Describe the approach.
Initiate maneuvers to dislodge the aspirated FB (see table below for technique instructions).
Back blows: preferred initial maneuver in all patients
If back blows are ineffective
Infants: Perform chest thrusts.
Adults and children ≥ 1 year old: Perform abdominal thrusts (formerly known as the Heimlich maneuver).
Failure to dislodge the FB with repeated back blows and chest/abdominal thrusts
If trained: Proceed with emergency airway procedures for FBA.
Untrained or instruments not on hand: Continue maneuvers to dislodge the aspirated FB until help arrives.
Patient becomes unresponsive
If trained, proceed to emergency airway procedures in FBA.
If not trained, start CPR (see “Unresponsive patient”).
When should back blows/abdominal thrusts not be performed?
If the patient can speak, cry, or cough, do not attempt back blows or abdominal thrusts, as these maneuvers risk dislodging the FB and converting a partial obstruction into a complete obstruction.
Dislodge maneuvers (table).
Describe the suspected partial upper airway FBA management.
Sit the patient upright.
Encourage coughing to dislodge FB.
Monitor for signs of deterioration.
Signs of increased work of breathing
Signs of poor gas exchange (e.g., cyanosis)
Weak or ineffective cough
Inability to dislodge the FB and patient remains stable: urgent ENT referral for planned removal of an upper airway FB
Describe the suspected partial lower airway FBA management.
Optimize oxygenation
Encourage coughing to dislodge the FB.
Inability to dislodge the FB and patient remains stable: urgent pulmonology referral for planned removal of a lower airway FB
If at any time the patient becomes unresponsive despite treatment, start CPR, and, if trained, proceed to emergency airway procedures in FBA.
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