Elsevier

Prehospital Emergency Care

Volume 8, Issue 2, April–June 2004, Pages 196-199
Prehospital Emergency Care

Focus on airway management
Airway obstruction in children aged less than 5 years:: The prehospital experience

https://doi.org/10.1016/j.prehos.2003.12.014Get rights and content

Abstract

Background

Treatment of choking in children has been well studied, but few data are available on the various causes of the choking episodes in the pediatric population.

Objectives

To assess frequency and to stratify etiologies of children less than 5 years of age who had a 911 advanced life support (ALS) ambulance response for airway obstruction.

Methods

A prehospital database was searched and information was collected defining type of obstruction, age of the child, parents' action, paramedic treatment, and incident outcome.

Results

There were 182 patients with airway obstruction under 5 years of age, of whom 99 (55%) were less than 1 year old. Liquid obstructions (i.e., formula, juices) were most common in the youngest children, whereas solid food and nonfood solid obstructions were most prevalent in children over 1 year old. One hundred seven (59%) of these obstructions resolved before paramedic arrival (69% of liquid obstructions, 72% of food, and 36% of nonfood solid objects). Interventions used by parents included bulb suction (3%), finger sweeps (6%), Heimlich maneuver (3%), and back blows (12%). Paramedics used ALS skills in only three cases. After paramedic evaluation, 47% of parents refused transport against medical advice (AMA).

Conclusions

Although most episodes of pediatric airway obstruction will have been resolved by the time of paramedic arrival, age-specific and item-specific treatment skills need to be reinforced with parents and prehospital providers.

Section snippets

Materials and Methods

Prehospital records over a one-year period (January 1, 1999, to December 31, 1999) were retrospectively reviewed for all pediatric patients 5 years of age and younger who presented with a chief complaint of airway obstruction. Extracted data included demographic characteristics, vital signs, chief complaints, type of obstruction, parental actions, disposition, and treatments initiated by the paramedics.

The data source was the mobile intensive care nurse (MICN) data from the prehospital patient

Results

A total of 110,367 emergency patients resulting in paramedic 911 responses with base hospital contact occurred over the one-year study period, with 4,894 (4.4%) of these patients being 5 years of age or younger. There were 182 patients under 5 with airway obstruction, representing 3.7% of all children responded to under the age of 5 years and 50% of all patients to whom paramedics responded with a complaint of airway obstruction. Ninety-nine (55%) of these patients were less than 1 year of age.

Discussion

Although choking is a frightening experience for parents or caregivers, the data show that the majority of all choking episodes will resolve before the arrival of EMS, with very few requiring ALS level of care. The patients who required ALS care were the older children, most likely reflecting the fact that most infants tend to choke on liquid items, which are more likely to spontaneously resolve.

Previous work has used dogs, baboons, human cadavers, and anesthetized volunteers to test various

Limitations

Limitations to this study include that, as a retrospective review, the study was limited to records included in an existing database. Some cases potentially could be missing if the chief complaint was not among the categories searched. In other words, if the airway obstruction caused a hypoxic seizure and the chief complaint was seizure, then the record might not have been pulled for review. Some of the records were incomplete, specifically when identifying the object, although in many cases

Conclusions

Although most episodes of pediatric airway obstruction will have been resolved by the time of paramedic arrival, age-specific and item-specific treatment skills need to be reinforced with parents and prehospital providers.

Acknowledgements

The authors thank the mobile intensive care nurses and paramedics of San Diego County.

References (10)

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Abstract presented as a poster presentation at: Emergency Medical Services for Children Statewide Conference, San Diego, California, November 2000.

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