Davis, John

50y · Male·Hypoxic-ischaemic encephalopathy secondary to choking on food bolus

A 50-year-old man with acquired brain injury and intellectual disability died from hypoxic-ischaemic encephalopathy following aspiration of a food bolus during lunch at his disability care residence. The carer appropriately called 000 and commenced CPR, but communication difficulties with the emergency dispatcher delayed recognition of cardiac arrest. Paramedics initially failed to visualise and remove the airway obstruction due to inexperience with laryngoscopy and faulty equipment; a critical care paramedic removed the bolus 10 minutes later. By then, prolonged hypoxia had caused irreversible brain damage. Clinical lessons include: disability care providers should systematically assess swallowing risks using standardised checklists; carers need training to recognise choking and perform basic airway manoeuvres; emergency dispatchers must maintain high suspicion for cardiac arrest despite unclear caller information; paramedics require regular training in foreign body airway removal; and post-hospitalisation recommendations regarding diet and swallowing must be clearly communicated to all care providers.