Perfusing the FBAO patient

[Pipey]

How best to answer the question: What's the point of performing compressions, with rescue breaths, on a choking patient who has become unresponsive since the circulating blood is not oxygenated due to the airway blockage? Thank you.

[defib_wizard]

There is still residual O2 in the blood. In fact there is a few studies going on with cpr with no ventilations but with a non-rebreather mask in place. The chest compressions hopefully will dislodge the foreign body by the increase in intrathoracic pressure. we check the airway to see if the obstruction is seen to remove it. We do ventilations because maybe it was dislodged enough to move some air into the lungs. Anything is better than nothing.

I see this is your first post please introduce yourself and certification level, thanks. Hopefully this helps.

[WolfmanHarris]

Actually this was a question I had that I couldn't get a good answer on. I teach CPR and know the standard so my debate isn't on whether we're supposed to ventilate while we're managing the FBAO. My question is this: with an airway obstruction wouldn't PPV increase the risk of gastric distension, or pushing the object further down into the mainstem bronchi? And the potential problem I see here is that we're being counter productive by pushing against the progress made by the compression or we manage to push it deep enough to open one lung at the cost of aspiration pneumonia and increased chance of mortality. I'm not second guessing ILCOR here, what I'm curious about is what thoughts you guys have on these complications and why in the balance of risks-benefits we still ventilate the FABO. (Keeping in mind that as a BLS provider, McGill forceps and laryngoscope is not an option for me)

[defib_wizard]

That is the hope, either we dislodge it enough to ventilate some or hopefully push it past the carina down one of the mainstem bronchi and ventilate one lung. Yes aspiration is a risk but you have to be alive to die if infection. Your mortality rate is 100% without oxygenation. Hope this helps.

[akroeze]

Further to that, if you are unable to remove the obstruction with direct visualization you should consider actually pushing the foreign bolus FURTHER down with the ETT in hopes of forcing it into a mainstem.

[WolfmanHarris]

Okay so the consensus so far is that the pressure from PPV is not a significant counter force to any progress made from compressions?

As for the mainstem bronchi I was pretty much of the same mind, but it was a big discussion when I was doing a CPR recert for a classmate last week. They were told not to ventilate by one of the lab instructors and I had to contradict based on the standard but said I'd look into it more.

[crotchitymedic1986]

Actually the consensus is that you have no choice. If you do nothing, the patient dies. Your actions may only be minimally helpful, may save the life, or do nothing at all -- but you tried to save the patient. It is the same logic behind rapid extrication of the trauma patient who just arrested in front of you, C-spine is important, but lack of oxygenation is more important, so you do not spend 10 minutes applying a ccollar and KED. Yes, they may have a cspine fracture, but that doesnt matter if they die.

Layperson CPR on your patient may keep enough oxygen rich blood circulating to save a few brain cells, until an ALS unit can arrive and unclog the airway (or even a BLS unit with portable suction).

[firedoc5]

If your ventilations pushes the obstruction down into the lung(s), it's easier to take care of the infection and pneumonia than having a pt. that won't survive at all is what my very first Instructor told us.

[okmedic]

I am assuming we are discussing cpr with the lay person right?

[WolfmanHarris]

No we're discussing ILCOR reccomendations (that result in AHA, Red Cross and all the other standards) for foreign body airway obsturction for CPR-HCP and the rationale behind certain standards. Hence bagging and mcgill forceps and all that fun stuff.