Emergency Situations: Foreign Body Obstruction
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Questions and Answers

What should a lone rescuer do before summoning assistance during CPR?

  • Check the patient's pulse
  • Perform CPR for one minute (correct)
  • Administer medications as needed
  • Call for help immediately

    • What action should be taken before repeating ventilations during a rescue?

  • Encourage the patient to cough
  • Ensure the airway is clear
  • Check for foreign objects in the mouth (correct)
  • Administer back blows

    • What symptoms should prompt parents or carers to seek medical advice after FBAO treatment?

  • Normal breathing patterns
  • Increased energy levels
  • Dysphagia and persistent cough (correct)
  • Relief of choking symptoms

    • What defines a severe airway obstruction?

    <p>Patient unable to speak and nods without coughing</p> Signup and view all the answers

    What is the recommended action for a patient experiencing mild airway obstruction?

    <p>Encourage the patient to cough</p> Signup and view all the answers

    What should be monitored continuously after a patient has suffered from mild airway obstruction?

    <p>The potential for severe obstruction</p> Signup and view all the answers

    What is a potential risk of aggressive treatment during mild airway obstruction?

    <p>Exacerbating the obstruction</p> Signup and view all the answers

    What should be done after performing chest compressions in a patient?

    <p>Examine the patient for injuries</p> Signup and view all the answers

    What does the presence of black eyes and bruising behind the ears typically indicate?

    <p>Ruptured blood vessels due to significant force</p> Signup and view all the answers

    What is a common reaction to serious head injuries that may persist for a while?

    <p>Nausea and vomiting</p> Signup and view all the answers

    What should you do if a person with a head injury is unconscious?

    <p>Monitor their airway and breathing</p> Signup and view all the answers

    During first aid for a conscious head injury victim, what is the most important step?

    <p>Control any significant blood loss with pressure</p> Signup and view all the answers

    Which symptom is a danger sign to watch for after a concussion?

    <p>Persistent headache</p> Signup and view all the answers

    What is a characteristic of concussion regarding its diagnosis?

    <p>It requires confirmation of no more serious injury</p> Signup and view all the answers

    When providing first aid for scalp injuries, what is a key consideration?

    <p>Control bleeding with direct pressure</p> Signup and view all the answers

    What should you do if a person with a head injury shows signs of impaired breathing?

    <p>Tilt their head back carefully to support breathing</p> Signup and view all the answers

    What is a common cause of bradycardia following cervical or high thoracic injuries?

    <p>Unopposed vagal activity</p> Signup and view all the answers

    Why is continuous heart rate monitoring necessary in the intensive care unit for patients with autonomic instability?

    <p>To detect bradycardia or other cardiac abnormalities</p> Signup and view all the answers

    What is an important aspect of managing blood pressure in patients with neurogenic shock?

    <p>Administering vasopressors if necessary</p> Signup and view all the answers

    How often should temperature measurements be taken in the acute stage of admission for patients with autonomic instability?

    <p>Every 4 hours</p> Signup and view all the answers

    Which of the following is a common complication associated with autonomic instability?

    <p>Pressure sores</p> Signup and view all the answers

    What condition can result from the loss of temperature control in children with autonomic instability?

    <p>Hypothermia</p> Signup and view all the answers

    Which intervention is crucial when managing hypotension in patients with autonomic instability?

    <p>At least hourly blood pressure monitoring</p> Signup and view all the answers

    What can exacerbate the risks of pulmonary edema in patients requiring blood pressure maintenance?

    <p>Excessive intravenous fluids</p> Signup and view all the answers

    What is the potential consequence of performing abdominal thrusts and chest compressions?

    <p>Serious internal injuries</p> Signup and view all the answers

    What type of head injury can be classified as having visible wounds?

    <p>Open head injury</p> Signup and view all the answers

    Which of the following is NOT a symptom of a serious head injury?

    <p>Dizziness</p> Signup and view all the answers

    What fluid protects the brain from injuries caused by impacts to the head?

    <p>Cerebrospinal fluid</p> Signup and view all the answers

    What should be done if a child with severe airway obstruction is conscious and back blows are ineffective?

    <p>Deliver up to five abdominal thrusts.</p> Signup and view all the answers

    Which airway clearance device's routine use is not recommended by the Resuscitation Council (UK)?

