Dental patients are susceptible to choking and aspiration due to the presence of blood and secretions in their mouths for prolonged periods, suppressed pharyngeal reflexes due to local anaesthesia or the presence of impression material or dental equipment in their mouths.
Signs and symptoms include:
► Patient may cough and splutter
► Patient may complain of breathing difficulty
► Breathing may become noisy on inspiration (stridor)
► Patient may develop ‘paradoxical’ chest or abdominal movements
► Patient may become cyanosed and lose consciousness
Management
Aspiration
► Encourage patient to cough vigorously.
► Administer 100% oxygen – flow rate: 15 litres/minute. For children: As for adults.
► Administer a salbutamol inhaler, 4 puffs (100 micrograms per actuation), through a large-volume spacer, repeat as needed. For children: Salbutamol inhaler 2-17 years 1 puff via a spacer every 15 seconds (max. 10 puffs), repeat above regime at 10-20 minute intervals as needed.
► If you suspect that a large fragment has been inhaled or swallowed but there are no signs or symptoms, refer the patient to hospital for x-ray and removal of the fragment if necessary.
► If the patient is symptomatic following aspiration, refer them to hospital as an emergency.
Choking
► Remove any visible foreign bodies in the mouth and pharynx.
► Encourage the patient to cough.
► If the patient is unable to cough but remains conscious, commence back blows followed by abdominal thrusts.
► If the patient becomes unconscious, basic life support (BLS) should be started immediately; this may also help to dislodge the foreign body.
► Call an ambulance and transfer patient to hospital as an emergency.
