# Situation: A 64-year-old man on a medical ward is eating lunch in bed when he suddenly grasps his throat. He has no pacemaker and no do-not-resuscitate order. The unit's adult choking protocol calls for cycles of 5 back blows and 5 abdominal thrusts for severe airway obstruction in a responsive adult. Later his cough becomes silent, he cannot speak, and he becomes unresponsive. The nurse lowers him to the floor, calls a code, and begins cardiopulmonary resuscitation (CPR). Each time the nurse opens the airway to give breaths, what should the nurse do?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630237  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 64-year-old man on a medical ward is eating lunch in bed when he suddenly grasps his throat. He has no pacemaker and no do-not-resuscitate order. The unit's adult choking protocol calls for cycles of 5 back blows and 5 abdominal thrusts for severe airway obstruction in a responsive adult.

Later his cough becomes silent, he cannot speak, and he becomes unresponsive. The nurse lowers him to the floor, calls a code, and begins cardiopulmonary resuscitation (CPR). Each time the nurse opens the airway to give breaths, what should the nurse do?

## 보기

1. Give 5 abdominal thrusts before attempting a breath
2. Perform a finger sweep at the back of the throat
3. Check the carotid pulse for 10 seconds before breathing
4. Look in the mouth and remove an object only if seen **✔ 정답**

**정답: 4**

## 해설

When a choking adult becomes unresponsive, CPR is started, because chest compressions can dislodge the object. Each time the airway is opened for breaths, the rescuer looks in the mouth and removes an object only if it can be seen; blind finger sweeps are avoided.

## 심화 해설

When a responsive adult with severe airway obstruction becomes unresponsive, the management sequence changes fundamentally. The clinical priority shifts from active dislodgement maneuvers to basic life support with integrated airway inspection. Chest compressions generate intrathoracic pressure changes that can move an obstructing object, and each ventilation attempt provides an opportunity to visualize and remove accessible material.

The correct action is to look in the mouth and remove an object only if it is seen. This reflects a deliberate safety principle in airway management. Blind finger sweeps are avoided because they can push a foreign body deeper into the airway or injure the posterior pharynx. The rescuer opens the airway using a head tilt–chin lift, visually inspects the oral cavity, and removes an object only when it is clearly visible and graspable. If no object is seen, the rescuer immediately proceeds with the next ventilation attempt and continues CPR cycles.

Key point! In an unresponsive choking adult, chest compressions serve a dual purpose: they support circulation and may dislodge the obstruction. Abdominal thrusts are no longer the primary intervention once the person loses consciousness.

The distinction between responsive and unresponsive management is critical for nursing licensure examinations. A responsive adult with severe obstruction receives cycles of 5 back blows and 5 abdominal thrusts. Once unresponsiveness occurs, the rescuer lowers the person to the floor, activates the emergency response system, and begins CPR. The airway is checked before each breath, but only visible objects are removed.

| Patient Status | Primary Intervention | Airway Management During Breaths |
| --- | --- | --- |
| Responsive, severe obstruction | 5 back blows alternating with 5 abdominal thrusts | Not applicable; patient is breathing or coughing |
| Unresponsive | CPR with chest compressions | Look in mouth; remove object only if seen |

Watch out! A finger sweep is not performed blindly. The rescuer must see the object before attempting removal. This prevents worsening the obstruction and avoids trauma to the airway mucosa.

Checking the carotid pulse for 10 seconds before breathing is not indicated during CPR for a choking victim. Pulse checks interrupt compressions and delay ventilation. In the context of an unresponsive choking adult, the rescuer proceeds directly with compressions and ventilations according to standard CPR sequences. The airway is assessed visually as part of each breath attempt, not as a separate pulse-check step.

Performing abdominal thrusts on an unresponsive person is also incorrect. Abdominal thrusts require an upright or standing position to generate effective upward pressure. Once the person is supine on the floor, chest compressions provide the mechanical force needed to expel the object. The transition from abdominal thrusts to chest compressions reflects the change in body position and the need for continuous circulatory support.

The evidence from prehospital and registry-based studies reinforces the importance of early recognition and systematic intervention for foreign body airway obstruction. Bystander interventions improve survival and neurological outcomes, but the specific technique must match the patient’s level of responsiveness. In telephone-assisted airway management, dispatchers guide callers through position-appropriate maneuvers, emphasizing that unresponsive patients require CPR rather than continued thrusts.

For nursing practice, the sequence is straightforward: recognize severe obstruction, attempt back blows and abdominal thrusts while the person is responsive, and transition to CPR with visual airway inspection once unresponsiveness occurs. The mouth is checked before each ventilation, and removal occurs only when an object is directly visualized. This approach balances the need for rapid airway clearance with the imperative to avoid causing further harm through blind instrumentation.

## 임상 시나리오

Unresponsive Adult Choking: Airway Inspection During CPRLook before you ventilate, remove only what is seen
Once a choking adult becomes unresponsive, stop abdominal thrusts and begin CPR. Chest compressions may dislodge the object while supporting circulation.

Each time the airway is opened for breaths, perform visual inspection of the mouth. Remove an object only if it is clearly seen and graspable.

CautionNever perform a blind finger sweep. It can push the foreign body deeper or injure the posterior pharynx. If no object is visible, resume ventilations and continue CPR cycles immediately.

## 핵심 개념

- **Foreign body airway obstruction** — Partial or complete blockage of the airway by an object, causing ineffective or absent airflow.
- **Unresponsive choking algorithm** — Once a choking adult loses consciousness, start CPR and inspect the mouth before each breath; remove visible objects only.
- **Blind finger sweep** — Inserting a finger into the mouth without visualization; avoided because it may push the object deeper or cause trauma.
- **Chest compressions in choking** — Generate intrathoracic pressure changes that may dislodge an obstructing object while supporting circulation.
- **Head tilt–chin lift** — Maneuver to open the airway before ventilation and visual inspection of the oral cavity.

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