    <p>Various airway clearing devices</p> Signup and view all the answers

    What is the proper position for delivering back blows to a small child?

    <p>Over the lap with their head down.</p> Signup and view all the answers

    Which of the following actions should NOT be taken when dealing with an unconscious infant or child?

    <p>Attempt blind finger sweeps to remove an obstruction.</p> Signup and view all the answers

    What should be assessed in all head injuries, regardless of visible signs?

    <p>The potential for brain or spinal cord injury</p> Signup and view all the answers

    What is the correct technique for delivering abdominal thrusts to a child?

    <p>Place a clenched fist between the umbilicus and xiphisternum.</p> Signup and view all the answers

    Which condition can cause permanent damage by increasing pressure inside the skull?

    <p>Intracranial pressure</p> Signup and view all the answers

    What should be checked after each back blow when managing a conscious child with airway obstruction?

    <p>Whether the obstruction has been dislodged.</p> Signup and view all the answers

    What indicates that cerebrospinal fluid might be leaking after a head injury?

    <p>Clear fluid from the ears or nose</p> Signup and view all the answers

    When should chest compressions be commenced for an unconscious child?

    <p>If the child remains unresponsive.</p> Signup and view all the answers

    What is the primary purpose of delivering back blows to a child with airway obstruction?

    <p>To dislodge the obstruction.</p> Signup and view all the answers

    If an infant is conscious but severely obstructed, which action is NOT recommended?

    <p>Do nothing and monitor until they become unconscious.</p> Signup and view all the answers

    What is the primary consideration when managing facial trauma?

    <p>Maintaining airway, breathing, and circulation</p> Signup and view all the answers

    Which of the following symptoms would most likely indicate a nose fracture?

    <p>Purplish patch on skin (bruising)</p> Signup and view all the answers

    Which bones are included in the facial skeleton?

    <p>Zygomas and maxillary bones</p> Signup and view all the answers

    What could be a sign of an orbital fracture?

    <p>Diplopia (double vision)</p> Signup and view all the answers

    Which of the following is NOT a typical cause of facial fractures?

    <p>Walking on a flat surface</p> Signup and view all the answers

    What is a common symptom of upper or lower jaw fractures?

    <p>Loose or broken teeth</p> Signup and view all the answers

    Which statement best describes necessary interventions for patients with facial trauma?

    <p>Establishing IV access for medications may be required</p> Signup and view all the answers

    What is a sign of a deviated septum in cases of facial injury?

    <p>One nostril blockage</p> Signup and view all the answers

    Study Notes

    High Acuity and Emergency Situations

    • Foreign body obstruction is a life-threatening clinical emergency.
    • Obstructions can be partial or complete, caused by foreign objects (e.g., food, toys).
    • Respiratory distress, sudden coughing, and agitation are common symptoms.
    • Improper chewing of large food pieces, alcohol intake, loose dentures, and childhood behaviors (e.g., running while eating) can contribute to obstruction.
    • Obstructions are categorized into anatomical (tongue dropping back) and mechanical (foreign objects lodged in the pharynx).
    • Mild obstruction is characterized by responsive victims with effective coughing, often with wheezing.
    • Severe obstruction is where victims have ineffective coughs, high-pitched inhaling noises, increased respiratory difficulty, possible cyanosis, and inability to speak, breathe, or cough. Movement of air is absent.
    • A choking algorithm, based on the Resuscitation Council's guidelines, provides quick guidance.
    • Assessment of the severity and the appropriate procedure for infants (<1 year) and children (>1 year) is crucial.
    • Prevention advice includes cutting food into small pieces, keeping small objects out of reach for children, and always supervising young children while eating.
    • A mild obstruction, with effective coughing, does not require external maneuvers, but close observation is needed.

    Foreign Body Airway Obstruction

    • Foreign body airway obstruction involves a blockage of the breathing tubes to the lungs.
    • The blockage is caused by a foreign body, such as food, beads, or toys.
    • The onset of respiratory distress often involves coughing.
    • Agitation can be a key symptom at initial stages of obstruction.
    • This situation is a clinical emergency that could be life-threatening.
    • Nurses need to confidently assess the severity of the airway obstruction, intervene to relieve the obstruction, and know when to call emergency assistance.

