Respiratory

Choking at community fair — elderly male

Foundation

Elderly · 75yr · male

Patient Information

Dispatch	A 75YO male has come to the FAP after a bystander reported him choking at the community fair food stall. (Harold Sutton)
Patient	Harold Sutton — 75yr (75kg)
Incident History	Pt was eating a sausage roll at a food stall when he began clutching at his throat and coughing. A bystander walked him to the FAP. He is conscious and distressed.
Emergency Contact	Margaret Sutton (Wife) — 0412 883 741

Initial Rapid Assessment

Response	Alert
Airway	Partially obstructed. Pt is coughing but cough is becoming increasingly ineffective. Mild stridor audible on inspiration. No visible foreign body in oropharynx.
Breathing	Laboured. RR elevated with accessory muscle use. Pt unable to speak in full sentences — mouthing words between coughing attempts. Mild cyanosis noted around lips.
Circulation	Radial pulse present, rapid and strong. Skin flushed. No external bleeding.
Disability	GCS 14 (E4V4M6). Orientated to time, place and person. Visibly anxious and panicking.
Exposure	Nil rashes or injuries noted. No medic alert jewellery. Food debris visible on shirt.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	91% (RA)	Moderate	24	102	138/88	<2s	14	4 4 ++	–	–	3
10 mins	97% (O2 simple mask 6L)	Nil	16	88	134/86	<2s	15	4 4 ++	–	–	1

History Taking

Treatment Response

Diagnosis

This patient is suffering from a partial (mild) Foreign Body Airway Obstruction with risk of progression to severe/complete obstruction.

Facilitator Triggers — if trainees miss a critical step

! (If trainee does not continuously reassess the effectiveness of the patient's cough within the first 2 minutes, the patient's cough becomes silent and he can no longer speak — obstruction progresses to severe/complete.)
! (If trainee attempts a finger sweep, inform them the patient recoils and the obstruction worsens — cue progression to severe obstruction.)
! (If trainee performs back blows and chest thrusts correctly for severe obstruction, the foreign body dislodges after the 3rd cycle — patient coughs up food debris and reports immediate relief.)
! (If trainee does not call for backup or arrange Priority 1 transport when obstruction progresses to severe, prompt with: 'The patient is now unable to breathe — what do you want to do next?')
! (If patient becomes unresponsive at any point and trainee does not commence CPR, patient ceases all spontaneous movement.)

Treatment Objectives

1. Don appropriate PPE — gloves minimum; eye protection given potential for expelled material.
2. Ensure suction equipment is available and functional at the bedside throughout care.
3. Perform primary survey — identify partial airway obstruction with effective but weakening cough.
4. Continuously reassure the patient — keep him calm to preserve effective cough effort.
5. Encourage coughing — allow patient to remain in a position of comfort (seated, leaning slightly forward).
6. Do NOT perform finger sweep — risk of worsening obstruction and local trauma.
7. Monitor continuously for deterioration from mild/partial to severe/complete obstruction (loss of voice, silent cough, cyanosis worsening, decreasing conscious state).
8. Apply oxygen therapy — simple face mask at 5–8L/min targeting SpO2 94–98%.
9. Obtain SAMPLE history including medications, allergies and events leading to presentation.
10. Record baseline observations: GCS, SpO2, RR, HR, BP, pain score.
11. IF obstruction progresses to severe/complete (patient unable to speak, silent/ineffective cough): Position patient so gravity assists — lean forward if standing/seated.
12. Deliver up to 5 back blows firmly between the scapulae at 90° to the patient's back — check for dislodgement after each blow.
13. IF obstruction not relieved after 5 back blows: Deliver up to 5 chest thrusts (sharper than CPR compressions) — check for dislodgement after each thrust.
14. Continue alternating 5 back blows and 5 chest thrusts until obstruction dislodges or patient loses consciousness.
15. IF patient becomes unconscious: Position supine and commence CPR as per Cardiac Arrest CPG — call for ambulance backup immediately.
16. Activate Priority 1 transport and pre-notify receiving facility if obstruction is severe or patient deteriorates.
17. Once obstruction clears: Reassess airway, breathing, circulation. Record post-event observations.
18. Advise patient to remain at FAP for ongoing monitoring — elderly patients may experience delayed complications including aspiration.
19. Record full observations every 5–10 minutes or as clinically indicated.
20. Scenario ends on arrival of ambulance and IMISTAMBO handover.
21. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Choking (Foreign Body Airway Obstruction) · Foreign Body Airway Obstruction · Oxygen Delivery · Suction · Cardiac Arrest - Adult

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Signs/Symptoms	Throat discomfort, sensation of something stuck. Coughing, mild stridor, difficulty speaking.
Allergies	NKDA
Medications	Ramipril 5mg daily, Atorvastatin 40mg nocte.
Pertinent History	Known hypertension and hypercholesterolaemia. No history of dysphagia or swallowing disorders. No prior choking episodes.
Last Oral Intake	Sausage roll approximately 5 minutes ago — the precipitating event.
Events Leading	Pt was eating at a community fair food stall and took a large bite of a sausage roll. He began choking and clutching his throat. A bystander recognised the signs and escorted him to the FAP.
Treatment Prior	Bystander encouraged pt to cough. No back blows or chest thrusts attempted prior to arrival at FAP.

Onset	Sudden onset approximately 5 minutes ago while eating a sausage roll.
Pain	Mild discomfort in throat rated 3/10.
Quality	Sensation of a foreign body lodged in throat. Not painful as such — more a feeling of obstruction.
Radiates	Nil
Severity	3/10