A 5-year-old boy suddenly begins coughing while eating peanuts. He is choking and gagging. When he is brought to the emergency department, but he is awake and is able to give his name. On physical examination, his vital signs are stable. On examination of the chest, inspiratory stridor and intercostal and suprasternal retractions are apparent.
Which of the following is the most appropriate initial step in management?
A . Position patient and perform back blows
B . Clear or oropharynx with multiple blind sweeps with finger
C . Stand behind patient and perform abdominal thrusts
D . Allow patient to clear foreign object by spontaneous coughing
E . Perform emergency tracheostomy and take to surgery.
Answer: D
Explanation:
Since the patient can cough and breathe, he should be allowed to clear the foreign object spontaneously, if possible. In the management of foreign object obstruction, if the patient can cough and breathe, it is best to initially observe and allow spontaneous resolution, since intervention may actually be damaging.