Question

A 5 year old boy, while having dinner, suddenly becomes aphonic and is brought to the casualty with respiratory distress. What should be the next step in management?

• A. Cricothyroidotomy
• B. Emergency tracheostomy
• C. Humidified oxygen
• D. Heimlich maneuver

Hint:

Sudden aphonia while eating plus distress equals choking on a food bolus; expel it first.

Answer 1

The Correct Option is D

Step 1: Identify the scenario. A child eating dinner who suddenly becomes aphonic (unable to phonate) with respiratory distress is the classic picture of acute foreign body aspiration causing laryngeal or upper airway obstruction.
Step 2: Recognise the urgency. Sudden aphonia plus distress means the airway is mechanically blocked by a food bolus, not an inflammatory or infective process. The immediate goal is to physically expel the obstructing object.
Step 3: Choose the first manoeuvre. The Heimlich maneuver (abdominal thrusts) generates a sudden rise in intrathoracic and intra-abdominal pressure that forces air upward, dislodging the bolus from the airway. It is the recommended first response in a conscious choking patient.
Step 4: Reject the invasive options first line. Cricothyroidotomy and emergency tracheostomy are surgical airways reserved for when simpler measures fail and the obstruction cannot be relieved. Humidified oxygen does nothing for a mechanically obstructed airway.
Step 5: Conclusion. The next management step is the Heimlich maneuver, making option 4 correct.