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Choking Victim
Pierce, Wa
2007-06-14
Mission Report by Dr. Fletcher Taylor
This “mission” was not a call out, but an individual response by a team member. It occurred on the 5000 block of Orchard St. West in south Tacoma at 2:10pm. I was informed of a “man who is turning blue in the parking lot” adjacent to a daycare center along the busy Orchard St. I ran less than ½ a block to respond and found an unconscious male of approximately 25 years of age. He was being pulled from his vehicle and, before a group of onlookers, someone was attempting the Heimlich maneuver without success. The patient was apneic, cyanotic, minimally responsive, and with occasional audible inspiratory stridor in his efforts to breathe. His cyanosis was rapidly deepening. I identified myself and offered assistance, and quickly attempted the Heimlich maneuver, sharp, focused very hard thrusts, repeatedly, also without success. With assistance from a just-arrived aid car team, we laid him out on the street and I attempted to visualize the obstruction, which was lodged too deep for visualization or digital removal. I asked for a tracheostomy kit and was told that the ambulance was not authorized to do the procedure. I offered to do it, but no equipment was available. I had a pen which taken apart would serve as a tracheostomy tube, so the quick search began for a knife to make my initial incision. 5 minutes had elapsed and at this point and his cyanosis was extreme, breathing efforts had ceased, but he still had a strong carotid pulse of 120bpm. A Tacoma Fire truck arrived and I described the patient’s condition and a medic used a larygoscope and was still unable to visualize the obstruction. I exaggerated the patients cervical dorsiflection and the jaw thrust and with very long forceps the medic was then able to visualize and remove the obstruction. A ravioli square. We intubated him and after checking his airway, he spontaneously began breathing. Within another minute his color had returned and he was responsive and was transported to St Joesephs’ in fair condition
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