    Causes of Obstruction

    • Improper chewing of large food pieces
    • Excessive alcohol intake
    • Loose dentures
    • Children running/playing while eating
    • Unattended children at the “hand-to-mouth” stage

    2 Types of Obstruction

    • Anatomical obstruction: The tongue blocks the throat. Other causes include acute asthma, croup, diphtheria, swelling and whooping cough.
    • Mechanical obstruction: Foreign objects in the pharynx or airways, or fluids accumulating in the back of the throat.

    Classification of Obstruction

    • Mild obstruction: The victim is responsive and can cough forcefully. Wheezing commonly occurs between coughs.
    • Severe obstruction: The victim shows a weak, ineffective cough, high-pitched inhaling sounds, increases respiratory difficulty, and possible cyanosis. The victim cannot speak, breathe or cough and may clutch their neck with their hands. Air movement is absent.

    Prevention of Choking in Infants and Children

    • Always cut food into small pieces.
    • Keep small objects, like small toys, out of reach.
    • Always supervise infants and young children while eating.

    Mild Airway Obstruction (Effective Cough)

    • Coughing generates high and sustained airway pressures, potentially expelling the foreign body.
    • Encourage the child or patient to cough.
    • Patients with an effective cough are able to cry or respond verbally to questions.
    • No external maneuvers (e.g., back blows) are needed but continuous observation until improvement is needed.

    Severe Airway Obstruction (Ineffective Cough)

    • Infants (<1 year):
      • Call for help immediately.
      • Deliver up to 5 back blows (slaps). Place the infant prone, head downward, supporting the head and neck.
      • Stabilize the head by placing one hand on the angle of the jaw and the other hand on the opposite side of the jaw.
      • Deliver 5 sharp back slaps between the shoulder blades.
    • Check for improvement after each maneuver.
    • Children (>1 year): Similar procedure, but the child can typically be guided to a leaning forward position.

    If Back Blows Fail

    • If the object doesn't dislodge, and the infant is still conscious, deliver up to 5 chest thrusts.
    • Turn the infant supine, head in a downward position.
    • Locate the xiphisternum
    • Deliver 5 sharp chest thrusts at a slower rate.
    • Check for improvement after each maneuver.
    • Alternate back blows and chest thrusts if necessary.

    Management of the Unconscious Infant or Child

    • Carefully support to a flat surface.
    • Call for help.
    • Open the infant or child's mouth and check for visual obstruction. If present, attempt removal with a single finger sweep.
    • Open the airway, perform 5 ventilations, and reposition head if chest does not rise.
    • If unresponsive, begin CPR: 30 compressions, 2 ventilations, check the mouth, and remove any present object before repeating these steps.

    Aftercare

    • Medical advice is critical even after successful treatment and/or removal of the foreign body.
    • Complications may arise from the initial incident as well as interventions (e.g,. chest/abdominal thrust).
    • Evaluation by the appropriate health professional is important.
    • Patients requiring these interventions should be examined for potential injuries.
    • Nurses have the professional responsibility to implement these steps according to approved protocols and local policies.

    Treatment of FBAO in Adults

    • If a Foreign Body Airway Obstruction (FBAO) is suspected in an adult, start by assessing the severity using a choking algorithm.
    • Always ask the patient if they are choking. This will help distinguish mild from severe airway obstruction.

    Severity of Airway Obstruction

    • Mild obstruction: Patient can talk and has an effective cough.
    • Severe obstruction: Patient responds to "yes" by nodding, but cannot speak or cough effectively.

    Mild Airway Obstruction (Effective Cough)

    • Coughing generates high pressures needed to expel a foreign body.
    • Encouraging patients to cough is a key step.
    • Patients with mild airway obstruction should be continuously monitored for any signs of worsening. Aggressive treatment is not immediately needed.

    Severe Airway Obstruction (Ineffective Cough)

    • Call for help immediately, encourage coughing.
    • Support the patient's chest using one hand.
    • Lean the patient slightly forward.
    • Use the heel of your hand to deliver up to five back blows between the scapulae.
    • Check for improvement after each blow.
    • If required use, abdominal thrusts if the patient is still conscious and back blows continue if necessary.

    First Aid for Conscious Patients

    • Minimise head and neck movements; control bleeding with direct pressure and dressings.
    • Avoid disturbing any blood clots and reassure the patient.

