The emphasis of management of obstruction of the upper airway by foreign material will depend on the level of consciousness and the severity of airway obstruction. If air movement appears satisfactory, spontaneous respiratory effort and coughing should be encouraged as these will tend to clear any obstructing material. Supplementary oxygen therapy will help to compensate for mildly compromised alveolar ventilation. Back blows and abdominal thrusts (Heimlich maneuver) may help to dislodge impacted matter by augmenting forced expiration. Finger sweeps, using a gloved finger wrapped in a handkerchief or swab, should be reserved for those who do not have a gag reflex or the ability to bite. The optimal technique is the use of direct vision (usually with a laryngoscope) and suction for liquid or Magill's offset forceps for solid matter.
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