165 Airway Obstruction 81 Definition Partial or complete block of normal air exchange, causing rapid decreased blood oxygen sat- uration and oxygen deficit to the brain. Loss of consciousness and death follows rapidly. Air- way obstruction can be caused by vomitus, edema resulting from respiratory infection, smoke inhalation or poisoning, bronchial spasms, neck trauma, the tongue, or such foreign objects as food, ice, dentures, or broken teeth. Characteristics Airway obstruction can have either good or poor air exchange. In a conscious person with a completely obstructed airway, the characteristics include an inability to speak or cough and clutching the neck (universal distress signal). Partial airway obstruction with poor air ex- change can result in gurgling, crowing, wheezing, skin discoloration, changes in breathing, and weak cough. Good air exchange includes a forceful cough and ability to respond. Policy Airway obstruction is an emergency. Immediately administer abdominal thrusts (Heimlich maneuver) for conscious employees or immediately begin CPR per American Heart Associa- tion Basic Life Support (AA BLS) guidelines for an unconscious employee. Evaluate em- ployee in the occupational health unit by available professional or trained first responder and arrange for immediate medical care as appropriate. Always maintain emergency sup- plies in an emergency cart or bag in the occupational health unit or other areas of the work setting to facilitate emergency response. Include supplies necessary to comply with stan- dard/universal precautions (see page 21). Objectives Clinical Assessments and Interventions Referral for Medical Action ● Undislodged obstruction requiring immediate medical treatment (i.e., transport to hospital). ● Rule out any life-threatening complications from abdominal thrusts. ● Pregnant employee. ● Health history requires further medical attention. Follow-up Actions ● Educate employee regarding the cause of obstruction and preven- tive measures. – Eat slowly, chew food thoroughly. – Be alert for small pieces of bone, seed, or shell. – Avoid laughing and talking dur- ing chewing and swallowing. Employee conscious: Monitor and aid employee in remov- ing obstruction if necessary. ● Remain with employee who is experiencing a partial airway obstruction, but do not in- tervene if employee is able to cough force- fully. Encourage person to continue efforts to dislodge object. ● Monitor and be prepared to begin subdi- aphragmatic abdominal thrusts (abdominal thrusts) based on current guidelines (Heim- lich maneuver) or assign a trained em- ployee to do so. (See figure, page 167.) ● Assess employee for signs of poor air ex- change and determine airway occlusion (see Characteristics, above). ● If employee has a complete obstruction or poor air exchange, administer abdominal thrusts (see figure, page 167): – Stand behind a sitting or standing employee. – Make a fist with one hand and place it thumb side against abdomen—midline slightly above naval, below xiphoid process. Guideline continues on next page