A school nurse observes a 3-year-old begin to choke and turn blue while eating lunch. What should be the nurse's initial action?

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11ecbb05_cb79_7d20_b433_398e921906fb_MD0009_00 Foreign body aspiration is an emergency that requires immediate intervention when witnessed or highly suspected. The primary rescue intervention for adults and children over age 1 is abdominal thrusts, known as the Heimlich maneuver. This maneuver entails applying upward thrusts with a fist to the upper abdomen just beneath the rib cage. The upward action causes the diaphragm to forcefully expel air out of the airway, carrying the foreign body out with it. If the child is conscious and able to cough or make sounds, the nurse should ask the child to forcefully cough before intervening. These signs indicate a partial obstruction still allowing airflow, which may be cleared with strong coughing. However, any signs of respiratory distress (eg, stridor, inability to speak, weak cough, and cyanosis) require immediate intervention. (Option B) Back blows and chest thrusts are appropriate interventions for a choking infant under age 1. Older children require abdominal thrusts to clear an obstructed airway. (Option C) Blind sweeping a child's mouth can force a loosely obstructing object to fully block the airway or cause the object to fall farther into the airway, requiring surgical removal. (Option D) This child is experiencing a blocked airway, which is a medical emergency that requires intervention at the skill level of a nurse. The nurse can ask a bystander to contact 911 while attempting to clear the airway. This differs from a situation such as anaphylaxis, in which the nurse would require epinephrine and would call 911 for immediate assistance. Educational objective: The Heimlich maneuver (ie, upward abdominal thrusts under the rib cage) is the primary rescue intervention for children over age 1 with a foreign body airway obstruction causing respiratory distress. Back blows and chest thrusts are appropriate interventions for a choking infant under age 1. Blind sweeping of a child's mouth should not be attempted.

A School Nurse Observes a 3-Year-Old Begin to Choke and Turn