Pedi Choking Call

[uglyEMT]

I think this belongs here Admin if it needs to be moved feel free to do so.

This was a real call, all facts will be presented as they actually occured.

Dispatched at 2000 for an allergic reaction. No further information from dispatch....

Arrive on scene to find a 4 year old female loudly crying in her mothers arms, father happy to see you and is the one communicating to you.

Says the child was eating a grape and swallowed it then began not breathing, no noise, was drooling heavily. He believed the child was having an allergic reaction. Thats when he called 911. By the time he got back to the child, child was crying, grape not found anywhere.

Child presents with good color, loudly crying, and resistant towards EMTs and just wants Mommy to hold her.

You hear a high pitch in her cry, almost wheezing like in nature.

.............

Edited April 28, 2010 by UGLyEMT

[rat115]

What's the girl's capillary refill like? Any changes in lung sounds?

I hope that this girl was taken in to get checked out. I sounds like the grape may have moved from a complete blockage of the airway to a partial blockage. With toddlers, it's important to have the airway checked after choking to make sure no damage has been done even if the airway is cleared without incident (that's according to the pediatrician I used to take my own kids to).

[Chief1C]

Moving air good? Got good color and crying, so she's breathing. Look, if you can't see it.. Assess and Transport w/o ***ing w/ it. Suggest cutting the grapes in half next time.. or quartered. IMO, any pediatric patient w/ airway obstruction of any degree, out by the time you arrive, or moved down farther, warrants an ER visit. Since the top killer of kids is airway troubles.

It can be a typical call, had a good number. Balloon, Tootsie Pop, GI Joe Gun, Peas, a stick, and a few "possibly swallowed ______". A dog caught in a fence, reported as baby choking.

[HERBIE1]

Nothing much to add except that with that high pitched cry- stridor?- it sure sounds like it could be a partial blockage and the grape is lodged in the right mainstem bronchus. Check the sats, give some O2 via a blow by if that's all the kid tolerates, and transport. Sounds like the doc may need to go fishing...

[uglyEMT]

Yes suggested to Mom try cutting the grapes.

Yes transported to ED for X-rays and exams.

Cap refil was normal.

No changes in lung sounds during transport (all 4 times we ran vitals)

Crew was thinking same thing as far as stridor...

I was confirming here the stridor.

I always suggest to family or patients themselves (if over 18) to go to the ED for a checkup after a choking incident. The patient did extremly well during transport, vitals were all within normal limits, skin became cool just prior to ED(2min out).

I figured it was a pretty typical call but wanted to confirm my thoughts on stridor without saying it But any choking call can turn serious if the partial obstruction decides to move. We did do a quick look into her mouth and couldn't see the grape so it was pretty far down.

Edited April 28, 2010 by UGLyEMT

[AnthonyM83]

Something I've started asking after two recent calls: Were any interventions done for the child?

People might not be willing to speak up about having done abdominal thrusts, back blows, compressions, ventilations on others, especially if they spontaneously recovered. There's the fear that it wasn't really needed, but the children need to be evaluated further for any trauma the inteventions might have caused.

[Kiwiology]

Could have been stridor, sounds more like she swalloed a grape that was too large and it got temporarily stuck but she managed to swallow it.

If it were me, give the kid the works (full respiratory workup, SPO2 etc) and if the parents seems amicable to the idea we could leave her be at home.

I know people who have transported kids who are otherwise fine just because the parents are so worked up sooo I wouldn't overlook it.

[crotchitymedic1986]

Could be the plastic wrapping from the grape bag. I remember working the ER, had a toddler came in with constant drooling, been to 2 ERs and Pediatrician, x-rays negative. When they scoped her, found the top piece of plastic wrapping that goes on cigarette box.

[Happiness]

Personally I think that grapes should have a warning lable. I know a girl 2 that choked on down for 10min and now has many disabilities.

[uglyEMT]

Anthony - according to the father nothing was done, from the time he dialed 911 till he turned around the child began crying. When asked about back slaps or anything of that nature he stated no. I agree that anytime an intervention is done on a small child a checkup should be done, just in case.

Kiwi - We did ascultate the lung fields with nothing remarkable heard. With capillary refill good, the loud crying and good skin color, and her pulling away from us twords Mommy we felt she was in good shape. We did recommend to them to seek further medical at their own physician (thinking RMA here) but they had just recently moved to the area, there words not mine, and asked us to transport. For a pedi I have no problems being a taxi LOL

Crochiti - It was the grape itself, parents witnessed it. As stated earlier we did notify the Mom to start cutting the grapes into smaller pieces. And we also told both parents to come to our family CPR course so next time they will have the knowledge to help their daughter before we arrive.