A 3-year-old child is brought to the emergency department by parents who report that the child was playing with small toys and suddenly began coughing violently. The child now appears anxious and is drooling. Which assessment finding would be most indicative of a complete airway obstruction from foreign body aspiration?
1Inspiratory stridor and retractions
2Expiratory wheezing and prolonged expiration
3Wet, productive cough with fever
4Inability to speak or make sounds with cyanosis✓ 정답
해설
Inability to speak or make sounds with cyanosis indicates complete airway obstruction requiring immediate intervention. Other findings suggest partial obstruction or infection.
Clinical Judgment
This question assesses your ability to distinguish the degree of airway obstruction. The key is to identify the most definitive sign of a "complete airway obstruction". Sudden coughing, drooling, and anxiety strongly suggest foreign body aspiration, but these can also occur with a partial obstruction. A complete obstruction means a state of no air exchange at all, which manifests as an inability to speak or make sounds (aphonia) along with cyanosis. This is an absolute emergency requiring immediate life-saving interventions (e.g., the Heimlich maneuver).
Memory Tip
Remember complete obstruction as No Air Flow: No sound, Anxious face, Failure to breathe (cyanosis). Partial obstruction is Some Air Flow: Stridor, Air movement (wheezing), Foreign body sensation (drooling).
KR vs US
In Korea, it is common to immediately induce coughing or attempt back blows when foreign body aspiration is suspected, but NGN/US guidelines clearly differentiate: for a partial obstruction where an effective cough (strong and resonant) is possible, encourage coughing, and for a complete obstruction (or decreased consciousness) where an effective cough is impossible, immediately perform the Heimlich maneuver (age 1 and older) or back blows/chest thrusts (under age 1). The emphasis is on immediate intervention based on the condition, rather than "first tilt them back and check."
Clinical Practice Guide
1Partial Airway ObstructionIf the patient can speak, cry, or cough effectively, encourage them to continue coughing and monitor from behind to watch for any worsening of their condition. Coughing is the most effective method of clearance.
2Complete Airway ObstructionIf the patient cannot speak, cry, or cough, and displays a terrified expression or clutches their throat, begin emergency measures immediately.
Infants under 1 yearFirst, alternate between 5 back blows and 5 chest thrusts.
Children over 1 year / AdultsPerform the Heimlich maneuver (abdominal thrusts).
3. If the patient loses consciousness during emergency measures, start CPR immediately, and after every 30 chest compressions, open the airway and attempt to remove the foreign object if it is visible.
Caution
- In SATA (Select All That Apply) questions asking for "signs of airway obstruction," you can include symptoms of both partial and complete obstruction. However, for questions asking for the "most indicative" or "best indicates complete obstruction," you must select "inability to speak/ineffective cough" and "cyanosis."
- "Inspiratory stridor" is a sign of partial obstruction, typically occurring when a foreign object is lodged in the upper airway. "Expiratory wheezing" is more common when a foreign object has passed into the lower airway (bronchi).
Complete Airway Obstruction — Complete airway obstruction. A condition where the airway is completely blocked, preventing any air exchange, and is a life-threatening emergency. Immediate airway obstruction removal techniques (such as the Heimlich maneuver) are required.
Foreign Body Aspiration — Foreign body aspiration. This refers to the inhalation of foreign objects such as food or toy fragments through the airway into the lungs. It is common in children, especially those under 3 years of age, and causes sudden coughing, choking, and difficulty breathing.
Stridor — Stridor. A harsh, high-pitched sound made when air passes through a narrowed upper airway (larynx, trachea). Stridor heard during inspiration suggests upper airway obstruction.
Cyanosis — Cyanosis. A condition where the skin and mucous membranes (especially the lips and nails) turn bluish due to low oxygen saturation in the blood. It is a sign of severe hypoxia and can develop rapidly in complete airway obstruction.
Heimlich Maneuver — Heimlich maneuver. This is an emergency procedure performed on conscious patients aged 1 year and older who are experiencing complete airway obstruction. It involves rapidly thrusting upward below the diaphragm to use residual air in the lungs to expel the foreign object.