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Category: Pediatrics
Keywords: severe airway foreign body obstruction, heimlich, back blows, chest thrusts (PubMed Search)
Posted: 11/6/2026 by Mary Girgis, MD
new AHA guidelines recommend changes to standard of care for pediatric severe airway foreign body obstructions
Key changes:
-A recent observational study of adult and pediatric FBAO suggests improved clearance of a foreign body with the use of back blows over abdominal thrusts
-To create consistency for instructional purposes, and in the absence of inferiority from pediatric data, management of severe FBAO in children now starts with a series of back blows instead of abdominal thrusts. Repeated cycles of 5 back blows followed by 5 abdominal thrusts are performed until the obstruction is cleared or the child becomes unresponsive.
-Abdominal thrusts are not recommended for infants, given the potential to cause abdominal organ injury
-The risk of blind finger sweeps outweighs any potential benefit in the management of FBAO
Dunne CL, Cirone J, Blanchard IE, Holroyd-Leduc J, Wilson TA, Sauro K, McRae AD. Evaluation of basic life support interventions for foreign body airway obstructions: A population-based cohort study. Resuscitation. 2024 Aug;201:110258. doi: 10.1016/j.resuscitation.2024.110258. Epub 2024 May 31. PMID: 38825222.
Category: Pediatrics
Keywords: Agitation, Pediatrics, BRACHA-S, Aggression, Psychiatric emergencies, restraints (PubMed Search)
Posted: 9/4/2026 by Mary Girgis, MD (Updated: 9/4/2026)
BRACHA-S is a 5 item scoring tool that demonstrated moderate discrimination and identified clinically meaningful risk gradients for agitation requiring intervention (ARI) that may support early safety planning.
Objectives: To validate the 5 item Brief Rating of Aggression in Children and Adolescents- Short (BRACHA-S) completed by ER nurses for patients presenting with mental and behavioral health encounters for predicting agitation requiring intervention.
Background: MBH concerns account for about 13% of all pediatric ER visits and approximately 10% require the use of physical or pharmacologic restraints.
Methods: They conducted a prospective observational prognostic validation study in 2 pediatric EDs. After patient arrival with MBH concern, ED nurses completed the BRACHA-S. Discrimination was assessed with AUROC and performance was estimated for a 3 tier model.
Results: Among 472 encounters, 55 (11.7%) had ARI. BRACHA-S scores were associated with ARI (AUROC, 0.72; 95% CI, 0.64–0.79). ARI incidence increased with score: 0, 3.3% (2/60); 1, 6.3% (6/96); 2, 6.4% (7/110); 3, 12.4% (17/137); 4, 31.8% (14/44); and 5, 36.0% (9/25). Scores 0 to 1 had a negative predictive value of 96.7% but a specificity of 13.9%. Scores 4 to 5 had a specificity of at least 89% and a positive predictive value of greater than 33%. Compared with scores 0 to 2, relative risk of ARI was 2.2 (95% CI, 1.1–4.3) for score 3 and 5.9 (95% CI, 3.3–10.7) for scores 4 to 5.
Conclusions: In pediatric ED MBH encounters, the nurse-completed triage BRACHA-S demonstrated moderate discrimination and identified clinically meaningful risk gradients for ARI that may support early safety planning.
Lynn Babcock, Lily Klein, Yin Zhang, Nancy Daraiseh, Ryan Siders, Beatrice Thomas, Ryan Murphy, Holly R. Hanson, Bijan Ketabchi, Shelby Tanguay, Drew Barzman, Wendy J. Pomerantz; A Brief Tool to Predict Agitation in Pediatric Emergency Psychiatric Patients. Pediatrics August 2026; 158 (2): e2026076729. 10.1542/peds.2026-076729