Focus on airway managementAirway obstruction in children aged less than 5 years:: The prehospital experience☆
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.
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Abstract presented as a poster presentation at: Emergency Medical Services for Children Statewide Conference, San Diego, California, November 2000.