Suspected Airway Foreign Body
Patient with witnessed choking, stridor, sudden respiratory distress, or history of aspiration
All Pathways
OtolaryngologyEmergency
Airway Foreign Body Management
Airway Foreign Body Management: Suspected Airway Foreign Body → Patient Responsive? → ⚠️ Unresponsive Patient → CPR with Airway Checks → ⚠️ Surgical Air...
Pathway Overview
16 steps
Algorithm Steps
16 total
01Start 02Decision Patient Responsive?
Is the patient conscious and responsive?
03Warning ⚠️ Unresponsive Patient
Activate emergency response. Begin CPR. Before each breath, look in mouth and remove visible object. Do NOT perform blind finger sweeps.
04Action CPR with Airway Checks
30 compressions : 2 breaths. Before each rescue breath, open airway and look for visible object. Remove only if seen. Continue until object removed or advanced airway available.
05Warning ⚠️ Surgical Airway
If complete obstruction and cannot intubate/ventilate: Emergency cricothyrotomy (adults) or needle cricothyrotomy (children). Only if FB is supraglottic.
06Action Bronchoscopy (Rigid or Flexible)
Rigid bronchoscopy is procedure of choice per ATS Technical Standards - superior for larynx/cervical trachea and operative manipulation. Flexible may be used for distal airways in adults. 2024 meta-analysis shows comparable success rates.
- ATS: Rigid superior for proximal FB extraction
- Flexible: less invasive, higher negative procedure rate
- Combined approach may be needed
- Success rate: up to 98% with bronchoscopy
07Outcome FB Removed Successfully
Post-bronchoscopy: observe for complications (mucosal injury, bleeding). Discharge when stable. Follow-up if prolonged impaction.
08Decision Object Expelled & Stable?
Has the foreign body been expelled? Is patient breathing normally?
09Outcome Object Expelled - Observe
If asymptomatic after expulsion, observe 1-2 hours. Counsel on prevention. Evaluate for aspiration pneumonia if symptoms persist.
10Action Imaging if Stable
CXR (PA/lateral) for radiopaque objects. CT chest if radiolucent or uncertain. Look for air trapping, atelectasis, or visible FB.
- Path rejoins step 06Shared downstream outcome
11Decision Complete or Partial Obstruction?
Complete: Cannot speak, cough, or breathe. Partial: Can cough, speak, or has air movement
12Action Encourage Coughing
If patient can cough effectively, DO NOT intervene. Allow patient to clear obstruction naturally. Monitor closely.
- Stay with patient
- Do NOT perform back blows if coughing effectively
- Call for help if condition deteriorates
13Action ENT/Pulmonology Consult
Urgent ENT consult for upper airway FB. Pulmonology for lower airway FB. Arrange bronchoscopy.
14Decision Age of Patient?
Different techniques for infant (<1 year) vs child/adult (≥1 year)
15Action Infant: Back Blows + Chest Thrusts
For infants <1 year: 5 back blows (head lower than trunk) followed by 5 chest thrusts (2 fingers on sternum). Repeat until object expelled or unconscious.
- Support head and neck
- Back blows: heel of hand between scapulae
- Chest thrusts: same landmark as CPR
- Do NOT use abdominal thrusts in infants
- Path rejoins step 08Shared downstream outcome
16Action Adult/Child: Back Blows + Abdominal Thrusts
For ≥1 year (AHA 2025): Start with 5 back blows (heel of hand between scapulae, patient leaning forward). If unsuccessful, perform 5 abdominal thrusts (fist above umbilicus). Alternate until expelled or unconscious.
- NEW 2025: Back blows now first-line for all ages
- 5 back blows → 5 abdominal thrusts (alternating)
- Position patient leaning forward for back blows
- Pregnant/obese: chest thrusts instead of abdominal
- Path rejoins step 08Shared downstream outcome
Guideline Source
AHA/ILCOR 2025 BLS Guidelines + ATS Technical Standards
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- BLS maneuvers require hands-on training
- Bronchoscopy requires specialist availability
- Does not address esophageal foreign bodies
- Pediatric airway anatomy differs significantly
Applicable Regions
USEU
Version 1Next review: 2027-01-11
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Related Resources
Frequently Asked Questions
What is the Airway Foreign Body Management?
The Airway Foreign Body Management is a emergency clinical algorithm for Otolaryngology. It provides a structured decision tree to guide clinical decision-making, based on AHA/ILCOR 2025 BLS Guidelines + ATS Technical Standards.
What guideline is the Airway Foreign Body Management based on?
This algorithm is based on AHA/ILCOR 2025 BLS Guidelines + ATS Technical Standards (DOI: 10.1161/CIR.0000000000001369).
What are the limitations of the Airway Foreign Body Management?
Known limitations include: BLS maneuvers require hands-on training; Bronchoscopy requires specialist availability; Does not address esophageal foreign bodies; Pediatric airway anatomy differs significantly. Individual patient factors may require deviation from these recommendations.
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