I had a call recently where I had to use a pair of magill forceps to clear out a patients airway. The call was also a bit of a challenge because the pt had a valid DNR/DNI and we were only able to provide supportive care. Nothing super ALCS or BLS other than suctioning, removing the obstructions, and BVM ventilation.
At any rate, it got me thinking about a few things I have read about, heard from other medics, and have seen in my time in medicine. I understand that just about anything can be an airway obstruction, but these are the ones that stuck with me. Here they are in order of worst to not as bad.
1.) Gel caps
I heard about this from JEMS magazine and it was probably the worst call the responding crew had to deal with. I will spare the details of the call, but it is important to note that once gel caps (pills) get wet or come in contact with wet surfaces, they can become very sticky if they are not allowed to completely dissolve. Imagine that in the airway of child. It can and will completely occlude the airway making an immovable obstruction and cementing the airway shut. No bueno. I have to say thank you to JEMS for the teaching moment on that one.
2.) Watermelon
I bet you were not thinking about that. A nurse friend of mine told me a story of a patient took care of that choked on some watermelon. Think about the flesh of a watermelon for a minute. It's fairly soft and mostly fluid. The problem with that is that once it becomes lodged in a confined space, like in someone's airway, you will have a heck of a time pulling it out. If you try and pull it out with your trusty magills, it will just fall apart. The one good thing about it (from my point of view) is that you might be able to push an ETT through it to initially get the airway some what open. Still a nasty situation.
3.) PB&J
This was my pt. They were eating a PB&J sandwich and started choking. The problem with PB&J is that once it gets all mushed together with saliva and what not, it forms a very thick paste. It looked similar to a hair ball the cat I had as a kid coughed up. The other bad thing about this is particular hazard is that it conforms to the shape of the airway very well and can pile up quickly and compact well completely occluding the airway. Another problem I see with it is that if you do the himlech, it has enough play where it could expand with the increased pressure from abdominal thrusts and not actually move out of the airway. The one good thing about this is that it can be removed fairly easily with magills and direct laryngoscopy if you get there in time.
4.)Bananas
This choking hazard shares a similar shape of the airway and can occlude it easily if it fell into the trachea. The good thing about bananas, (other than the fact that they are high in potassium) is that they can be broken up easily and pushed down into the airway and at one lung can be ventilated until definitive care can be started. Pulling out an overly ripe banana with forceps may be an exercise in futility since it may not have enough structure to it to be pulled out in one or two pieces.
5.) Hotdogs
If/when I have kids I don't want to give them hotdogs. Not because of the risk of developing HTN and all other sorts of badness, but because a hotdog cut up in to coins or medallions is perfect for occluding an airway. Sure a whole hotdog can do this too, but most people don't eat hotdogs like they owe them money. They are a bit easier to remove because they usually stay intact and do not break apart as easily as the previously mentioned foods. Still bad, but a bit more manageable.
I think that this was the first time I did a "top 5" or so post. I don't expect to be doing that very often, or even again. But you never know.
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