Management of an unstable patient with acute airway obstruction requires immediate attention to the airway. In the prehospital setting, the American Heart
Association recommends a series of five back blows and five chest thrusts in a child under the age of 1 (see Chap 10). The child should have the oropharynx examined between each series. In a child older than 1, the recommendation is a series of abdominal thrusts in either the upright or the supine position.
In the emergency department, the child with a partially obstructed airway should be rapidly assessed. If the child will tolerate it, a visual inspection of the hypopharyngeal and laryngeal areas should be attempted. Commonly, a child will tolerate this procedure poorly and thus should be taken to the operating room for general anesthesia and removal of the foreign body. In an unstable or completely obstructed patient, orotracheal intubation may dislodge the foreign body, and this should be attempted prior to needle cricothyroidotomy.
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