USMLE Forum Archives - USMLE Step 2 CK - Peds 3
Peds 3
TheOne - 11-02-06 19:52
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. Allow patient to clear foreign object by spontaneous coughing
B. Clear oropharynx with multiple blind sweeps with finger
C. Position patient and perform back blows
D. Stand behind patient and perform abdominal thrusts
E. Perform emergency tracheostomy and take to surgery
TheOne - 11-02-06 19:52
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. Allow patient to clear foreign object by spontaneous coughing
B. Clear oropharynx with multiple blind sweeps with finger
C. Position patient and perform back blows
D. Stand behind patient and perform abdominal thrusts
E. Perform emergency tracheostomy and take to surgery
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#1
Re: Peds 3 kingkong - 11-03-06 21:15 (D ) APPEARS TO BE THE ANSWER.FOREIGN OBJECT OBSTRUCTION, PERFORM HEIMLICH MANEUVER.
#2
Re: Peds 3
TheOne - 11-06-06 12:31 Explanation: The correct answer is A. 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.
Blind finger sweeps (choice B) is NEVER used now to treat upper airway obstruction due to foreign object impaction.
The next step would be performing back blows if the patient was less than 1 year of age (choice C).
If the patient were over 1 year old, abdominal thrusts would be the next management option (choice D).
An emergency tracheostomy (choice E) should be the last option and should be undertaken only by a physician trained to perform the procedure.
#4
Re: Peds 3 bingousmle - 07-19-10 08:59 Stand behind patient and perform abdominal thrusts according to he standarD BLS protocols as he is gagging and choking.. wonder how his vitals are stable
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