rescue breaths are administered, the mouth should be opened and inspected for foreign bodies that may have become dislodged. CPR should not be initiated as this patient is currently conscious. (Choice C) Infants age <1 with complete airway obstruction should be placed face down on the rescuer's arm with the head down and receive alternating back blows and chest thrusts. This process should be repeated until the obstruction is relieved or until the patient becomes unconscious, when cardiopulmonary resuscitation (CPR) should be initiated. Educational objective: Abdominal thrusts should be performed immediately in conscious children age >1 with complete airway obstruction. Infants age <1 with complete airway obstruction should be placed face down/head down on the rescuer's arm and receive alternating back blows and chest thrusts. Cardiopulmonary resuscitation should be initiated immediately in unconscious patients. References: Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. (http://www.ncbi.nlm.nih.gov/pubmed/20956229) Diagnostic evaluation of foreign body aspiration in children: a prospective study. (http://www.ncbi.nlm.nih.gov/pubmed/16034756)

A Physician Receives a Call from a Parent About a 3-Year-Old