In The Emergency Department: –

If the first aid measures failed to clear the complete obstruction and the patient is deteriorating or there is ongoing chest compression, then follow the next steps: –

1. A trial of laryngoscopy (Video is preferred), If object is visualised above the vocal cords, then remove of the with Magill forceps or suction (Attach suction to Endotracheal Tube and attempt to withdraw object with the suction).
2. If failed and CPR is going, then the management will depend on the level of the obstruction: –
   • If the FB is visualised above the level of the vocal cord —– Front of neck access i.e., cricothyroidotomy.
   •  If the FB is NOT visualised above the level of the vocal cord (i.e., obstruction is below the level of cricothyroidotomy) —–
     1. Perform Endotracheal Intubation & push the object into right main bronchus.
     2. Pull back the Endotracheal tube for few centimetres and position the patient on the Rt side to ventilate the Lt lung.
     3. If succeeded then arrange Immediate rigid bronchoscopy in the theatre.
   • If NOT able to intubate then consider positive pressure ventilation to force the FB into Rt or Lt main bronchus.