    First Aid for Unconscious Patients

    • Do not move the person unless an immediate danger is present.
    • Protect injured persons from any dangers at the scene.
    • Monitor their airway and breathing until the arrival of help/ambulance.
    • If breathing or pulse stops, initiate cardiopulmonary resuscitation (CPR).

    Treatment of Concussion

    • Concussion is a mild traumatic brain injury (TBI) after head trauma assessed by a doctor
    • Symptoms may persist up to 3 weeks.
    • Seek medical attention if persistent vomiting, loss of coordination, or worsening headaches occur.

    Facial Trauma

    • Facial trauma includes injuries to the mouth, face, and jaw.
    • Common causes include assaults, vehicle accidents, industrial injuries, sports injuries, and falls.
    • Facial fractures can affect eating, speaking, breathing, hearing, sight and overall function.

    Facial Fracture Causes

    • High-impact accidents
    • Sports injuries
    • Workplace accidents
    • Falls
    • Interpersonal trauma

    Facial Fracture Symptoms

    • Pain, bruising, swelling, or tenderness.
    • Bleeding, purplish skin patches (ecchymosis).
    • Discoloration under the eyes (black eyes).
    • Blockage of nostrils; crooked or indented nose bridges.
    • Nosebleeds
    • Vision changes
    • Weakness/difficulty with jaw, swallowing or chewing or speaking

    Orbital Fracture Symptoms

    • Blurred, decreased, or double vision (diplopia)
    • Difficulty moving eyes
    • Swollen forehead or cheeks
    • Flatness of cheeks
    • Sunken or bulging eyeballs
    • Facial numbness near the injury.
    • Blood or discoloration in the white (sclera) part of the eye.

    Upper and Lower Jaw Fracture Symptoms

    • Difficulty with chewing, eating, or speaking.
    • Loose, broken, or missing teeth.
    • Teeth not fitting together properly.
    • Cheek pain when opening the mouth.

    Determining Priorities of Care

    • Maintain airway, breathing, and circulation (ABCs).
    • Provide supplemental oxygen if indicated.
    • Establish intravenous access for crystalloid fluid or blood products.
    • Obtain and set up necessary equipment and supplies.
    • Prepare for any medical interventions or treatments.
    • Administer any necessary medications or therapies.

    Protocol for Airway Management in Maxillofacial Trauma

    • Anticipate airway obstruction.
    • Clear the airway (chin lift, jaw thrust).
    • Confirm that the oral and nasal apertures are clear.
    • Perform bag-valve-mask ventilation, ideally via a two-person technique.
    • Proceed with intubation if necessary.
    • Consider surgical airway if intubation is unsuccessful..

    Spinal Cord Injury (SCI)

    • SCI is damage to any part of the spinal cord or nerves in the spinal canal.
    • Common causes are motor vehicle accidents, acts of violence, and sporting injuries.
    • The mechanism of injury influences the injury type and severity (complete or incomplete).
    • Classification is based on the level and extent of neurological deficit (e.g., tetraplegia or paraplegia).

    SCI Physical Findings

    • Physical findings vary based on the level of injury, degree of spinal shock, and phase of recovery.
    • The classifications are generally categorized by levels.
    • Different levels result in different functional deficits. (Examples provided in the text)

    Signs and Symptoms of SCI

    • Unusual body positioning
    • Skin feeling clammy or cool
    • Inability to move limbs
    • Flaccid paralysis below the injured level
    • Loss of spinal reflexes below the injured level
    • Loss of sensation (pain, touch, temperature, proprioception)
    • Loss of sweating below the injured level
    • Loss of sphincter tone (bowel and bladder dysfunction)

    Diagnostic Tests for SCI

    • X-rays
    • CT scans
    • MRIs
    • Myelography

    Toddlers and Head Injuries

    • A fall from a child's own height does not usually cause serious head injury.
    • Head injury severity is not related to the size of the bump.
    • Minor head injuries can usually be treated with medication and parental reassurance.
    • Medical attention needs to be sought immediately if the child shows unusual drowsiness, vomiting or appears unconscious after a fall.

    Initial Care - Immobilization

    • Immobilise the entire spine of any patient suspected of or known to have SCI, using a hard collar.
    • Turn patients only using a log roll with adequate personnel.
    • Using an airway pad for children under eight years old will promote neutral cervical spine position.
    • Within 6 hours, the hard collar should be changed to a two-piece collar.

