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Abstract
In Reply.—
Day and colleagues1 at tye Yale University School of Medicine reported studies proving that back blows propel a foreign body downward and backward into the throat or larynx in a direction toward the lung at a force of 3 g. Day et attributed this finding to Newton's Third Law of Motion: "To every action there is always opposed an equal reaction." They conclude that, in a choking person, "in the case of a partial obstruction, a back blow could transform the situation into one of compleete blockage."
... If loose, the meat would appear to move down, relative to the throat. Several criticisms (18)(19)(20)(21)(22)(23) of this work have betrayed a misunderstanding of the elementary physics involved. These misunderstandings make it likely that the original advocates of back blows were similarly misled, and thought a foreign body would be jolted out, in addition to being loosened as described in the written reports. ...
Pediatric Research publishes original papers, invited reviews, and commentaries on the etiologies of diseases of children and disorders of development, extending from molecular biology to epidemiology. Use of model organisms and in vitro techniques relevant to developmental biology and medicine are acceptable, as are translational human studies.
Recently, the Committee of Accident and Poison Prevention of the American Academy of Pediatrics presented its recommendations regarding the emergency management of the choking child. Renewed interest was stimulated in the controversy regarding whether back blows, abdominal thrusts, or chest thrusts should be used in the initial treatment of foreign-body obstruction of the upper airway. Two cases exemplifying problems in patient management are presented as a basis of focusing on the current controversy. Review of the clinical and experimental data suggests that back blows, followed by either chest or abdominal thrusts, are a reasonable approach to emergency airway obstruction, but that this recommendation is based on limited evidence.
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