Looks like half of a fortune cookie lodged in there.
Agree I'd grab it ASAP, before it softens up and drops into the trachea / lungs.

Im coming to this conversation late. But as a CRNA and an old street medic, I would remove the obstruction with the Magils and admin O2. Ive had this exact scenario once before.

Why would you intubate after removal? Possible airway edema secondary to trauma?

Airway edema is surely possible and if the obstruction is complete, negative pressure pulmonary edema is possible. If the patient is tolerating my laryngoscope then he will tolerate the ETT. I can always extubate later.

Based on my current level of training (EMT-B): Obtain an initial oxygen saturation level and closely monitor O2 sat throughout treatment and transport. Administer 15 lpm O2 via BVM, rapid transport. Depending on ETA to more advanced emergent care, request ALS intercept en route.

If we're a significant distance from an ER, I would guess we're looking at an emergency cric. This is beyond my scope of practice, thus the request for ALS intercept. That being said, if I'm driving an ALS unit with a medic in the back, he/she's probably already performed the procedure and we're running lights and sirens with liberal application of diesel.

Edit: Sorry guys, just realized the age of this thread. Didn't mean to resurrect it. Hope these scenarios continue, fun times.

I agree

If Magills available then 1 attempt to remove. If successful then attempt to ventilate.
If unsuccessful removing then Cric

Tough call
 

First some observations:

1 - Not a typical laryngoscope view. Looks more like what one would see with a bronchoscope in the OR. And . . . it's upside down.

2 - Is this a pediatric AW? The narrowest part of a child's AW is below the cords, just like the picture. If that is indeed macaroni, look at its size in relation to the glottic opening. The opening is not much bigger than the macaroni.

Well, just some observations. Now to the scenario of the adult.

- Unresponsive, but struggling to breath
- Cyanotic
- Foreign body visible with laryngoscope

My initial reaction would be grab the McGills and promptly remove . . . if possible! If it is well cooked it may come out in pieces, or just get pushed further down. I would not spend a lot of time with the forceps if unsuccessful. This tissue is very friable. The scenario could easily turn into cyanotic, unresponsive patient with FB obscured by blood.

No luck with the forceps? Intubate, push the obstruction into the right main stem and ventilate one lung. Bring an alive patient to the ED and let the ENT doc bronch the patient in the OR.

Cric? You're trying to open an AW right at the FB. It may very well be that once the AW is surgically opened you could push the FB cephalid and open an AW below. Then, again . . . maybe not. It's a small opening and hard to visualize. If you're successful you'll look like a hero.

Tough call . . .