    Airway with Cervical Spine Protection

    • Early and safe airway management is crucial for favourable long-term patient outcomes.
    • Look for signs of airway obstruction (accessory muscle use, paradoxical respiration).
    • Listen for upper airway sounds (diminished or noisy).
    • Spinal patients are at risk of passive regurgitation.
    • High cervical injuries put patients at risk of impaired gag and cough reflex.

    Attempt Simple Airway Manoeuvres if Required

    • Open the airway via a chin-lift or jaw-thrust.
    • Suction the airway if excessive secretions are present.
    • Use an oropharyngeal (OPA) or nasopharyngeal (NPA) airway if required.

    Secure the Airway if Necessary

    • Treat airway obstruction as a medical emergency.
    • Consider early intubation with signs of decreased level of consciousness or an unprotected airway.

    Intubation/Manual In-Line Cervical Stabilization

    • Skilled and teamwork are vital during intubation and maintaining spinal precautions.
    • Maneuvers that mobilize the cervical spine (e.g., neck tilt) should not be used.
    • Only use chin lift and jaw thrust movements.
    • Manual in-line cervical stabilisation must be maintained while changing collars.
    • A second assistant should deliver cricoid pressure.

    Assess the Chest

    • Monitor respiratory rate and oxygen saturation.
    • Auscultate to identify any abnormal breath sounds.

    Circulation with Hemorrhage Control

    • Intravenous access is needed for early fluid replacement.
    • Preventing hypotension is important; A systolic blood pressure above 90 mmHg is a target goal.
    • Assess the patient for any signs of external or internal hemorrhaging.
    • Administer direct pressure on external wounds.
    • Recognize the possibility of internal bleeding based on the mechanism of injury.
    • Expect hypotension/bradycardia (low heart rate) in injured patients ( particularly if the injury is above the 6th thoracic vertebra)
    • Medications such as atropine may be required.

    Disability: Neurologic Assessment

    • Perform an initial AVPU assessment. (Alert, Verbal, Pain, Unresponsive).
    • Check pupillary response.
    • All trauma patients should be treated as having a spinal injury until proven otherwise.
    • High spinal injury diagnoses should involve evaluating key signs such as Priapism, diaphragmatic breathing and anal tone loss.

    Exposure/Environmental Control

    • Remove clothing to conduct a thorough examination.
    • Monitor body temperature; prevent or treat hypothermia.
    • Keep the environment warm.

    Secondary Survey

    • Commence after the primary survey and any life-threatening injuries have been treated.
    • Gain a thorough history from the patient, witnesses, or other sources. (AMPLE acronym (Allergies, Medications, Past medical history, Last meal and Events leading to incident))

    Neurological Assessment

    • Document sensory and motor levels.
    • Contact Rehab team after 72 hours.
    • Perform hourly neurological checks for 24 hours, decreasing to 4 hourly if stable..
    • Note any evidence of brain or spinal cord injury.

    Vital Signs (and Autonomic Control)

    • Trauma patients frequently have abnormal vital signs; these may be due to factors other than spinal cord injury.
    • Monitor heart rate, blood pressure, and temperature continuously and/or hourly.
    • Specific issues like bradycardia may require specific treatment.

    Blood Pressure

    • Loss of autonomic control leads to reduced vasomotor tone, resulting in vasodilation and hypotension.
    • Monitor blood pressure closely; maintain a systolic blood pressure above 90mmHg.
    • Maintain adequate fluid resuscitation but avoid overload.
    • Vasopressors may be needed, and treatment needs to be managed in a critical care/intensive care unit (ICU).

    Temperature

    • Patients with SCI may lose temperature regulation causing either hypothermia or hyperthermia.
    • Monitor temperature frequently, particularly during acute admission.

    Potential Complications and Management

    • Common complications include pressure sores, autonomic hyperreflexia, pneumonia, urinary tract infections, constipation, deep vein thrombosis, bone demineralisation, latex allergies, and spasticity.
    • Manage these issues with prevention and appropriate, timely treatments.

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    High Acuity and Emergency Situations PDF

    Description

    This quiz explores high acuity and emergency scenarios involving foreign body obstruction. It covers the causes, symptoms, and classifications of obstructive emergencies, as well as the chocking algorithm based on the Resuscitation Council's guidelines. Test your knowledge on how to identify and respond to these life-threatening situations.

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