Conscious FBAO algorhythm (Aussies only PLEASE)

[akflightmedic]

Ok me Aussie mates...heres me problem.

Had a delightful debate today regarding FBAO in the conscious victim.

For this discussion, the airway is totally obstructed, no coughing, no breathing, nothing and the patient is conscious.

We had members of several different nations taking part in this discussion and the one that stood out were the Aussies. I also have a few questions I need direct factual support for, not "I think I know" or "I suppose".

I do have a copy of the Australian Resus Council guidelines and if you go by what is written, this is the procedures to be performed.

1. After safety check and confirming the victim is choking

2. Give 5 back blows...you will check in between each back blow to see if there is relief.

3. If this fails, you go to chest thrusts

Pausing now, because it is the chest thrusts that is the crux of the situation.

One said you lay the victim down and perform it like CPR compressions and the other mentioned a side chest thrust.

While I know what is written and you have guidelines to follow, how in the world are you going to convince a panic stricken, hypoxic person to lay down so you can chest thrust???

I asked the Aussies if you could perform them from a behind position and do it like we would do it on a pregnant woman instead of abdominal thrusts. They supposed you could but stated they were instructed to lay the victim down.

Another medic said what is written and what he would do is two different things. For example, he said if the back blows were ineffective, he admits the victim would not lay down and he would go to abdominal thrusts even though they are NOT recommended in Australia. He said he would document otherwise. Why would a system be in place where in order to do the right thing, one must falsify a document to best serve the patient?

He said his hands are tied, because officially all he can do is back blows and knowing the victim wont lay down, he will have to wait until they get WORSE in order to do something more for them, such as chest thrusts or laryngoscope and magills.

Can you please tell me why Australia no longer recognizes abdominal thrusts?

Can you tell me when Australia did away with abdominal thrusts?

Can you tell me why a medic (if following the guidelines as written) would have to wait for the patient to decompensate before being able to assist if the back blows don't work and they don't lay down?

If you have any further questions, please ask away.

Confused in a far away land....

[akflightmedic]

For those that are confused or not aware, the abdominal thrusts I refer to are what some may still refer to as Heimlich, which we stopped calling that several years ago. Abdominal thrusts are just that, thrusts to the abdomen usually from a standing position behind the victim who is still conscious and choking.

[Camulos]

Can you please tell me why Australia no longer recognizes abdominal thrusts?

As stated by the Australian Resuscitation Council – "The ARC does not recommend the use of abdominal thrusts as there is considerable evidence of harm caused by this procedure". The "evidence" (if it can be referred to as that) by ILCOR in 2005 cites twenty two separate case reports of adverse events secondary to the abdominal thrust procedure. Some of the adverse events noted in this literature review included gastric rupture, abdominal aortic thrombosis, internal carotid artery dissection, mesenteric laceration, diaphragmatic hernia, pneumomediastinum, ruptured oesophagus and vomiting with subsequent aspiration.

Although not specifically cited by the ARC as a reason to abolish abdominal thrusts it is interesting to note three studies that exhibit that higher airway pressures can be generated by using chest thrusts rather than abdominal thrusts. One was a randomised trial using cadavers and the other two were prospective studies utilising anaesthetised volunteers. Without an official statement by the ARC however one can only postulate whether these studies weighed into their decision making process on this topic. However being only three small studies I would think, or hope, not.

Can you tell me when Australia did away with abdominal thrusts?

February 2006 – Based on ILCOR recommendations from 2005.

Can you tell me why a medic (if following the guidelines as written) would have to wait for the patient to decompensate before being able to assist if the back blows don't work and they don't lay down?

The topic of chest thrusts did cause some confusion when first published. One misunderstanding here was the positioning of a casualty to be administered chest thrusts. As you seem to have been incorrectly informed it is NOT compulsory for the pt to be lying down to have chest thrusts administered. Lying down is one possibility however you have already highlighted the improbability of the pt cooperating with that approach. Therefore as it states in the ARC guidelines when referring to chest thrusts - "Children and adults may be treated in the sitting or standing position". Furthermore on the topic of chest thrusts the ARC states;

"Chest thrusts are applied:

• At the same point on the chest that is used when providing chest compressions during CPR.

• They are delivered sharper and slower than chest compressions during CPR.

In order to do chest thrusts you need to have the back of the patient supported. This can be achieved by either:

• Placing your other hand on the patients back.

• If the patient is sitting use your other hand to support the back of the chair.

• Have someone stand behind to provide support.

• Stand against a firm surface like a wall.

• Lie the patient down.

It is very hard to state categorically on how to achieve back support when using chest thrusts but the overall principle remains the same. Support the back any way you can. Remember if chest thrusts cannot be applied continue with back blows. If the patient becomes unconscious commence CPR."

I have not touched on the role here of larnygoscopy and magills as I believe that would be a whole new topic in itself.

I hope this helps and if you really want the actual references for any of the above just let me know. What an interesting post that is going to make – LOL.

Stay safe,

Camulos

Edited May 26, 2009 by Camulos

[akflightmedic]

Fantastic!!!

Cheers mate!

[spenac]

For those that are confused or not aware, the abdominal thrusts I refer to are what some may still refer to as Heimlich, which we stopped calling that several years ago. Abdominal thrusts are just that, thrusts to the abdomen usually from a standing position behind the victim who is still conscious and choking.

I thought it was the hind lick maneuver?

Edited May 26, 2009 by spenac